You can generate superbills that you can then have patients upload to their insurance's portals to get reimbursed for out-of-network services.

Prerequisites

Part 1: Create billing providers (EMR)

The billing provider is the provider or business entity submitting the claim and represents the person or entity being reimbursed. The billing provider should be the entity contracted with the payer.

Follow the instructions here to set up your billing providers.

Part 2: Create service facilities (EMR)

Next, set up your service facilities.

The service facility is location a medical service was rendered, such as the provider office of hospital. For telehealth, the service facility can be the provider’ location when the service was delivered (e.g. home) or the location where the in-person would have taken place. The service facility address listed must match what you provided to the payer during the credentialing process.

Follow the instructions here to set up your service facilities.

Part 3: Set patient demographic details (EMR or Patient Portal)

We pull the patient’s name, gender, MRN, date of birth, and address for the insurance claim from the patient’s profile. This information is automatically added to the patient profile during the registration process. F

ollow the instructions here to ensure that all the pertinent demographic details are set on the patient’s profile.

Steps:

Step 1: Create a superbill (EMR)

To create a superbill:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner > Patients
• Click on the “View Chart” button of the appropriate patient
• There are two ways to create a new superbill
  1. Click on “Add” button on the top right corner and select “Superbill” in the dropdown
  2. Pick the “Bills” shortcut in the patient panel on top bar, click on “Add a new bill” button on the top right corner, and select “Superbill” in the dropdown
• Fill out the requisite information
  • Name: Name of the superbill
  • Patient: Verify that the patient name, gender, MRN, date of birth, and address are accurate.
  • Appointment: Appointment this superbill is associated. If there is no appointment this superbill is associated, leave this dropdown blank.
  • Visit Note: Visit note this superbill is associated with. If there is no visit note this superbill is associated with, leave this dropdown blank.
  • Rendering provider: Provider that provided the medical services. This field is auto-populated with either:
    • The provider who wrote the note that is generating this bill, if this bill was generated from a note
    • The provider who clicked “Create a new bill,” if this bill was NOT generated from a note If you want to change the rendering provider, simply choose another provider from the dropdown.
  • Service facility: Location a medical service was rendered, such as the provider office of hospital. This field is auto-populated with the default service facility set in Prerequisites Part 2 of this document. If you want to change the service facility, simply choose another service facility from the dropdown.
  • Billing provider: Provider or business entity submitting the superbill and representing the person or entity being reimbursed. This field is auto-populated with the default billing provider set in Prerequisites Part 1 of this document. If you want to change the billing provider, simply choose another billing provider from the dropdown.
  • Diagnoses: Relevant diagnoses for this superbill. If this bill has been generated from a note, the ICD codes from the note are automatically added as diagnoses. For each diagnosis, specify whether it is active, onset date, and end date (if not active anymore).
  • Billing Items: Relevant billing items for this superbill. If this bill has been generated from a note, the CPT codes from the note are automatically added as billing items. For each billing item, specify the date of service, any modifiers, quantity of the procedure performed, fee per procedure, and associated diagnoses. Each billing item must have at least one associated diagnosis.
• All information set is autosaved so click “Finish and Go Back” if you are done editing the superbill for now

Step 2: Request review (EMR)

You can request review of the superbill before downloading it. Follow the instructions here to request review.

Step 3: Add comments (EMR)

You can add comments to the superbill before downloading it. Follow the instructions here to add comments.

Step 4: View, edit, and delete superbills (EMR)

To view, edit, or delete superbills:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner > Patients
• Click on the “View Chart” button of the appropriate patient
• Either:
  • Scroll through the patient’s chart to find the desired superbill OR
  • Click the “Bills” shortcut on the patient panel and scroll to find the desired superbill
• Click on the superbill card to go into viewing mode
• Toggle the top dropdown to go into editing mode
• Scroll to the bottom right-hand corner of the card to find the “Delete” button (NOTE: the “Delete” button is only visible when you are in editing mode)