Insurance Billing: Frequently Asked Questions
Our goal at therapyzen 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 therapyzen platform.
What insurance companies are compatible with therapyzen?
Therapyzen'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 therapyzen.
What Clearinghouses or insurance portals are compatible with therapyen?
Our providers use many Clearinghouses, however therapyzen only integrates with Office Ally for direct claim submission. Many claims are also uploaded directly into insurance portals.
How can I add my biller to the platform?
You can add a biller (third party or internal) to your account for free. Billers are considered non-clinicians and can be given administrator privileges.
Can I create a CMS 1500 form for another provider in my organization?
Yes. While creating your CMS 1500 form, select the option to Use staff NPI to bill insurance.
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 upload the document to the insurance company provider portal.
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 client 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.
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 (ICD-9 will likely be rejected because it is outdated).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 therapyzen
Can I add a Service Facility with no NPI number?
When adding a Service Facility, NPI number is not required field. For Medicare billing, you may need to have NO NPI number associated with the facility.
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.
CPT Modifiers
- CPT Code modifiers can be added to your CPT codes by navigating to Settings > CPT/DX Codes and selecting a specific CPT code. Add up to 4 modifiers to any CPT Code.
- CPT Code modifiers can also be added to CPT codes based on insurance payer. Some payers may require specific CPT modifiers that differ from others. Navigate to Settings > CPT/DX Codes and locate the Insurance Carrier CPT Modifiers option. Use this area to add or override CPT modifiers you already have set.