Creating a Claim (CMS 1500 Form)

practiceQ allows you to create insurance claims with just a few clicks. Once a claim is created, you can print a CMS 1500 form, or submit it through Office Ally/TriZetto.

Note: At the time of this writing, practiceQ does not offer support for secondary or institutional claims.

Before you create your first claim, there are some required information that need to be entered, like NPI numbers, diagnosis and CPT codes, etc. Let's start by looking into these prerequisites.

Setting Up Your Account for Generating Claims

1. Enable Required Features

If you haven't done it yet, head over to "More > Settings > Features" and enable the following features: Patient Diagnosis, Superbills, and Insurance Claims.

2. Enter your DX Codes and CPT Codes

Most practices work with a limited number of diagnosis codes and CPT codes. In order to enter them into the system, navigate to "Lists > Invoices > Invoice Settings > Superbill", and Click on "Manage Diagnosis Codes" and "Manage CPT Codes" to access these lists.

3. Enter the Clinical Information

Now navigate to "Lists > Claims > Claims Settings" and go through each tab to enter the information about your practice. Here you will inform your default billing NPI, facilities, rendering provider clinical information, etc.

4. Limiting the List of Payers (Recommended)

By default, practiceQ will pull the list of payers supported by Office Ally or TriZetto (based on the provider you're connected to), in case you plan to submit electronic claims through their system. Since this list is quite extensive, we recommend that you limit it to only show the Payers you work with. This will reduce errors as some payers have very similar names. Additionally, if you collect insurance information in your intake forms, you will limit the choices your patients can pick from.

In order to add a payer to your list, open the Payers tab in the Claims Settings page, and start typing its name. Choose the payer from the list of suggestions and click on Add Payer. Once a payer is added to your list, you can click on Edit in case you want to add an address to that payer (some clearinghouses may require it).

5. Assign CPT Codes and Rates to your services (Optional)

In case your services have a predetermined set of rates and procedure codes, you can set them upfront instead of setting them individually on each claim.

To set your procedures per service, navigate to "Bookings > Booking Settings > Services", click on "Edit" on a service, and open the "CPT Codes" tab. Here you will be able to set the default Place of Service, CPT Codes, Units and Rate per Unit. Now when a claim is created for this type of session, this information will be pulled automatically.

6. Adding Insurance Questions to Your Intake Forms (Recommended)

Since claims require the client's insurance information to be populated, it's a good idea to collect it in your intake process. We have created a standard insurance question that will map directly to the client profile, and you can easily add it to your intake forms.

The screenshot below shows how to add the standard primary insurance question to your form.

Note that the question will be added to the end of the form, but you can always move it to a more convenient position.

Creating a Claim

Claims can be created in 2 different places, in the appointment dialog (which can be opened via the calendar and appointment list), or in the Client Profile, under the Claims tab.

When you click on Create Claim, IntakeQ will ask you to choose which sessions you are creating a claim for. The system will only display appointments that are not part of other existing claims.

When you click on Continue, practiceQ will pull as much information as it can to populate the claim form, including Diagnosis Codes from the client, CPT codes from the appointments, insurance information from the client profile, and all the default settings you have entered beforehand.

The "Actions" menu will show you options to print, or export the claim; note that you are free to edit any of this information before doing so.

We recommend that you click on Validate before printing a claim, as the system will perform a simple validation and sanity check. Once a claim is validated, its status will be changed to Validated. If you need to fix something after a claim has been validated, you will have to explicitly click on Edit in order to change its status back to Draft.

Notice that the Change Status menu allows you to keep track of the status of a claim.

Managing Multiple Claims

practiceQ makes it easy for you to export or manage a large number of claims by allowing you to perform bulk actions under "Lists > Claims". Use the filter to show a list of claims and then the check box to select the specific claims you want to perform a bulk action on.

Notice that you can export all claims to a single PDF file, export them to EDI in case you wish to submit them to Office Ally/Trizetto, change their status, validate them, etc.

We have integrated directly with multiple clearinghouses, so you can submit claims without leaving IntakeQ: