Set up insurance and billing
Insurance & Billing (staff-facing) covers eligibility, claims, remittances, and payer settings. Enable it during company setup or anytime from company RCM settings.
Before you start
- [ ] Company setup is complete
- [ ] You have your practice EIN or billing SSN and NPI-2 (when billing as an organization)
- [ ] Rendering providers have NPI-1 and enrollments
- [ ] At least one client with insurance on file (for eligibility testing)
Steps
1. Enable insurance billing
Go to Settings → Company or finish the RCM Settings step in company setup. Turn on Enable insurance billing.
Add your tax ID type, billing address, and company NPI-2 when applicable.
2. Enroll payers
Add payer enrollments with status In-Network, Out-of-Network, Pending, or Not Applicable. Accurate enrollment status drives claim routing and expectations.
3. Configure fee schedules (optional)
Set reimbursement rates by CPT code and payer when you want TherapyAlly to estimate allowed amounts.
4. Verify client eligibility
Open Insurance & Billing (/revenue-cycle), select a client, and run Verify eligibility. Confirm Member ID and coverage dates match the payer response.
5. Submit and track claims
Create claims from documented sessions with appropriate treatment and diagnosis codes. Track status and remittances from the same area.
Use Check for new remittances to import ERA payments. Open View remittance or View claim for details — avoid raw JSON on primary workflows.
6. Private pay and one-off invoices
For non-insurance charges, use One-off invoices and ensure Stripe Connect is ready for card payments.
Terminology
| UI label | Meaning | | --- | --- | | Insurance & Billing | Staff RCM hub | | Manage insurance & billing | Primary action — not “Manage RCM” | | Member ID | Insurance card subscriber ID | | Remittance (ERA) | Electronic payment advice from payers |
Troubleshooting
| Issue | What to do | | --- | --- | | Eligibility fails | Verify Member ID, payer, and client date of birth | | Claim rejected | Review payer enrollment status and rendering provider NPI | | No remittances | Confirm payer connection and run Check for new remittances |