What you’re looking at
The page is headed Insurance — “Submit claims, review statuses, and record insurance payments.” Its header carries Add insurance payment, Batch verify, and a Create menu holding Create claims and Create and submit claims. A stats bar sits under it on every tab, counting Draft, In Progress (submitted, accepted or in review), Paid (including partly paid) and Denied (including rejected).
A claim carries one of these statuses: Draft, Submitted, Accepted, Rejected, In Review, Adjudicated, Paid, Partial, Denied, Appealed or Voided.
A brand-new practice sees No unbilled appointments, No claims found — “Create claims from unbilled appointments to get started.” — and No insurance payments yet.
Set up payers and enrollment
1
Fill in your insurance profile
Go to Settings → Insurance. Insurance Profile Settings holds your practice’s billing identity, and everything else reads from it.
2
Add the payers you bill
On Payers, open the payer search sheet — “Search by payer name, ID, or alias (e.g. Aetna, Blue Cross, 62308)…” — and add each one. Afterwards you can Deactivate a payer or Remove payer entirely.
3
Enrol each provider with each payer
On Provider Enrollment, create an enrollment, submit the draft, then sync its status. This is the step people skip and the one that blocks everything: a payer accepts nothing from a provider it has not enrolled, however correct the claim is.
Record coverage and check eligibility
Coverage lives on the client’s record: open the client, choose Edit, and go to the Insurance tab — the Insurance Coverage card (“Manage payer coverage and check eligibility”). There are three ways to get a client’s coverage in, in order of how little typing they cost you:1
Ask the patient — send the Insurance Profile intake
From the client’s record, open Send intakes and select Insurance Profile under Questionnaires & intakes. The patient fills in their carrier, member ID, group number and subscriber details from their own card — the document that actually has the right answers on it. When they submit:
- If their carrier matches a payer in your network, the coverage record is created for you.
- If it cannot be matched confidently, you get a review item, and opening the Insurance tab from it shows the coverage form prefilled from their answers — the payer picker is the one field left for you, because matching a carrier name to your payer list is exactly the judgement that needs a human.
2
Type it — Add Coverage
Select Add Coverage and fill the form yourself from the card in front of you: Insurance Payer (picked from your own payer network — add the payer in Insurance settings first if it is not there), Member ID (required), Group Number, and the Subscriber Details when the patient is not the subscriber. Mark one coverage Primary when there are several.
3
Let the network find it — Discover
When the patient does not know their coverage — no card, a confused answer, a minor whose parent holds the policy — select Discover. It searches across payers for active coverage in the patient’s name (“Searching across payers… This may take up to 2 minutes”) and adds what it finds. No active coverage found for this patient is also an answer: it means self-pay is the honest conversation. Discovery is a paid check, like eligibility.
Create the claims
1
Open Unbilled appointments
Tick the clients you are billing — each row selects that client’s appointments together. The bar reports how many are selected and what they come to.
2
Create them as drafts
Select Create {n} claims. The toast reads “{n} claims created as drafts”. Create claim on a single row opens the prefilled claim form instead, so you can read it before it goes.The form arrives filled from what you already recorded. Rendering Provider (Box 31) takes its name from whoever the visit was actually billed to on the invoice, when that is known and only one clinician is involved — otherwise the field is left for you to choose. Its NPI and taxonomy come from that clinician’s own Billing Profile in Insurance Profile Settings when one exists for them (preferring one scoped to this claim’s payer over a general one), and only fall back to your practice-wide defaults when no such profile exists — never guessed, and never left silently blank when a profile could have supplied it. If a claim bills more than one clinician across its service lines, the claim-level field stays blank for you to review and each line carries its own clinician’s NPI where one could be resolved. Diagnosis Codes (Box 21) come from the visit the claim bills: codes a clinician chose in the note’s own ICD picker land directly, and where only free-text exists the AI suggests ICD-10 codes from the clinical record — marked as suggestions, for you to review. Service Lines (Box 24) take their CPT/HCPCS codes and charges from the appointment’s services, with the AI proposing codes for uncoded services and modifiers (95 for telehealth, 25, 59) for every line. When the visit happened at one of your Locations that has a Facility NPI set, Box 32 (service facility) and the Place of Service are seeded from that site instead of your billing provider’s own address. Every field stays editable, and the code fields have a live ICD-10/CPT search that shows codes as soon as it opens and the description of any code that arrived from the visit — nothing goes to a payer without a person confirming it. If the visit has no clinical notes to draw on, the form says so — “No clinical notes found for this visit” — and Box 21 is yours to fill; the suggestions work the same whether you opened the form from Unbilled appointments or from the client’s Billing tab.
