Insurance Claims

HIPAAtherapy can send insurance claims on your behalf, track whether the payer accepted them for processing, and show what the payer ended up paying.

What’s in scope today

HIPAAtherapy currently supports:

Eligibility checks - confirm a client’s coverage and benefits before the session
Claim submission - send professional insurance claims (837P files) to the payer through Stedi (our insurance clearinghouse partner)
Payer enrollment - register your practice with Stedi (our clearinghouse partner) and enroll with each payer for the transactions they require, then track where each enrollment stands
Acknowledgment tracking - receive claim status responses through Stedi and surface accepted or rejected status on the claim
Payment and denial tracking - read the payer’s payment report (835 ERA) on the claim: amount paid, denials with reason codes, reversals, and the client’s share
Automatic payment posting - record what the payer paid to your payment ledger automatically
Rejected claim correction and refile - fix a rejected claim and refile it as a fresh submission
Replace and void - once the payer confirms a claim with a control number, send a corrected version or void the claim entirely

What HIPAAtherapy does not do yet is covered under current limitations.

How a claim moves through HIPAAtherapy

You check eligibility, then fill in diagnosis codes, place of service, and the services being billed (service lines) on the session and submit. From there:

Who talks to whom

1 Check eligibility , from You to Payer and back. Coverage and benefits come back
2 Submit claim , from You to HIPAAtherapy. Diagnoses, place of service, service lines
3 Sends the claim , from HIPAAtherapy to Stedi. 837P
4 Forwards it , from Stedi to Payer. To the payer
5 Acknowledgment , from Payer to HIPAAtherapy. 277CA: claim shows Accepted or Rejected
Usually a few weeks while the payer processes it
6 Payment report , from Payer to HIPAAtherapy. 835 ERA: Paid, Denied, Reversed, or Processed. Needs ERA delivery enrollment

Responses from the payer pass back through Stedi. HIPAAtherapy checks for them automatically.

HIPAAtherapy checks for new acknowledgments and payment reports automatically, so claims update on their own. Payment reports need a live ERA delivery enrollment with the payer.

Before you submit a claim

A few pieces of data have to be in place before you can submit a claim.

Three places to fill in before Submit claim appears

Practice settings Settings > Practice

NPI
EIN
Office phone
Taxonomy code
Office address, with zip code

My Profile The rendering provider

Taxonomy code
NPI, only if it differs from the practice's

Client record The client's profile

Date of birth
Current address
Insurance with member ID
Group and policy numbers, when the plan uses them

You can submit the claim Until then, the session's claim card lists what's missing, with a link to where to add it.

Claim card reading No claim yet, with a warning that lists the client’s incomplete address and an Edit client link, and a No claim needed button

Checking eligibility

Open the client’s profile and find their plan under Insurance, or add one if it’s missing.
Use Choose services to review what you’re checking. The first check defaults to Plan coverage, Mental health, and Psychotherapy. Later checks use the previous selection for that insurance.
Click Check coverage. Results appear when the payer responds.

Read Coverage notes for visit limits, authorization requirements, and out-of-network warnings.

Not reported means the payer didn’t supply that information. An active plan alone doesn’t confirm therapy coverage.

Checks require an NPI on the therapist’s profile or practice settings and a payer that supports eligibility checks.

Eligibility result with therapy benefits, network costs, coverage notes, and previous checks

Submitting a claim

On the session page, click Submit claim
Pick the insurance, diagnosis codes (up to 12, in priority order), place of service, and one or more service lines
Click Submit Claim

Claim form with diagnosis codes, place of service, and service lines

If you won’t bill the payer for a session - the client is paying out of pocket for it, say - click No claim needed instead. Undo reverses it.

If several clients attended the session, each of them can be claimed for on their own. A couples or family session is usually one claim; group therapy is a claim per member, each under that person’s plan with their own diagnoses and service lines. See Couples, Families & Groups.

