Getting Started: Enabling Insurance Features

Accepting Insurance in Therapyzen

By default, Therapyzen is set up for practices that do not accept insurance and provide superbills to clients. However, if your practice accepts insurance, you can enable this feature in the Settings -> Billing section by selecting the "My Practice Accepts Insurance" option.

Clearinghouse Integration with Therapyzen

Therapyzen integrates with Office Ally for easy claim submission, but manual submission to a clearing house is also possible. If you choose to use Office Ally, the majority of the work will be handled by the integration, but you will need to monitor claim status and close claims after receiving payments with an EOB.

Steps for Integrating with Office Ally

1. Go to the Settings -> Integrations section and click the "Set Up" button in the Office Ally integration box.
2. Establish an account with Office Ally and obtain an FTP account that Therapyzen will use for communication.
3. Enter the FTP URL, username, and password in the Office Ally Integration setup in Therapyzen.
4. By default, claim submission is in test mode. This allows you to test a few claims to ensure that Office Ally is receiving them correctly.

Requirements for Creating Claims

Before you can create a claim, you must have the following set up in Therapyzen:

• Insurance features enabled
• Insurance payers set up
• Client insurance information filled out on the client profile

For more information, see the Accepted Insurance Payers Setup article.

Creating Claims

1. Scrubbing and Testing Claims: 
   1. a. Create a test client or use the built-in demo account Morris Buttermaker. 
   2. To simplify the claim creation process, generate a test claim by creating an invoice for the relevant service. 
   3. Find the invoice in Open Invoices and click CMS 1500 using the action button. 
   4. Review the automatic scrubber to correct any errors. 
   5. Make corrections on the form or use the reload button if any data was updated outside of the CMS form. Then, update it by clicking Update CMS. Some data may not automatically populate, so be sure to fill in any missing information. 
   6. If necessary, edit the client and/or practice data and repeat steps 3 to 5 to ensure all data is correct. 
   7. After all information has been properly filled out, you will be presented with an option to send the claim to staging.
2. Submitting Claims (Manually or through Office Ally):
   1. Go to Claims -> Staging to view any staged claims. 
   2. If submitting claims manually, print and mail the CMS 1500 form from the Staging area. 
   3. If using Office Ally, the claims will be automatically submitted to your clearinghouse and the status will be updated in Therapyzen.

Monitoring Claim Status

After claims have been submitted, it is important to monitor their status to ensure that they have been processed and paid correctly. You can do this in Therapyzen by checking the Open Claims section for updates. Please note, if you are not integrated with Office Ally, claims will remain in the Submitted status under Open Claims.

Closing Claims

Claims can be closed one of two ways. If using Office Ally and the insurance payer provides an ERA, Therapyzen will scan the file and process any claim information. For manually submitted claims or Office Ally claims for which an EOB was received, claim data can be manually entered in the Payments section. To do this, navigate to Claims -> Payments - Make Payment.

Once there, use the filters to narrow down to a provider, client & date range. Specify the check details and total amount paid. Carefully inspect each of the clients & services presented and fill out any that belong to the EOB in hand. If all relevant data has been filled and reconciles with the total previously entered, the payment data can be saved.