Insurance billing involves a lot of moving pieces: your practice details, clearinghouse enrollment, payer rules, and client policies. The AI Assistant walks you through each of these steps, and can also help with everyday billing tasks once you're set up.
Note: Insurance billing is available for practices in the US only. This feature is evolving quickly, and Upheal is adding and refining capabilities on an ongoing basis.
Below is a rundown of what the AI Assistant can do when it comes to insurance billing. To get help from the AI Assistant, first click Assistant on the bottom right of your screen. Then, type your request into the text box, and click the purple arrow icon to send your message. The Assistant will guide you from there, and if you get stuck, you can always contact support.
Setting up insurance billing
When you start insurance billing setup, the AI Assistant guides you through each stage in order. If you step away partway through, it picks up right where you left off instead of walking you through steps you've already completed.
Getting your billing details ready
Before your practice can enroll with Upheal's clearinghouse, a few business details need to be on file: your NPI, tax ID, phone number, and address. The AI Assistant checks whether these details are complete and lets you know what's missing, if anything.
The Assistant can't fill these fields in for you. It links you to the right settings page so you can add or update the missing information yourself.
Registering your billing profile
Once your billing details are complete, the AI Assistant can register your practice's billing identity with Upheal's clearinghouse, Stedi, using the information already saved in your settings. This is what allows the ERAs for your claims to come to Upheal automatically.
You can also register your billing profile manually if you'd rather handle this step yourself, or if your practice has multiple NPIs that need separate billing profiles.
Setting up your payers
The AI Assistant helps you find and confirm the insurance payers you work with. For each payer, it can explain whether enrollment is required, and what for: eligibility checks, claims, ERAs, or some combination of these.
Claims vs. superbills, explained
If you're new to insurance billing, the difference between a claim and a superbill isn't always obvious. For example, you might check a client's out-of-network eligibility, which means you're enrolled with their insurance for eligibility purposes, but you'd still give the client a superbill for the actual services rather than submit a claim yourself. The AI Assistant can walk you through this distinction whenever it's relevant to your setup.
Setting up a client's insurance
When you're ready to bill your first insured client, the AI Assistant walks you through saving their policy details and running an eligibility check. That way, you know what's covered before you bill.
Common points of confusion
The AI Assistant also flags things that tend to trip people up, like what happens when you switch clearinghouses, or how ERA enrollment connects to your ability to submit claims. As more of these come up, Upheal keeps adding guidance.
Using the AI Assistant for day-to-day billing tasks
Once your practice and payers are set up, you can turn to the AI Assistant for ongoing insurance billing work, not just the initial setup. It can help you:
Check a client's coverage and eligibility before a session
Create and submit claims for sessions you've delivered
Track the status of a claim with the payer, such as pending, paid, or denied
Draft an appeal when a claim is denied or underpaid
Record and allocate payments received from insurance companies
Set up and update client policies, member IDs, and authorization requirements
Handle coordination of benefits when a client has secondary insurance
Generate superbills for out-of-network or self-pay clients
Manage your billing profile and payer enrollment, including your NPI and taxonomy
How to ask for help
To get help with a specific task, give the AI Assistant the client's name and what you need. For example:
"Check coverage for Maria before her first session"
"Draft an appeal for the denial on her July 15 claim"
"Post the Aetna remittance from last week"
The AI Assistant looks up the relevant details and takes it from there.
Note: Insurance billing is separate from client-paid invoicing. For regular invoices, payment links, refunds, and client statements, use Upheal's regular billing tools instead. Those don't involve insurance.
What the AI Assistant can't do yet
A few things to keep in mind while this feature continues to develop:
It's available for US practices only.
It can guide you and point you to the right place, but it can't type or fill in information on your behalf.
Contracted rates are filled in after enrollment. The Assistant doesn't currently prompt you to complete them, though a separate reminder in the product will.
It isn't a substitute for a professional biller. If you mention a third-party biller or credentialing service, the Assistant will let you know that this flow is meant for managing your own billing directly.
Upheal is actively developing the AI Assistant's insurance billing capabilities, so expect this experience to keep improving.