Insurance Billing and CMS 1500 claims

Therapyzen's CMS 1500 feature makes it easy for you to create CMS 1500 claims and submit them (electronically or physically) to an insurance company for reimbursement for services. You can use this feature if you are credentialed with an insurance company and considered to be in-network. In this instance, after a session with a client, you can prepare this standardized form, and then submit this for possible reimbursement. This is distinct from creating a Superbill, in which you receive payment for services from the client at the time of service.  

Claim Scrubbing

Therapyzen's CMS 1500 feature contains safeguards as you fill out the form, to help ensure that you have completed all required fields. It is important to double-check that you have completed fields correctly prior to submission to an insurance company, in order to minimize the likelihood that a claim is denied. We recommend reviewing the NUCC official instruction manual and coordinating directly with your payer to understand best practices on Creating a Claim and Submitting this form for insurance reimbursement. 

Creating a new CMS 1500 form

There are two ways to access a CMS 1500 Form within your therapyzen account:

1. After marking an appointment as 'kept' for a client with insurance, navigate to Claims > Open Claims > View Print CMS
2. Navigate to a Client Record > Client Ledger > Open Invoice > View CMS

This will generate the standard CMS 1500 form template that you will need to complete. If you have client information stored within therapyzen, the form will pre-populate with information that is already on file, in order to save you time entering information.

Moreover, if you have previously created a CMS 1500 form for the client that you have selected, past information will pre-fill, so you will be able to leverage that information, and make modifications as necessary, to complete and submit your form.

Editing a CMS 1500 form

You will be prompted to enter required fields of the CMS 1500 form prior to creation and submission of the Form. Once you have filled out an initial CMS-1500 form, basic information will populate into subsequent claims created in therapyzen. Therapyzen's CMS 1500 form generator is broken into 8 sections. These sections include: 

• Payer Information
• Client Information
• Insured Information
• Services and Diagnostics
• Rendering Provider
• Billing Provider
• Facility Information
• Additional Information

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Submitting the CMS 1500 form to an insurance company

There are two ways to submit your CMS 1500 form to an insurance company.

1. Connect your therapyzen account with Office Ally for direct claim submission. Instructions can be found here.
2. Download the file generated within therapyzen as a PDF document. Text fields that you have entered will show up as filled in within the standard form template below. You will then be able to upload or mail this document in, following instructions that you have received from your insurance company.
   
   

   

Insurance Reimbursements

While you can track claim status and reimbursement details within therapyzen, actual reimbursement payments will be made by the insurance payer directly to you. This is typically done via: 

• Paper check mailed to your business address 
• Direct deposit into your bank account
  • Tip: Contact your insurance payer to set up Electronic Funds Transfers 
• Via payment card for payment processing 

Payments cards are an increasingly popular way for insurance payers to issue funds. Through the card (which may be a physical card, or simple a written card number), you must process the card as a "payment" into a payment processor.  Once you've been issued reimbursement, we suggest that you review your claims and update any reimbursement details for reconciliation.