The claim moves through these states:

Where a claim can go

Pending Queued, not sent yet

error

Failed Submit new claim

sent

Submitted Stedi has it. Waiting on the payer

rejected

Rejected By Stedi or the payer. Fix it and file again

277CA

Accepted The payer is processing it

payer claim number

Replace or Void Correct or retract it, before or after the ERA

835 ERA

Paid The payer paid

Denied Won't pay. Reason codes shown

Reversed Took back an earlier payment

Processed Charge went to the client, or no payment

Correct and refile (after a payer rejection) and Submit new claim (after a Stedi rejection or a failure) open a fresh claim for the same session, which starts again at Pending.

Accepted means the payer took the claim in for processing, not that it paid. The outcome arrives later on the payment report.

State	What it means
Pending	The claim has been queued but hasn’t been transmitted yet
Submitted	Stedi accepted the claim; the payer hasn’t responded yet
Accepted	The payer sent a claim acknowledgment (277CA) indicating the claim was accepted for processing
Rejected	Stedi or the payer rejected the claim
Failed	The submission hit an error; after a timeout, delivery may still be unconfirmed

Once the payer finishes processing and sends its payment report, the claim moves past Accepted to one of these:

Status	What it means
Paid	The payer finished processing and paid the claim
Denied	The payer processed the claim but won’t pay it
Reversed	The payer took back a payment it had issued earlier
Processed	The payer finished processing, but the charge went to the client or no payment was issued

“Accepted for payer processing” doesn’t mean the claim has been paid. It means the payer accepted the claim into its processing workflow. Final payment, denial, and adjustment details arrive later on a separate payment report (the 835 ERA); when it does, the claim’s status changes to reflect the outcome. See Payments and denials.

When a payer isn’t ready for claims

Most supported payers accept claims as soon as your practice’s billing details are in place. Two cases are different, and the claim form tells you which one when you pick the insurance.

The payer requires enrollment. Some payers won’t accept claims until your practice has enrolled with them. You can’t submit to them until the enrollment goes live. Admins complete it on the Insurance settings page; other staff need a practice admin to do it.

Claim form with the enrollment-required warning and Submit Claim disabled

See Enrolling with payers for how to complete it. Once the enrollment is live, the warning clears and you can submit as usual.

The payer isn’t supported. The form shows a warning and disables Submit Claim.

Eligibility checks remain available when the payer supports them, even if claim submission is unavailable or needs enrollment.

What a claim sends

Client demographics - name, date of birth, and address
Practice and provider details - NPI, EIN, taxonomy code, office address and phone
Payer details - the plan, member ID, and group or policy numbers when the plan uses them
Diagnosis codes - up to 12, in priority order
Place of service - where the session happened
Service lines - procedure code, charge, units, date of service, modifiers, and the diagnosis each is tied to

Enrolling with payers

Some payers won’t accept electronic claims - or send electronic remittances - until your practice has enrolled with them. Enrollment lives in Practice Settings > Insurance and is admin-only: other staff won’t see the tab. There are two steps - register your practice with Stedi once, then enroll with each payer.

1 Once Register with Stedi

Organization name, 5+ characters
Practice NPI
EIN

Stedi provider ID

2 For each payer Enroll with each payer

ERA delivery Most payers

Payment reports reach your claims

Professional claims Only payers that require it

Claims to that payer can go out

Office address with zip, 10-digit US office phone
PTAN, when the payer asks for one

Already getting ERAs for a payer through another clearinghouse? Enrolling for ERA delivery here moves that delivery to Stedi.

Admins only, from Practice Settings > Insurance. A payer shows up once at least one client has that plan on file.

Insurance settings page with the Stedi provider registration and payer enrollment sections

Register your practice with Stedi

This is a one-time step, and every payer enrollment builds on it. Registration sends your practice name, NPI, and EIN to Stedi to create a provider record.

You’ll need these in your practice settings first:

Organization name, at least 5 characters
Practice NPI
EIN

If any are missing, the page lists them in place of the button. Once they’re set, click Register with Stedi. Registration runs in the background - the page shows it’s in progress and then, once it completes, your Stedi provider ID and the date you registered.

If you later change your practice NPI or EIN, enrollment pauses until the provider record is reconciled - the page shows a notice when that happens, so keep those two fields stable once you’ve registered.

