Note: Insurance billing is currently in closed beta, which means it is only available to a small number of users while we test it out and make improvements.
It's not yet available to all users. Learn more and join the waitlist here.
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.
Before you start
A few things to know before you set up insurance billing:
Insurance billing is only supported in the US.
For now, you can only submit primary claims.
Setting up insurance billing
Create your insurance profile
Your first step in insurance billing is setting up your insurance profile.
To set up your insurance 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.
Enroll with payers
To bill insurance companies that you contract with, you’ll need to add them in Upheal.
During this process, you can choose to use Stedi as the clearinghouse for each payer you add. 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 Stedii 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 Payment reports (835).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.
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.
Fill in the client’s insurance details.
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.
From this tab, you can also:
Run eligibility checks. After you run an eligibility check, click Apply suggestion to fill in the client’s copay and other information, or update the information manually.
Upload the client’s insurance card for your reference.
Collect a Release of Information (ROI) from the client.
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.
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.