Sapient

​​Introduction to superbills

Dolorum

3

min read

June 24, 2021

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The overall workflow most clinics use is this: patient pays clinic upfront → clinic provides patient with a superbill → patient submits the superbill on the Osmind mobile app to their insurance company for out-of-network reimbursement → we digitally send the reimbursement claim directly to the insurance company → patient directly receives reimbursement and explanation of benefits from insurance company.

Basic background on superbills

  • A superbill is a document that contains all of the information necessary for an insurance company or other third party to make a decision on reimbursement for health expenses incurred by a client. It is similar to a receipt or invoice. The patient can submit this superbill through our platform directly to the insurer, giving the insurance company all the information they need to pay the claim.
  • Usually, you should create a separate superbill for each treatment session.
  • Superbills should contain the following information:
  • The patient's identifying and contact information (full name, date of birth, address, phone number)
  • Provider's name and credentials
  • Provider office/clinic address, phone number, email
  • Provider's tax ID / EIN
  • Provider's NPI
  • Billing NPI (if different from the provider NPI, e.g. if using an organizational NPI)
  • Date of service (some include the appointment start time too but this is not required)
  • Diagnosis codes
  • CPT codes for each service
  • including any modifiers or units/quantities
  • including the fee for each service paid by the patient
  • Payment information
  • total charges
  • total paid by the patient (should be equal to the total charges for cash-pay patients)
  • balance (should be $0 for cash-pay)

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