Insurance Billing Automations [In Beta]

Healthie enables providers and organizations to create CMS 1500s and to optionally submit them to an RCM or Clearinghouse.

We are currently launching and beta testing new functionality that will streamline insurance billing processes by automating administrative tasks, including: 

• Automatically Create a CMS 1500 [Beta Test]
• Link Billing CPT codes with Appointment Types [Coming Soon]

Automatically Create a CMS 1500 [Beta Test]

As part of our commitment to streamline billing workflows, we’re enabling the ability to auto-create a CMS 1500. This update will greatly reduce admin time previously spent manually creating each CMS 1500.

Note: This feature is currently available for beta and will only be available to paid plans once live.

You will now notice a new Automated Insurance Billing section in your Insurance Settings. Once there, you have the ability to enable the Automatically Create CMS 1500s setting. When toggled on, a CMS 1500 will be automatically created each night for any appointments that meet the following criteria:

• Insurance billing is enabled for that appointment type.
• Automated billing is selected for the scheduled appointment.
• Appointment status is set to "no status" or "occurred" at the end of the day.

To enable insurance billing for specific appointment types, head to Settings>Appointment Types>Edit where you will see a new Insurance Pricing toggle. Once applied, the setting will be automatically enabled for that appointment type for any future appointments created.  

Note: This setting is not available for Group Session appointment types. 

When you go to schedule a new appointment on the calendar, you will notice a new setting that will allow you to enable or disable this setting at the individual appointment level.

If an appointment status is marked as Occurred or the appointment end time has passed, a CMS 1500 will automatically be created. 

However, if the appointment status is marked with a Canceled, No-show, Late Cancellation, or Re-scheduled status, the Healthie system will not generate a CMS 1500. 

Note: The batch job to create all CMS 1500s runs at 12AM UTC for all applicable appointments that day.

Link Billing CPT codes with Appointment Types

To help reduce manual billing tasks and ensure pricing consistency, you can now automatically associate CPT codes with appointment types. This update improves accuracy in claims, minimizes administrative work, and ensures standardized pricing across services.

Within Organization Settings > Services, you can enable or disable CPT Code Pricing for your account. When enabled:

• CPT codes, units, and fees can be tied directly to appointment types.
• Pricing remains consistent across appointments, reducing manual entry and discrepancies.
• Revenue Cycle Management (RCM) partners can retrieve CPT codes, units, and fees from the appointment object in Healthie's API.
• Organization admins can enable or disable this setting at any time.

To enable CPT Code Pricing:

1. Navigate to Organization Settings > Services.
2. Locate the CPT Code Pricing option.
3. Toggle the setting ON to begin linking CPT codes to appointment types.
4. Use the Add button to enter CPT codes, units, and fees that will populate based on appointment selection.
5. Save changes to apply updates across your practice.

Note: This feature is available for Plus plan and above.

Linking CPT Codes to Appointment Types

Once CPT Code Pricing is enabled, you must manually associate CPT codes with appointment types:

1. Navigate to Settings > Appointment Types.
2. Select an appointment type and click Edit.
3. Under Insurance Pricing, select a CPT code from the dropdown.
4. Enter the appropriate units for billing.
5. Save changes to apply the CPT code to that appointment type.

Once linked, the assigned CPT code and fee will automatically populate when scheduling an appointment of that type, ensuring consistent pricing and accurate billing.