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