Maximizing Valant's Features: Navigating Electronic Billing For Insurance Claims

Valant is a software designed specifically for the billing needs of behavioural health professionals. It helps users submit bills and track payments with ease. The software offers intuitive billing reporting, simplified EHR claims, superbill statement generators, rule-based fee schedules, charge capture on rails, role-based billing access, patient payment transfers, and a pending transactions queue. Valant's billing feature streamlines the billing process by automatically generating a bill component when services are scheduled, which can then be approved by the user. The software also integrates with two insurance clearinghouses, offering fast access to a variety of insurance providers.

Creating superbills

To create a superbill in Valant, follow these steps:

Step 1: Understand the Components of a Superbill

Firstly, it is important to know the components of a superbill. A superbill typically includes the following information:

• Provider's first and last name
• Provider's National Provider Identifier (NPI) number
• Address where the service took place
• Provider's contact information (phone and optionally, email)
• Referring primary care physician's name and NPI (if a referral took place)
• Patient's information, including name, date of birth, address, and phone number
• Patient's insurance information (if collected)
• Procedure codes and descriptions using Current Procedural Terminology (CPT) codes
• Diagnosis codes and descriptions using the International Classification of Diseases (ICD) codes
• Modifiers of codes needed to more accurately describe the services rendered (if any)
• Units or minutes for services rendered
• Fees charged for services rendered

Step 2: Collect the Necessary Information

Before creating a superbill, ensure that you have all the required information. This includes the patient's demographic details, such as their name, date of birth, address, and phone number, as well as their insurance information. Additionally, you will need the provider's information, including their name, NPI number, and contact details.

Step 3: Access Valant's Billing Features

Log in to your Valant account and navigate to the billing section. Valant offers a user-friendly system that simplifies the billing process and helps you recover overdue payments. Their billing features include a "superbill" statement generator for the patient portal and colour-coding to sort overdue, unbilled, and in-process claims.

Step 4: Input the Information

Once you have accessed the superbill generator, input all the necessary information collected in Step 2. Ensure that all the details are accurate to avoid rejections or delays in reimbursement.

Step 5: Review and Finalize the Superbill

Before finalizing the superbill, review it thoroughly for any errors or discrepancies. Double-check that the patient's and provider's information is correct, and ensure that the procedure and diagnosis codes are up to date and relevant. Once you are satisfied with the superbill, approve and finalize it.

Step 6: Deliver the Superbill to the Patient

After creating the superbill, you can deliver it to the patient either on paper or electronically through Valant's patient portal. Explain the superbill process clearly to the patient, including that they will need to pay upfront and then seek reimbursement from their insurance company. Provide guidance on checking with their insurance company regarding coverage for out-of-network behavioural health services.

Submitting bills and tracking payments

Valant's billing feature simplifies the process of submitting bills and tracking payments. The software automatically generates a bill component when services are scheduled, which then only needs to be approved by the relevant staff. The system also tracks overdue claims so that payment can be pursued in a timely manner.

Valant's reporting features help monitor overdue bills and keep track of the patient balance, allowing for timely overdue reminders. The software also allows for the generation of payroll reports and productivity comparisons between providers. The billing dashboard presents all the reporting insights a professional manager needs in an accessible format.

Valant's integration with two insurance clearinghouses offers fast access to a variety of insurance providers, serving a wide patient pool. The flexibility of the system also allows for the creation of EDIs with other payers.

The Pending Transactions Queue is a billing buffer that allows for the adjustment of recorded appointments for clean claim submissions. It automatically highlights errors such as coding issues or missing information, and does not allow bills with unresolved issues to be sent to payors.

Valant's billing software also includes a "superbill" statement generator for the patient portal, providing insurance-ready billing statements to ease patient reimbursement.

