Superbill

“Superbill” is a term for a billing format for the mental health clinician who wants to handle billing in a simplified manner.  Using this strategy allows the client to submit the bill directly to the insurance company.  The superbill form is all the client needs to file their own insurance; it removes the clinician from the billing loop and saves money on computer billing software and even postage.  It is particularly good for the new provider starting on a shoestring.  A superbill is usually one page and must contain the clinician’s name; the practice name and address; phone number; date and place of service; TAX ID; NPI number; state license number; checklist of CPT codes; a place to write DSM or ICD diagnosis codes; the charge for service and the payment; balance due; and signature of the clinician.  Any local printer can make three attached pages with NCR carbonless paper.  One copy goes in the client file to keep record of payment.  Two copies are given to the client: One is a receipt for personal records, and the other can be sent to the insurance company so the client can be reimbursed by their insurance plan.  With the superbill, the mental health clinician can ask for payment at the time of the session and save money by not purchasing billing software.  This has been found to be an excellent way to be accepted as a provider by many insurance companies!


Example of receipt form:

This 3-part form is printed on carbonless paper, 5 ½”X 8 ½”. The white copy for insurance, yellow copy for client, and pink copy for office use.



Name of therapist
Address
City, State, Zip

Office phone number
State license number
Tax ID number
NPI number

Client Name _________________________________
Address _____________________________________
Insurance ID #________________________________
DOB________________________________________
Profession Service Rendered on __________________
Place of Service _______________________________
Diagnosis: ___________________________________

  Code            Service    Fee
____90801Diagnostic Evaluation_______
____90804Individual psychotherapy      _______
____90806Individual psychotherapy_______
____90831Telephone consult     _______
____90847Family psychotherapy     _______
____90853Group psychotherapy            _______
____    Care Summary report _______
____    Other                 _______

                     Today’s Charges     _______
     Thank you                Payment       _______
                     Balance due _______


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      (signature)