Insurance Billing: Frequently Asked Questions

Our goal at Healthie is to make it easy for providers to create and submit insurance claims to streamline billing. Here are some answers to commonly asked questions regarding insurance billing via the Healthie platform.

What insurance companies are compatible with Healthie? 

Healthie's CMS 1500 platform is compatible with all insurance companies; the platform generates industry-standard forms. As a result, providers can submit claims to any insurance company using Healthie. 

What Clearinghouses or insurance portals are compatible with Healthie? 

Our providers use many Clearinghouses, commonly including Office Ally, Availity, and others. Many claims are also uploaded directly into insurance portals. 

We currently integrate with Office Ally for direct claims submission, and are launching an integration with Change Healthcare for claims management.  

Providers will be able to connect their Healthie account to either our integration with Office Ally, or to Change Healthcare for claims processing. Support for both RCMs is planned, but not currently supported. In the interim, an integration with one of these RCMs can be supported - and specific claims can be exported & manually imported into another portal or RCM of choice. 

How can I add my biller to the platform? 

You can add a biller (third party or internal) following these instructions. We recommend adding this individual as a "Support" role and sharing this Assistant Implementation Guide

How can I create a CMS 1500 form for another provider in my organization?

While completing your CMS 1500 form, adjust "Rendering Provider" within your organization.

How do I submit a document (e.g., chart note, physician referral) to accompany a claim? 

Download your document as a PDF and submit this directly through your Clearinghouse, or E-fax the document to the insurance company. 

Who is the Policy holder on a claim form? 

The Name of the Policy Holder is the "Primary Holder" of the insurance account. Oftentimes this is the name of the patient that you are working with. Sometimes, however, it is a relative - in this instance, put down the name of the primary holder, and the relationship between the primary holder and the patient. 

Is Policy address required? 

This is not a required field. Each Policy name has a designated code associated with it that auto-populates the address for you in the CMS-1500. 

What are CPT and ICD-10 codes? 

CPT codes are the shortened form of Current Procedural Technology. CPT codes show what treatment you provided for your client. They include every type of service or procedure (tests, evaluations, etc.). The CPT codes that you include on your Superbill are the services your client could be reimbursed for. Common codes for nutritional care are 97802, 97803, and 97804. 

ICD codes (or sometimes ICD-10) is shorthand for International Statistical Classification of Disease and Related Health Problems 10th Revision. ICD-10 is a clinical cataloguing system that assists in making a diagnosis. ICD-10 is the latest version of this code. (ICD-9 will likely be rejected because it is outdated). ICD-10 has been digitalized so that it now more accurately reflects our understanding of health problems today and includes a greater variety of classifications.  ICD codes, simply put, represent the symptoms that your client is seeking to treat.

• Here is a link to all active ICD-10 codes (note: many are pre-loaded into Healthie)

If you need to include a CPT or ICD-10 code that is not pre-loaded into the Healthie system, message our live chat or contact us: hello@gethealthie.com

ICD Ind field

The ICD Ind field denotes whether a diagnosis code is from the ICD-10 or ICD-9 set, and does not reflect the actual diagnosis entered. It may appear in a generated PDF as 9 or 0.

Is there a default Place of Service (POS) code? 

If you update the POS code for a specific client, that will become the default code for that particular client (but, not for all clients). 

Can I add a Service Facility with no NPI number? 

When adding a Service Facility, NPI number is a required field. However for Medicare billing, you may need to have NO NPI number associated with the facility. 

If this is the case, please send us an email to hello@gethealthie.com and request that a Service Facility be added to your account without an NPI. Our support team will be able to add it on the back-end for you, and it will be rendered as a drop-down option for you to select.

How can I delete a Service Facility? 

You can edit or delete Service Facilities directly within a new claim form. 

Start a new claim > Service Facility > Edit Facility > Delete Service Facility (at bottom of box) 

More details can be found here.

Diagnostic pointers

Diagnostic Pointers (Box 24e on the CMS 1500 form) are used to indicate the line letter from the diagnosis code, that relates to the reason the service(s) was performed. You can include up to 4 diagnostic pointers on each line. The first pointer designates the primary diagnosis for the service line. Remaining diagnosis pointers indicate declining level of importance to service line.

Add a Modifier

Navigate to Client Profile > Billing tab > CMS 1500s > New CMS 1500 > Billing Items > Modifier.

Can I generate X12 837 Claims?

Healthie can generate the values in CSV, pipe the claims to your RCM, and your RCM may be able to produce that report on their side (it may depend on your RCM). Healthie does not currently generate X12 837 directly.

Can I generate ANSI X12 batch files to support Availity's software?

Healthie does not currently generate ANSI X 12 files.