Insurance Billing Process

The instructions below highlight the key steps of processing and billing claims.

1. Search for and select insurance claims that have not yet been billed or that require attention. These claims will have one of the following statuses:
   • Ready to Bill
   • On Hold
   • Billed-No Activity for 60 Days
   • Underpaid
   • Overpaid
   • Rejected

   For more information, go to Searching for Claims.

2. Review and edit claims, if needed. For more information, go to Reviewing and Editing Claims.
3. Preview CMS 1500 forms, if needed. For more information, go to Previewing CMS 1500 Forms.
4. Set the status of claims to Ready to Bill, if necessary. For more information, go to Setting the Claim Status to Ready to Bill.
5. Bill claims to insurance carriers by using one of the methods below:
   • Bill VSP claims automatically. If you have the VSP integration set up, the system automatically sends claims to VSP when you generate invoices for VSP orders in Material Orders. For more information, go to Setting Up VSP Claim Submissions.
   • Bill individual claims manually. For more information, go to Manually Sending Individual Claims to Carriers.
   • Bill claims manually in batches. For more information, go to Manually Sending Claims to Carriers in Batches.
   • Bill safety claims. For more information, go to Billing Safety Claims.
   • Bill claims through Gateway EDI or Standard EDI. For more information, go to Billing Claims Electronically .
6. If an insurance carrier rejects a claim, perform one of the following actions:
   • Review and resend the claim to the insurance carrier.
   • Bill the claim to the patient. For more information, go to Billing Patients.
   • Write off the claim. For more information on writing off claims, go to Writing Off Claims.