Enroll with each payer

The enrollment list shows the payers your practice actually bills. It’s built from the insurances on your clients’ records, so a payer appears once at least one client has that plan on file - if the list is empty, add insurance to a client first. Each payer can show up to two enrollments:

ERA delivery - lets the payer send its electronic remittance (the 835 payment report) through Stedi. Most payers support it; when one doesn’t, the row says so instead of offering enrollment.
Professional claims - shown only for payers that require enrollment before they’ll accept your claims. Payers that accept claims without it don’t show this row.

Enrollment also draws on your practice billing settings - on top of provider registration, it needs your office address (with zip code) and a 10-digit US office phone. Click Enroll next to the transaction you want; if either is missing, the page brings you back with a note naming what to add. A few payers ask for a Provider Transaction Access Number (PTAN) - the form shows a field for it when it’s required. Submit, and the enrollment goes to Stedi and on to the payer.

Heads up: if you already receive ERAs for a payer through another clearinghouse, enrolling for ERA delivery with Stedi moves that delivery to Stedi and stops it at the other one.

Tracking enrollment status

Enrollment isn’t instant. How long a payer takes to approve is up to the payer - it can be minutes or weeks. HIPAAtherapy checks for updates automatically, and you can click Refresh status on any in-progress enrollment to check right then.

From Enroll to live

Queued for submission Waiting to go to Stedi

Stedi is processing Stedi has it

Waiting on the payer Can take several days

Live ERAs flowing, or claims enabled

An error sending to Stedi Message on the row, with Retry

The payer can also answer

Action required: complete the task Rejected, with the reason Canceled

The payer sets the pace: minutes or weeks. HIPAAtherapy checks for updates on its own, and Refresh status checks right away.

Status	What it means
Queued for submission	The enrollment is waiting to be sent to Stedi
Stedi is processing	Stedi is processing the enrollment
Waiting on the payer	The enrollment is with the payer; approval can take several days
Action required	The payer needs something from you before it can finish - see Enrollment tasks
ERAs are flowing / Claim submission enabled	The enrollment is live
Rejected	The payer declined the enrollment; the reason shows on the row
Canceled	The enrollment was canceled

If sending an enrollment to Stedi hits an error, the row shows the message and a Retry button.

Once a Professional claims enrollment is live, the enrollment-required warning clears on the claim form for that payer and Submit Claim works normally. A live ERA delivery enrollment turns on the payment report, so paid, denied, and adjustment outcomes show on the claim - see Payments and denials.

Enrollment tasks

Some payers want extra steps before they’ll finish an enrollment - a form to fill in, a document to upload, or a value only you have. When they do, the enrollment shows Action required with the task listed underneath. Handle it right on the page: fill in the fields or attach the requested PDF (tasks that ask for a file expect a PDF) and click Complete task. Some tasks include instructions or a link to the payer’s own form.

A few task types can’t be handled in the app yet. For those, the page points you to Stedi’s provider portal to finish the step.

Reading the claim status

Accepted claims

An accepted claim has entered the payer’s review process. While the payer works it, the claim shows Accepted for payer processing. Once the payer also returns a claim number, the claim becomes eligible for in-app corrections - see Correcting an accepted claim below.

When the payer finishes and sends its payment report, the claim moves to a payment status - Paid, Denied, Reversed, or Processed. See Payments and denials.

Accepted claim card with a dated ledger showing the claim sent to Aetna and accepted with a payer claim number, and Replace and Void buttons

Rejected claims

A rejection can come from two places: Stedi (the claim failed Stedi’s claim validation checks - called claim edits - so the payer never saw it) or the payer (the payer received the claim but won’t put it through review). Typical payer rejections: an invalid NPI, a member ID that doesn’t match the payer’s records, or a mismatch between a service and the diagnosis it’s tied to. Either way, the rejection message is shown on the claim.

To resolve a rejected claim, use the actions on the claim card:

Correct and refile - after a payer rejection, opens a fresh claim form for the same session. Make your corrections and submit.
Delete - removes the rejected claim if you don’t want to refile.

When Stedi rejected the claim, or it failed to send, the payer never saw it. Fix the problem and click Submit new claim.

