Optional: Set up insurance billing
US-only, paid-plan-only. Set up your billing foundation, configure client insurance details, connect appointments to coverage, then submit and track claims, in four discrete phases.
Phase 1: the foundation
Before any claim can go out, you need seven things in place:
- Credentialing with each payer, handled outside Carepatron. A payer won't pay a provider it hasn't credentialed.
- A billing profile at Settings → Insurance: your organisation or practitioner name, NPI, and tax info.
- Payers added under the Payers tab: import from the clearinghouse or add manually.
- ERA enrollment with each payer, so payments come back electronically.
- Practitioner NPIs added under Your team.
- Billable services with CPT codes at Settings → Scheduling → Services.
- Co-pay collection enabled, which requires Stripe from Lesson 4.1.
Phase 2: client insurance details
- Open the client's record → Insurance tab → Edit Claim Settings → Client Billing Method → Insurance.
- Add the policy: type, payer, member ID, group ID, plan ID, deductible, co-pay, coverage level, plan type.
- Run an eligibility check to confirm active coverage.
- Review benefits, deductibles, and exclusions before the first appointment.
For new clients, build an insurance-card upload field into your intake form (Lesson 2.3) so you collect the card image upfront.
Phase 3: connect appointments to insurance
Per appointment:
- Open the appointment and click View.
- Confirm eligibility.
- Add diagnosis codes.
- Expand Billing details to add CPT codes, modifiers, and payer-specific details.
- Generate a co-pay invoice if applicable.
Most practices set defaults on the service so these auto-populate; the appointment-level edit is for the cases that don't match defaults.
Phase 4: submit and track
From the completed appointment, + Add claim (or Create claim from the dropdown next to Create invoice). Click Validate: Carepatron checks client, payer, service, diagnosis, and provider info. Then Submit electronically, and the status changes to Submitted.
Track claims in Billing → Claims; click any claim for its status header and history. Statuses include Validated, Submitted, Rejected (clearinghouse error: fix and resubmit free), Denied (payer decision: appeal with the payer, outside Carepatron), Accepted, Paid, Partially paid, Processed, and Closed. For secondary insurance, open the primary claim → Create Secondary Claim → select the secondary policy.
Five real insurance billing setups.
Real practices, real cadences. Insurance is detailed; copy the closest pattern.
Two payers (BCBS + Aetna), ERA enrolled, eligibility check the day before each appointment. Co-pay invoiced same-day.
Six practitioners, each with their own NPI added under Your Team. Billing profile is the organisation, not individuals.
Place of service modifier 02 (telehealth) on every claim. Real-time eligibility check 5 minutes before each video call.
Insurance for in-network services. Cash invoice with no claim for self-pay clients. Same workspace, different billing methods per client.
Primary claim submits, ERA arrives, secondary claim created with the leftover balance, submits to secondary payer.
Where is insurance billing available?
United States only. International practices can use Carepatron's other features (scheduling, notes, invoices) but the insurance module isn't available outside the US.
What happens if my billing profile is missing an NPI or tax number?
The profile shows Incomplete and can't be enrolled with payers. Add the missing fields under Settings → Insurance → Billing profile.
Can I submit claims while enrollment is pending?
Yes, claims can be submitted for pending enrollments. The enrollment documents themselves won't be processed until approval, but you don't have to wait to start billing.
How long does an eligibility check take?
Usually instant, but some payers take a few minutes. Refresh the page to see results; click View report for details on coverage, benefits, deductibles.
What's the difference between a rejected and a denied claim?
Rejected = clearinghouse or system error (missing field, wrong format). Fix and resubmit, no charge for resubmission. Denied = payer decision (not medically necessary, wrong code, out of network). Appeal outside Carepatron, with the payer directly.
Are there CPT or diagnosis code requirements?
Yes, every claim needs CPT codes per service rendered and at least one diagnosis (ICD-10) code per appointment to support medical necessity. Configure CPT codes per service at Settings → Scheduling → Services.
Which Carepatron plans include insurance?
Paid plans only. Plus or Advanced. The Free plan covers everything else (scheduling, notes, client billing, AI note-taking) but not insurance.
How much does claim submission cost?
Per-claim pricing: roughly $0.25 per claim for the first 199 claims per month, decreasing with volume (down to $0.19 at 1000+ claims). Failed or rejected claims aren't charged on resubmission. Full pricing at help.carepatron.com.