eBilling Setup Tip Sheet

This guide walks you through setting up and submitting electronic billing (eBilling) so claims can be generated and submitted successfully.

1. eBilling Integration

• Once enabled by support, you’ll be able to create claims in Payer Invoicing in Menu → Accounting → Payer Invoicing and view the Claims Table in Menu → Accounting → Claims.
  
  

2. Payer Setup

For each payer you bill:

• Go to Menu → Clients → Invoicee → Add Payer.
  
  

• Enter:
  
  

• Name (e.g., Indiana Medicaid, Anthem, Humana, United, etc.)
  
  

• Email Address

• Address

• Select Multi-Client Invoices

• Invoice Preference = Email
  
  

• Save.

• Select the Calculator Icon

• Enter the Payer ID (e.g., SKIN0 - as required by clearinghouse).
  
  

3. Client Profile Requirements

For each client:

• Full Name

• DOB

• Address

• Place of Service = 12.Home
  
  

While still in the client profile,  Accounting Section:

• Add payer in Client/Invoicee Attachments

• ICD-10-CM Diagnoses

• Only Primary Diagnosis is needed

• Billing Code Config

• Create an entry for all of the services that this patient has been authorized to receive (e.g., S5140)

• Billing Codes can be created in Menu → Clients → Billing Codes

• Combine Same-Day Shifts

• All = Combines all same-day visits for the same billing code into one claim line, regardless of caregiver

• By Caregiver = Combines same-day visits only if the billing code and caregiver match; different caregivers are split

• None = No combining; each visit is billed as its own claim line

• Enter Appropriate Modifiers if applicable (e.g., U7, U2, U3, etc.)

• Select Code Pointer 1

• Enter NA in Pay-To NPI field

• Enter Taxonomy Code

• Enter the agency Medicaid ID in Secondary Billing Provider Identification

• Unit Type

•  Use Shift Rate Based Units for services billed in 15-minute increments

• Use Fixed Number of Units = 1 Unit for SFC services

• Subscriptions

• Select the Invoicee/Payer

• Claim Creation Preference = One Claim Per CPT Code

• Select Client is Subscriber & enter their Medicaid/Policy ID

• Check both boxes in Legal

• Payer Priorities

• Create a payer priority for each Payer

• Enter Authorization Begin and End date

• Pays For = Shifts

• Matching Billing Code - Select Billing Code or Multiple that the payer is responsible for.

• Enter Authorization Number

4. Service Rates

• In Accounting → Client Fees, assign the Unit Rate or Flat Fee for each billing code/service.
  
  

• Example: S5125 = $8.59 per 15 minutes.

• Example: S5140 = $120.00 Flat Fee
  
  

5. Scheduling for Billing

• All visits must have:
  
  

• Billing Code applied.
  
  

• Unit Fee Rate or Flat Rate assigned.
  
  

• Use Bulk Actions in the Scheduling Dashboard to apply billing codes or rates to multiple visits.
  
  

6. Claim Generation

• Go to Menu → Accounting → Payer Invoicing.
  
  

• Create the Billing Period.

• Generate the Invoices for selected clients

• In the Actions Column, hover your mouse on the action icons and select Prepare Claims
  
  

• Review Claims

• Add Caregiver Relationship (if required)

• Expand the claim

• Select the pencil icon under Additional Claim Information

• Enter in this format:

NAME-Caregiver Name REL-Relationship

(e.g., NAME-Jane Doe REL-Other)

• Select Submit All Claims.
  
  

7. Review Submitted Claims

• Menu → Accounting → Claims
  
  

• Use search filters to quickly find claim submissions.

• Manually Fail claims to resubmit by selecting the red circle icon

• In Payer Invoicing, when generating the claim to resubmit, select the claim and select This is a corrected claim to enter the last paid claim number

• Claims that were never paid do not require the corrected claim box to be selected; they can be sent as a brand new claim by selecting ‘I have reviewed the contents of this claim in full and verify that all the information is correct’ or ‘Submit All Claims’
  
  

✅ Once these steps are complete, your eBilling workflow is ready: Visits → Claims → Clearinghouse → Payer.