Claim card stamped Rejected after Stedi rejected it over the provider NPI, with Submit new claim and No claim needed buttons

Payments and denials

Once the payer finishes processing an accepted claim, it sends back a payment report - the 835 ERA (electronic remittance advice). HIPAAtherapy reads it and updates the claim’s status to Paid, Denied, Reversed, or Processed, with the details right on the session’s claim card - so you can see what the payer decided without opening the payer portal.

These reports only arrive once your ERA delivery enrollment with the payer is live.

Depending on what the payer reported, the claim shows one of:

Outcome	What it means
Paid $X by [payer]	The payer adjudicated the claim and issued payment
Denied by [payer]	The payer processed the claim but won’t pay it; the denial reason codes appear underneath
Payment reversed by [payer]	The payer is taking back a payment it issued earlier, usually correcting an overpayment
Processed; $X is the client’s responsibility	The payer applied the charge to the client’s deductible, co-pay, or coinsurance instead of paying it
Processed; no payment issued	The payer finished processing but neither paid nor left a balance to the client

Payment reports arrive automatically, the same way acknowledgments do, so you don’t have to do anything to pull them in. How long the payer takes to send one is up to the payer - usually a few weeks after acceptance.

Paid reflects the payer’s report; it doesn’t confirm the money has reached your account.

Claim card stamped Paid, with a ledger showing the claim sent to Aetna and Aetna paying $112.00 by ACH with $38.00 as the client’s share, and Replace and Void buttons

A denial carries the payer’s claim-level adjustment codes, which tell you why the claim wasn’t paid. Line-level adjustments and remark codes aren’t shown in the app, so check your payer portal or EOB when you need the full breakdown before you refile or appeal.

Claim card stamped Denied, with a ledger line reading Denied by Oscar Health and the CO 50 non-covered services reason

What happens to each part of a paid claim

Session $150.00

$112.00 $38.00

Paid by Aetna Posted to your Payments ledger for you. Read-only. Automatic

Client's share Copay, coinsurance, or deductible, as the payer reports it. Collect it and record it like any client payment. You collect

Example: a paid Aetna claim on a $150.00 session. Paid reflects the payer's report, not money in your bank.

When the payer pays, HIPAAtherapy records that payment in your ledger for you - it shows up in your Payments list.

Payment card stamped Paid with $150.00 collected: a read-only $112.00 insurance payment from Aetna, a $38.00 card payment with edit and delete icons, and the client’s share marked Paid in full

Record payments you collect from the client through the usual payment flow. Payer reversals don’t undo posted payments; see Current limitations.

Correcting an accepted claim

Once a claim is accepted, you can correct it in two ways: Replace to send a corrected version, or Void to cancel the claim with the payer.

Both depend on the payer returning a payer claim number (also called a payer control number, or PCCN). This is the payer’s own identifier for the claim - they need it on the corrected or void submission to tie it back to the original. The payer claim number can arrive on the acknowledgment or later on the 835 ERA; until then, Replace and Void stay disabled with a “Waiting for … to confirm processing” note on the claim.

Replace or Void

Both need the payer claim number. Until it arrives, the buttons stay disabled with a "Waiting for ... to confirm processing" note.

Question Replace Void

Use it when

The accepted claim had something wrong: a code, a modifier, the diagnosis tied to a service

You billed the wrong session or client, or shouldn't have billed at all

You

Edit a form pre-filled from the original. The insurance is locked to the same payer

Confirm. There is no form

Then

It goes through submit and acknowledgment again, and takes the original's place right away. If it doesn't reach the payer, the original comes back

Once acknowledged, the claim and its replacements close. Submit new claim starts over

Original Medicare handles replacements differently and doesn't support void. The claim card says which action isn't supported.

Replace a claim

Use Replace when the original claim was accepted but had something wrong - a procedure code mismatch, a missing modifier, the wrong diagnosis tied to a service. The replacement supersedes the original with the payer.

From the session, find the accepted claim and click Replace
The form pre-fills with the original claim’s details. The insurance is locked - replacements have to go to the same payer as the original
Make your edits and click Submit Replacement

Replace Claim form with the insurance locked to the original payer

The replacement goes through the same submit and acknowledgment cycle as an initial claim. It takes the original’s place on the session as soon as you submit it. If it doesn’t reach the payer - Stedi rejects it or it fails to send - the original becomes the current claim again.