3
Submit from the Claims tab
Open a draft’s Actions menu and choose Submit to payer, or tick several and use Submit {n} to payers. The confirmation says what it costs: “Each claim is sent to its payer and uses one claim credit.”
4
Follow the status
Check status with payer asks the payer for the claim’s current status. It asks you to confirm first, because each check uses one claim credit, and payers usually need two to three days after submission before they can answer. It is not offered on a claim the payer rejected on acknowledgement — there is nothing to fetch for one of those, so use Reopen for correction instead. Reopen for correction turns a rejected or denied claim back into a draft — “Claim reopened as draft — correct it and resubmit”. Only drafts are editable, and Edit reopens the full CMS-1500 form the claim was built in — the same four steps, the same live ICD-10 and CPT search, the same date and modifier fields — filled with what was saved. Correct the diagnoses, the service lines, the payer or the member ID, then submit again. A claim that must be undone after submission is voided in ClinikEHR (with a required reason, kept in the audit trail) — voiding here does not void it at the payer, so follow their replacement process too.
Telehealth claims
A telehealth visit needs two things to agree, and a payer will deny the claim if they do not. Place of service — set on the claim, under Claim Settings:
A modifier on each service line — set on the line itself, under Modifiers:
The place of service is suggested from the appointment. If the appointment was booked as an online or video visit, the claim starts on 10 rather than 11 — Office. It is only ever a starting point — change it if the client was not at home.
If the code you need is not listed, type it. Both Place of Service and Modifiers accept anything you enter, so a code your payer asks for is never blocked by our list. An unrecognised place of service is flagged so a typo does not slip through — the claim still sends it exactly as you typed it.
GT is not the same as 95 any more. It has been replaced by 95 for most payers and survives only with some institutional and Medicaid plans. Use 95 unless your payer specifically asks for GT.
Reconcile what the payer sends
Electronic remittances land on Payments by themselves. For anything that arrives another way, Add insurance payment opens Record insurance payment — “Manually post a payer payment (e.g. a mailed check or a portal EOB) against a claim.” Choose the claim, enter the amount, pick the Method — Check, EFT / ACH, Card or Other — and add a reference. A claim raised from an invoice settles that invoice by itself. When the payer’s electronic remittance arrives, the payment posts against the invoice the claim came from, and once the invoice is fully covered its status flips to Paid — the front desk never chases a patient for money insurance already sent. A partly paying remittance accumulates; the invoice stays open until covered. A claim showing Paid with nothing reconciled against it is money you have not received yet. The Payments tab lists every electronic remittance as it lands; if the list cannot load it says so rather than pretending nothing arrived. Analytics turns the claim history into the numbers a biller watches — total charged and paid, collection rate, denial rate, average turnaround (measured from submission to the payer’s actual response, not to today), aging buckets and revenue by payer.Who can do this
Plan, not role, is what decides this screen. There is no role→route layer on a solo or team practice, so Insurance opens for everybody in it once the plan allows.
The invite sheet carries a File insurance claims toggle, but on Solo and Team it is recorded rather than enforced: the working lever here is your plan. There is no per-role navigation editor on these plans.
Where a genuine server-side rule exists, the product states it. Voiding a recorded payment is owner, manager or accountant only — “Only a clinic owner, manager or accountant can void a payment.” And an invoice with a payment against it cannot be deleted by anybody: “This invoice has recorded payments and cannot be deleted. Cancel it instead to keep the record.”
