How to Bill Self Pay Claims

Owned by Joseph Hernandez
Mar 30, 2023
3 min read

How to Bill Self Pay Claims

You will start with creating a Self Pay Insurance, go into Billing>Insurance Providers and Select New Insurance Provider. Name will be Self Pay, Nick Name Self Pay and you can place a “-“ for all other required fields make sure to click off “No Insurance” and for Max Amount you can put as much or little as you would like the maximum amount to be on the claim just like with regular insurance. For claim type you can place 111,112,113,114. Keep in mind these claims are not going to the insurance company. Then click add.

 

(Please make sure that you select Self Pay for Submit to for Insurance on your Self Pay Clients that you are billing for on the Face Sheet)

Once this has been added you will go to Master Data, Managed Services and click on New Service:

In here you will want to label your Service Name (what you will see on the Census) with Self Pay in the title so you know this is the Self Pay charge ex. Self Pay Detox. Next line is the Description, this is what appears on the claim form, your Admission type, your Bill Under legal Entity, and your Bill Under Service Facility. The 3 checkboxes below really don’t apply to the Self Pay clients, but they would work in the rules the same way they do with Insurance Pay clients.

You would then assign your Global Rates, with an Effective Date; this would be your rate for this service. Below you would choose the CPT code (this CPT code is still the same regardless of the fact that it is Self Pay) the Insurance chosen will be Self Pay, then you will either place it on a 1500, or choose UB04 apply Rev Code place a POS (if on 1500) choose the NPI to use click on Inpatient if an inpatient service choose the Diag Code to use, and the physician to use and Add.

 

After you have added your services for Self Pay you will go to the Census and choose the dates of service to bill just like insurance clients: click on the N/A and choose the services that say “Self Pay Detox/PHP/IOP (however you have labeled them) then go to Billing Claims Submission and Generate Claims. Once your Self Pay Claims are in Ready Status you will Click on the Box next to the Claim Number and in the Upper Right Hand Corner just under Generate Claims you will see Edit Status of Selected, you will click on that and change the status of the claims to Submitted.