Insurance billing lets you enroll with insurance payers, submit claims for your sessions, and track payments, all inside Upheal. This guide walks you through setup, billing a session, and handling claim responses.
Insurance billing is only supported in the U.S.
Charges for insurance billing are usage-based: $0.30 per claim submission and $0.15 per eligibility check. There's no setup cost, no extra charge for ERAs or ERA downloads, and no monthly fee beyond your usual per-session pricing.
Setting up insurance billing
Create your billing profile
Your first step in insurance billing is setting up your billing profile.
Only admins can create and manage billing profiles. For more information, see Insurance billing with group practices.
To set up your billing profile:
Go to Settings in the left menu.
Click Billing settings.
Under Insurance billing, click Edit business details.
Enter your practice details, including your NPI and Tax ID.
Click Save.
Note: you can't change your NPI or Tax ID once your insurance profile is set up, so make sure they're correct before you save.
If you are an admin for a group practice or organization, and need to add billing profiles for multiple providers, see Adding billing profiles for providers.
Enroll with payers
To bill insurance companies that you contract with, you’ll need to add them in Upheal.
During this process, for each payer, you can choose to use a clearinghouse connected to Upheal (Stedi). When you use Stedi as a clearinghouse, the ERA for your claim (the insurance company’s response to the claim) will come to Upheal automatically.
It is not required to use Stedi as a clearinghouse; however, if you opt not to, you’ll need to record payments and denials manually.
To add insurance companies as payers:
Go to Settings in the left menu.
Click Payer enrollments.
Click Add payer.
Search by the payer name (e.g., Aetna), or ID.
Select the payer you want to add and click Next.
Choose your billing profile and click Next.
In this next step, you can choose to use Stedi as your clearinghouse for this payer.
If you want to use Stedi as your clearinghouse for this payer, select Remittance (ERA).Click Next.
If you opted in to using Stedi, read the statement and click the checkbox to confirm and authorize your enrollment, and click Submit.
If you chose not to use Stedi, click Done.
Setting up a client's insurance
After your payers are enrolled, add insurance details to each client's profile so you can bill their sessions to insurance. You can only add payers you've already enrolled with to client's profiles.
To add a client’s insurance to their profile:
Go to Clients in the left menu.
Select the client.
Click the Insurance tab at the top.
Click Settings on the right next to View payments.
Under Insurance details, click Add insurance details.
Fill in the client’s insurance details and click Add insurance.
Click Consent on file at the bottom.
Here, you will see required consent forms for insurance billing. You can send the forms through Upheal, or click Mark as on file to indicate the consent was collected outside of Upheal.Click Save.
After you add a primary insurance policy, you can also add secondary and tertiary insurance details to a client's profile.
If a client has more than one insurance policy on file, and there is still a balance due after a claim has been processed through the client's primary insurance, you can then submit a secondary claim.
To add secondary/tertiary insurance:
Click Add insurance details.
Under Coverage, select Secondary or Tertiary.
Fill in the client's details, and click Add insurance.
After you add a client's insurance details, you can run eligibility checks.
To run an eligibility check:
Go to Clients in the left menu.
Select the client.
Select the Insurance tab at the top.
Click Settings on the right next to View payments.
Find the policy you want to check under Insurance details, and click Run eligibility.
After you run an eligibility check, click Apply suggestion to fill in the client's copay and other information, or update the information manually by clicking edit details.
Billing a session to insurance
Each session has a dedicated billing page showing you the information that needs to be provided to submit a claim.
To create a claim:
Go to the session you want to create a claim for by selecting it from either the client’s profile or by clicking Sessions in the left menu.
Click Billing in the top right.
You’ll be taken to the Billing overview, which will flag any missing information for you before you create the claim.
Click Create claim.
Review the claim, and when ready, click Submit to insurer in the bottom right.
In the top right, you can change the billing for the session from Insurance to Self pay. If you select Self pay, the billing will show the full cost of the session. If you select Insurance, the billing will show the client’s responsibility.
If you want to collect the client's responsibility, you can also create an invoice from the same page by clicking Create invoice.
