You can bill a session to insurance, edit claims and view their status, track payments, and draft appeals for denied claims.
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.
The progress note for the session will need to be signed in order to submit a claim. For more on signing progress notes, see Signing progress notes.
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.
From the client's profile:
From the Sessions list:
Click Billing in the top right.
You’ll be taken to the Billing overview.
If the message next to the Billing button displayed Action needed, you will see any missing information flagged for you here, and you can click Resolve next to each message to fill in the information needed.
Click Create claim.
Review the claim carefully, and when ready, click Submit to insurer in the bottom right.
From the billing page, you can also create an invoice to collect the client's responsibility 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's connected clearinghouse, Upheal automatically posts the insurance payment from the ERA. Payers issue remittance as usual, and Upheal tracks it for you. You can see the status of claims in the claims list, in the Status column.
For more detail, click the claim number to open the claim.
If you're not using Upheal's connected clearinghouse, you'll need to enter the payment information yourself. Click the claim number to open the claim, and click Add payment in the bottom right.
Handling a denied claim
If a payer denies a claim, you can easily draft the appeal text, and improve it 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 number of 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; just click Copy text.
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. A banner will display in the claim, explaining what needs to be edited. Click Reopen & edit in the bottom right to edit the claim.
