Set up insurance and billing
Use Insurance & Billing to check eligibility, submit claims, and import remittances (ERA). You need a Practice + Insurance plan. There is no separate “enable insurance billing” switch.
Before you start
- [ ] Your plan is Practice + Insurance (or Practice Complete, which includes it)
- [ ] Company setup includes legal name, billing address, EIN (Employer ID), and Company NPI-2
- [ ] Rendering providers have NPI-1 and are marked as rendering
- [ ] Diagnosis codes, treatment codes with rates, and place of service codes exist in Settings
- [ ] At least one client has insurance with a Member ID and Claim.MD payer ID
- [ ] A Claim.MD administrative user can change Account Settings for the Claim.MD login TherapyAlly uses
Steps
1. Confirm Practice + Insurance
Eligibility, claim upload, and remittances need Practice + Insurance. Without it, Insurance & Billing shows Eligibility and claims need Practice + Insurance, and company billing fields stay locked.
Choose that plan at register and activate, or upgrade from billing settings.
You can still save client insurance on Essentials. You cannot check eligibility or submit claims until the Insurance plan is active.
2. Complete the company billing entity
Open Settings → Company, then the RCM Settings step (revenue-cycle settings) in company setup.
Enter:
- EIN (Employer ID) (9 digits)
- Company NPI-2 (10 digits). Claims use this as the billing provider NPI. Do not leave it blank if you submit claims.
- Tax ID Type
- Billing Address (street, city, state, ZIP)
The Getting Started checklist can mark this task complete after you add an EIN, NPI-2, or a payer enrollment. Finish the rest of this guide before you expect a claim to go out.
3. Enroll payers
On the same RCM Settings step, add Payer Enrollments with status In-Network, Out-of-Network, Pending, or Not Applicable.
Enrollment status informs eligibility network context. It does not replace a Claim.MD payer ID on the client’s policy.
4. Add codes and rates
In Settings, add the libraries claims use:
- Diagnosis Codes (ICD-10)
- Treatment Codes (CPT) with a default rate
- Fee Schedules (optional per payer; use these when the default rate is not the billed amount)
- Place of Service
- Modifiers (optional, up to four per line)
Each claim line needs a charge greater than zero. If TherapyAlly cannot find a rate on the treatment code or fee schedule, upload fails.
5. Set rendering providers
In Team, give each clinician who appears on claims:
- NPI-1 (10 digits)
- Rendering provider type
- First and last name
- Billing Class
Assistants and clinical fellows cannot bill under their own NPI. Set Default supervising provider, and keep client-level assistant mappings current so the claim uses the licensed rendering NPI.
6. Add client insurance
Open the client and complete insurance (client wizard or Insurance & Billing):
- Member ID (policy number)
- Payer from the Claim.MD directory so Claim.MD payer ID is stored
- Subscriber name and date of birth
- Relationship (self, spouse, child, or other)
- Client date of birth, address, and sex Male or Female (other values block submit)
- For dependents, subscriber sex Male or Female
7. Allow Claim.MD to transmit claims automatically
TherapyAlly uploads claims to Claim.MD. Claim.MD holds them in pending with approval needed until someone approves them, unless Transmit Approval Required is off.
That setting is in Claim.MD Account Settings. TherapyAlly cannot turn it off for you.
In Claim.MD (administrative user):
- Sign in to Claim.MD.
- Open Settings → Account Settings.
- Uncheck Transmit Approval Required.
- Save.
Valid claims then go out for processing without a second approve step. Keep checking Manage Claims for rejections.
Claims already sitting in pending still need a one-time approve or transmit in Claim.MD. New claims after you save the setting should transmit automatically.
Use the Claim.MD login that receives TherapyAlly uploads. If claims appear under a different account, contact TherapyAlly support.
8. Check eligibility
Open Insurance & Billing (/revenue-cycle). Select the client. Use the Eligibility Check tab or the ribbon refresh control (Check Eligibility).
Eligibility uses company NPI-2 and EIN, not the clinician NPI-1. Confirm Member ID and coverage dates match the payer response.
Eligibility is recommended. It is not required to click Submit Claim.
9. Submit and track claims
Document the session first. See Write session and progress notes.
On Claim Upload, open Claim Generator (CMS-1500) and set:
- Date of Service (Applied to all lines)
- Place of Service (POS)
- Rendering Provider
- Each line: diagnosis, CPT, units, and charge greater than zero
Click Submit Claim. Then open Claim History and use Check Latest Status to refresh clearinghouse updates.
10. Import remittances
On Remittance History, click Check for new remittances. Open View remittance or View claim for details.
Claims usually need to be accepted at the clearinghouse before ERA matching. If the list is empty, wait for payer ERA, then run the check again.
11. One-off invoices (optional)
For non-insurance charges, use One-off invoices on Insurance & Billing. Card payments need Stripe Connect.
Terminology
| UI label | Meaning |
| --- | --- |
| Insurance & Billing | Staff insurance hub at /revenue-cycle |
| Manage insurance & billing | Opens eligibility, claim, and remittance workflows |
| RCM Settings | Company-setup step for billing entity, EIN, NPI-2, and payer enrollments |
| Member ID | Insurance card subscriber ID |
| Claim.MD payer ID | Clearinghouse payer identifier stored on the policy |
| Remittance (ERA) | Electronic payment advice from payers |
| Rendering provider | Clinician NPI on the claim (Box 24J) |
| Company NPI-2 | Billing provider NPI on the claim |
Troubleshooting
| Issue | What to do | | --- | --- | | Eligibility and claims need Practice + Insurance | Upgrade to Practice + Insurance, then sign out and back in if the gate remains | | Company NPI (billing provider) is missing | Enter Company NPI-2 on RCM Settings and save | | Primary policy is missing a Claim.MD payer ID | Re-select the payer from the Claim.MD directory on the client insurance step | | Client gender must be Male or Female | Set client sex to Male or Female on the client profile | | Subscriber gender must be male or female | For dependents, add the policy holder’s sex on insurance | | No charge or rate found for a CPT | Add a rate on Treatment Codes or a Fee Schedule for that payer | | Selected provider must be a rendering provider | Mark the team member as rendering and add NPI-1 | | Cannot use assistant NPI | Choose a licensed rendering provider and complete supervisor mapping | | Eligibility fails | Confirm Member ID, payer, client date of birth, company NPI-2, and EIN | | Claim rejected | Review payer enrollment, diagnosis and CPT codes, and rendering NPI-1 | | Claims stay pending in Claim.MD with approval needed | A Claim.MD admin unchecks Transmit Approval Required under Settings → Account Settings and saves. Approve claims already held, then submit a new claim from TherapyAlly. | | No remittances | Confirm the claim is accepted, then run Check for new remittances |