Getting credentialed with insurance companies

• Prepare for Credentialing: Credentialing is the process by which insurance companies verify your education, training, and professional experience to ensure you meet their requirements for serving as an in-network provider. It usually consists of two phases: Credentialing and Contracting. During the credentialing phase, the insurance company will verify your credentials, while in the contracting phase, they will issue a participating provider agreement outlining the terms of reimbursement for your claims. It's important to obtain a participating provider agreement to receive in-network reimbursement.
• Choose the Right Insurance Companies: Select the insurance companies that are most relevant to your service area and have a significant patient base. Consider seeking advice from peers or office managers with experience in billing to identify the most suitable insurance companies for your practice. Major national plans to consider include Aetna, Blue Cross Blue Shield, Cigna, United Healthcare, Humana, Medicare, and Medicaid.
• Obtain Necessary Credentials: Ensure you have the required credentials, such as a National Provider Identifier (NPI) number, professional liability insurance, and full licensing in the state where you will provide services. The NPI number is particularly important as it identifies your license type, level, and specialty.
• Complete the CAQH Application: The Council for Affordable Quality Healthcare (CAQH) is often used in conjunction with insurance company applications. You will need an invitation from the insurance company to complete the CAQH application. Make sure to submit the application online, as paper applications are prone to getting lost. Keep your resume up-to-date and ensure there are no gaps in your employment history. Re-attest to the information in your CAQH profile every quarter to maintain your ability to accept insurance.
• Devote Sufficient Time: Expect to spend a significant amount of time on each insurance panel application and follow-up. The process can be time-consuming, with each application potentially requiring 2-6 hours or even upwards of 10 hours of focused labor. Be prepared to retrieve applications, fill them out, organize necessary documentation, and follow up with insurance companies.
• Follow Up Regularly: Insurance companies sometimes lose provider applications or place them in "limbo." To prevent your application from expiring and being automatically rejected, call each insurance company after submitting any documentation and then follow up every two weeks to check the status of your credentialing application.
• Consider Getting Help: Consider engaging a reputable service to assist with medical credentialing. This can alleviate the frustration of the process, save time and money, and increase your chances of getting credentialed efficiently.

Remember that the credentialing process can take several months, and you may encounter panels that are closed or not accepting new providers. In such cases, you can appeal the decision or continue to apply periodically.

In-house vs third-party billing

There are several factors to consider when deciding between in-house and third-party billing for your practice. Both options have their own advantages and disadvantages, and the best choice for your practice will depend on your specific needs and goals.

In-house billing

In-house billing can be a good option for clinics with knowledgeable staff who want more control over the billing process. It can also help save money, as third-party services typically charge a fee of 4-6% of the revenue received through claims. In-house billing gives you direct access to all billing information and reduces security concerns by keeping billing strictly between your practice and payers.

However, in-house billing can be time-consuming and may require dedicated staff. Mental health billing requires approximately 10 work hours for every 40 hours spent treating patients. Additionally, your revenue is dependent on your billing and coding skills, and you will need to stay up-to-date with medical billing regulations, best practices, and trends.

Third-party billing

Third-party billing can be a convenient option for practices that don't have the time or resources to handle billing themselves. It frees up time for your practice to focus on patients and can help improve revenue by ensuring proper coding and maximizing reimbursement for services. Third-party billers can also help you stay organized, meet deadlines, and negotiate with payers on rejected claims.

On the other hand, third-party billing services typically charge a fee, and you may not have control over how quickly bills are submitted or followed up on. Some companies that provide these services also have high employee turnover, which can make it difficult to build a long-term relationship with a billing expert.

Making the choice

When deciding between in-house and third-party billing, consider your practice's size, staffing, and financial situation. If you have multiple providers and limited staff, third-party billing may be a better option. If you have the bandwidth and skilled staff to manage claims and coding, in-house billing could be more cost-effective. Ultimately, the choice depends on your practice's specific needs and goals.

Creating insurance claims

Step 1: Intake Information

When initiating a new patient record, it is crucial to ensure meticulous accuracy in information such as the patient's full legal name and insurance member ID number. Most bills rejected by insurance companies result from simple mistakes like typos or blank fields. Double-checking new patient information and their insurance coverage for mental health services can save hassles down the road. Collecting the patient's copay during their visit is also recommended to increase the chances of receiving payment.

Step 2: Create and Submit Your Claim

The industry-standard form for filing claims is the CMS-1500, which requests the patient's identifying information, insurance details, treatment data, diagnostic or service codes, and practice information. Claims can be created electronically or manually, depending on the user's preference. Valant's billing software can generate claims in the correct format and automatically pull relevant patient information, streamlining the process. Claims can be submitted directly from the software or through a claims portal provided by the payer or clearinghouse.

Step 3: Monitor Claims Progress

Once claims are submitted, it is important to track their progress through the system. Payers and clearinghouses typically provide a user dashboard to monitor electronically submitted claims. Valant's billing software also offers claims-tracking features to help users stay on top of their claims.

Step 4: Manage Denials and Appeals

Insurance companies may reject claims for various reasons, including coverage issues or missing information. Clearinghouses often screen for incorrect content and discrepancies before claims reach the insurance company, so addressing any issues at this stage is crucial. Communicating with insurance representatives can help identify the root cause of denials and potential solutions.

Step 5: Receive Payment

Once claims are approved, payment will be received, along with an explanation of benefits detailing the payment amount. If insurance does not cover the entire cost of services, the patient will need to be billed for the remaining amount, highlighting the importance of checking benefits eligibility upfront.

By following these steps and utilising Valant's mental health practice billing software, users can efficiently create and manage insurance claims, streamlining the billing process and improving the overall experience for both patients and providers.

Frequently asked questions