Viewing claims
You can see a list of all your claims by clicking Insurance in the left menu.
You can show all claims, or sort by drafts, submitted, or paid. You can also sort by claims or payments, or click Filter on the right to filter claims by status, client, provider, or payer.
Tracking payments
If you're using Upheal (Stedi) as a clearinghouse, Upheal automatically posts the insurance payment from the ERA. Payers issue remittance as usual, and Upheal tracks it for you.
If you're not using Stedi as a clearinghouse, enter the payment information yourself by opening the claim and clicking Add payment in the bottom right.
Handling a denied claim
If a payer denies a claim, you can easily draft the appeal text with Upheal Assistant.
To create an appeal for a claim:
Click Insurance in the left menu to see a list of your claims.
Click on the claim you want to appeal.
Click Appeal in the bottom right.
Upheal generates an appeal message for you that you can copy and paste to submit to the payer. You can also use the Upheal AI Assistant to improve the appeal with stronger clinical justification; just click Improve with Upheal Assistant.
Upheal can’t submit the appeal for you; once the message is generated, you’ll need to copy the text and submit it to the insurance company.
Claims can also be edited if rejected by the clearinghouse, or corrected if rejected or denied by the payer.
Insurance billing with group practices
If your group practice uses insurance billing with Upheal, here are a few things to remember.
Billing permissions in group practices
Admins and providers have different permissions when it comes to insurance billing.
Admin permissions
Admins can:
Set up billing for the organization
Create and manage billing profiles
Enroll payers
Set up client insurance policies
Create and manage claims for any provider
Track and add payments across the organization
Provider permissions
Providers can:
Set up and manage insurance policies for clients they have access to (including shared clients with admins)
Create, edit, correct, and submit claims for their own sessions
Manage claims for their own sessions even when the claim was originally created by an admin
View claims connected to other providers’ sessions when they share access to the client
Claims for another provider’s sessions are read-only. The provider cannot edit or submit them, correct them, or add payments.
Claim permissions are based on the sessions included in the claim, not on who created the claim.
For example, if an admin creates a claim for a provider’s session, that provider can still edit, correct, and submit the claim.
Adding billing profiles for providers
If you are an admin for a group practice or organization, and need to add billing profiles for other team members, here's how:
Go to Settings in the left menu.
Click Billing profiles.
Click Add profile.
Under Billing as, select Individual.
Select a provider from the dropdown menu.
Fill in the provider's information, including NPI and tax ID, and click Add profile.
FAQ
Do I keep my own payer contracts?
Yes. You bill under your own NPI, with your own payer contracts and rates. Upheal gives you the tools to submit claims, check eligibility, and track everything in one place. Your payer relationships stay yours.
Do I need a separate clearinghouse?
No. Clearinghouse connectivity is built into Upheal, the same way a payment processor handles card networks for you behind the scenes. Enroll a payer for electronic claims, eligibility checks, and ERAs, and everything runs through one loop. If you'd rather keep your current clearinghouse for now, you can. Just post payments manually from your EOBs or ERAs.
Do I have to learn billing to use it?
No. Claims fill themselves in from your notes and client details, problems are flagged before you submit, and payments match themselves when the ERA arrives. If a payer rejects something, you'll see why in plain terms. And when you're not sure about anything, ask the Assistant, or get in touch with Support.
What does it cost?
Insurance billing is usage-based: $0.30 per claim submission and $0.15 per eligibility check. There's no setup cost, no extra charge for ERAs or ERA downloads, and no monthly fee beyond your usual per-session pricing.
Can I bill for clients with secondary insurance?
Yes. Each client's profile holds their primary and secondary insurance, and you can bill secondary claims through Upheal, so clients with two plans don't mean two workflows. Tertiary insurance is also supported.
What happens if a claim is denied?
You'll see the denial next to the session it belongs to, along with the reason, and Upheal will draft an appeal for you, pulling relevant information from the client's chart to establish medical necessity. You review, edit if needed, and send. You can also edit the claim.
Is supervisory billing available?
Supervisory billing functionality will be available soon.
Is organizational billing supported?
Organizational billing functionality will be available soon.