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., Optum - HHA, Optum - Respite, etc.)
  
  

• Email Address

• Address

• Select Multi-Client Invoices

• Invoice Preference = Email
  
  

• Save.

• Select the Calculator Icon

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

3. Client Profile Requirements

For each client:

• Full Name

• DOB

• Address

• SSN

• 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. G0156)

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

• Select Code Pointer 1

• Enter Taxonomy Code

• Unit Rate = Shift Rate Based Units (Billed in 15-minute increments)

• Note: If you anticipate providing the same service twice in the same day for the same patient, be sure to create a second billing code with the (+2) extension (e.g G0156 (+2)) and include ‘76’ in the 1st modifier field, or as an alternative, reach out to support to turn on functionality to combine same-day shifts by billing code on claims. 

• Subscriptions

• Select the Invoicee/Payer

• Claim Creation Preference = One Claim Per CPT Code

• Select Client is Subscriber & enter in their ICN or type the word ‘ssn’

• Optum Patients ONLY - Select Use Facility Information

• Facility Name - Enter ‘Client First & Last Name Home’ (e.g., John Smith Home)

• Facility NPI - Enter ‘NO_NPI’

• Facility Address, City, State, Zip - Enter Client’s Home Address

• *Note: All 9 digits of the client’s zip code are required, no dashes (e.g., 123456789)

• 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 (e.g., G0156 & G0156 (+2))

• Enter Authorization Number

4. Service Rates

• In Accounting → Client Fees, assign the Unit Rate for each billing code.
  
  

• Remove hourly rate if not used.
  
  

• Example: G0156 = $9.75 per 15 minutes.
  
  

5. Scheduling for Billing

• All visits on the Scheduling Dashboard must have:
  
  

• Billing Code applied.
  
  

• Unit Fee Rate assigned.
  
  

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

6. Claim Generation

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 resubmitting already paid or partially paid claims, 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.