Before you can start billing through insurance with Upheal, you'll need to create your billing profile and add payers.
Create your billing profile
Your first step in insurance billing is setting up your billing profile.
Only admins can create and manage billing profiles. For more information, see Insurance billing with group practices.
To set up your billing profile:
Go to Settings in the left menu.
Click Billing settings.
Scroll down to Insurance billing, and click Edit business details.
Scroll down to Business details and enter your information, including your NPI and Tax ID.
Click Save.
Click Billing profiles on the left, and click Add profile.
Under Billing as, select Organization or Individual.
If you are billing as an individual, choose the provider name from the dropdown list.
Next, fill in the provider's billing details, and click Add profile.
If you are billing as an organization, fill in your organization's details, and click Add profile.
Note: you can't change your NPI or Tax ID once your insurance profile is set up, so make sure they're correct before you save.
If you are an admin for a group practice or organization, and need to add billing profiles for multiple providers, see Adding billing profiles for providers.
Enroll with payers
To bill insurance companies that you contract with, you’ll need to add them in Upheal.
During this process, for each payer, you can choose to use a clearinghouse connected to Upheal (Stedi). When you use our connected clearinghouse, the ERA for your claim (the insurance company’s response to the claim) will come to Upheal automatically.
You can see a list of payers you can connect to here. Note that Upheal only supports claim submissions, eligibility checks, and ERAs.
It is not required to use our connected clearinghouse; however, if you opt not to, you’ll need to record payments and denials manually.
To add insurance companies as payers:
Go to Settings in the left menu.
Click Payer enrollments.
Click Add payer.
Type the payer name (e.g., Aetna), or ID into the search bar.
Select the payer you want to add and click Next.
Choose the billing profile for this payer (the provider or organization that will be billing this payer), and click Next.
In this next step, you can choose to use our connected clearinghouse for this payer.
If you want to use our connected clearinghouse for this payer, select Remittance (ERA).
Click Next.
If you opted in to using our connected clearinghouse, read the statement and click the checkbox to confirm and authorize your enrollment, and click Submit.
If you chose not to use our connected clearinghouse, click Done.