Two behaviours surprise people:
- Enforcement is opt-in, per person. A colleague never saved in the permissions sheet is unrestricted. The sheet warns “Saving starts enforcing”.
- A denied action is recorded; an allowed one is not. Hiding a module from somebody’s sidebar is a convenience, not a security boundary.
Check it worked
- Every appointment you meant to bill has left Unbilled appointments.
- Each new claim appears on Claims with a status and the payer’s name.
- The stats bar totals match what you submitted.
- When money arrives, the claim is both Paid and reconciled on Payments.
Common issues
The payer rejected the claim straight away
The payer rejected the claim straight away
Usually enrollment rather than coding — the payer does not recognise that provider for that transaction type. Go to Settings → Insurance → Provider Enrollment, submit the enrollment and sync its status. Then Reopen for correction and resubmit.
Not enough claim credits
Not enough claim credits
Submission consumes a credit per claim, and the toast names how many you need against how many you hold. The claim is kept as a draft — top up, then submit it from Claims. See Plans.This message now means what it says. It used to appear for problems credits could not fix — a plan that does not include electronic claims, or a subscription that did not load — so practices bought credits that changed nothing. Those cases say what is actually wrong instead. If you are told to top up, topping up is genuinely the fix.Your monthly allowance is counted per month. If you are billed annually, the included claims reset every month on the same day of the month your plan renews — not once a year.
The eligibility check says Ineligible
The eligibility check says Ineligible
Check the member number, the payer and the date of birth on the client’s coverage; one wrong digit reads as no cover. If the details are right, the cover has genuinely lapsed — raise an ordinary invoice instead.
I removed a payer and it is still listed
I removed a payer and it is still listed
A payer with claims against it is deactivated rather than deleted: “This payer has existing claims and will be deactivated (not deleted).” That keeps your claim history readable. It stops appearing on new claims either way.
Nothing appears under Unbilled appointments
Nothing appears under Unbilled appointments
Only completed appointments that have insurance coverage and no claim are listed. Close off the appointment first, and check the client has cover recorded — see Appointments.
FAQ
I submitted a batch by mistake — can I recall it?
I submitted a batch by mistake — can I recall it?
No. Follow the claims on Claims and settle the outcome with the payer. Use Create claims rather than Create and submit claims so there is always a draft to read first.
Does voiding a claim cancel it with the payer?
Does voiding a claim cancel it with the payer?
No, and the dialog says so: voiding “does not void the claim at the payer — if it was already submitted, follow the payer’s void/replacement process too.” Voiding marks it voided in your records with an audit trail.
What is the difference between Rejected and Denied?
What is the difference between Rejected and Denied?
Rejected means the payer would not accept the claim as filed — usually a data or enrollment problem, and you correct and resubmit. Denied means they accepted it and refused to pay. Both can be reopened for correction.
Can I delete a claim?
Can I delete a claim?
Only while it is a draft. Use the delete icon in the claim’s detail panel, or Delete draft on the row’s Actions menu; both ask you to confirm first, and the claim goes with its diagnosis codes, its service lines and any attachments prepared for it. The control is not shown on a claim that has left draft. Once a claim has been submitted it is voided, never deleted, so the trail stays intact.
Can I attach documents to a claim?
Can I attach documents to a claim?
Yes — while it is still a draft. Open the claim and use Attach (275) to add a PDF, PNG, JPEG or TIFF of up to 64 MB; it is sent to the payer together with the claim when you submit, so the control is only offered before submission. To add documents to a claim that has already gone, use Reopen for correction, attach, and submit again. The payer network keeps an uploaded file for 45 days, so attach close to when you will submit.
A claim was refused for credits. Where do I top up?
A claim was refused for credits. Where do I top up?
The message offers Get credits, which opens your dashboard on the Subscription tab where claim credits are bought. Nothing about the claim is lost — it stays a draft and can be submitted once credits are available.
What does Partial mean on a claim?
What does Partial mean on a claim?
The payer has paid some of what you billed. The remainder is either patient responsibility, shown on Payments under Patient resp., or an adjustment you write off.