Void a claim

Use Void to retract a claim entirely - typically when you billed the wrong session, the wrong client, or shouldn’t have billed at all. There’s no edit form: HIPAAtherapy sends a void transaction referencing the payer claim number.

Click Void on the accepted claim and confirm. Once the payer acknowledges the void, the claim and any of its replacements are closed.

Voided claim with a Submit New Claim button

If you need to bill the session after voiding, use Submit new claim to start over.

When Replace and Void aren’t available

A few cases where these actions won’t show up or stay disabled:

No payer claim number yet. Wait for the payer to confirm processing. The claim card shows a “Waiting for …” note while we wait.
Payer doesn’t support that action. Original Medicare handles replacements differently and doesn’t support void at all. The claim card says which action isn’t supported.

Reading claim details

The claim Details page shows the identifiers for the current claim - HIPAAtherapy’s claim tracking number, the payer claim number (once it arrives), the Stedi claim ID, and the Intent (Replacement or Void) for any non-initial claim.

Claim Details page showing the control number, payer claim number, and accepted status

Current limitations

Here’s what isn’t supported in the app yet, so you can plan around it.

When a payer pays a claim, HIPAAtherapy records that payment in your ledger for you - see Payments and denials. Two kinds of money movement still don’t post on their own:

The client’s share. When the payer leaves a balance for the client - a copay, coinsurance, or deductible - collect it and record it through the normal payment flow, the same as any other client payment.
Reversals. The reversal shows on the claim, but the posted payment stays unchanged. Insurance payments are read-only; there isn’t an in-app adjustment workflow yet.

Appealing a denial

When the payer denies a claim, the denial and its reason codes show on the claim. If the payer returned a claim number, you can Replace the claim with a corrected version. A formal appeal - disputing a denial you believe is wrong - isn’t an in-app workflow yet; handle that through your payer portal.

Frequently asked questions

Does “Accepted” mean I’ve been paid? No. Accepted means the payer has queued the claim for review. When the payer finishes, the claim shows the outcome - paid, denied, or the client’s share. See Payments and denials.

How do I know if a claim was paid or denied? The claim shows the result on the session once the payer’s payment report arrives, usually a few weeks after acceptance. You don’t have to fetch anything - HIPAAtherapy pulls the report in automatically, as long as you’re enrolled with the payer for ERA delivery. When the payer pays, that payment posts to your Payments ledger on its own; the client’s share is still yours to collect through the normal payment flow.

Can I resubmit a rejected claim? Yes. Correct and refile opens a fresh claim form for the same session. If the form refuses to submit because the previous rejected claim is still blocking a new submission, Delete the rejected claim first and then refile.

What if I pick the wrong insurance at submission? For rejected claims or failures before sending, use Delete and file a new claim. After a timeout with unconfirmed delivery, deletion and refiling stay unavailable while HIPAAtherapy checks the outcome. Pending and submitted claims can’t be edited or canceled in the app. For accepted claims, use Void when available, then submit against the correct insurance.

What’s the difference between Replace and Void? Replace sends a corrected version of the claim - same session, same payer, with your edits. Void cancels the claim entirely. Both need the payer to have returned a payer claim number first.

Can I still bill clients directly? Yes. Claim submission is optional per session. Cash, card, and invoice flows work independently of the insurance workflow. See Payments for details.

Do I have to enroll with a payer before I can bill it? Only for payers that require it. Most payers accept claims as soon as your practice’s billing details are set. When one needs enrollment first, the claim form says so and points admins to Practice Settings > Insurance - see Enrolling with payers. Enrollment is admin-only.

How do I submit a claim for an out-of-area Blue Cross Blue Shield plan? Out-of-area Blue claims usually go to the Blue plan where you practice, which routes them to the client’s home plan using the prefix on the member ID. HIPAAtherapy sends each claim to the payer on the client’s insurance record, so select your local Blue plan as the payer there and keep the member ID exactly as it appears on the card, prefix included. For example, a Vermont therapist seeing a client with a BCBS of Texas card picks Blue Cross and Blue Shield of Vermont. Federal Employee Program and dental claims are exceptions, so check with your local Blue plan when you’re unsure.