Superbills are very similar to invoices. Mental health professionals can generate superbills to give their clients’ who are out-of-network. Clients can then submit them to their insurance providers to be reimbursed. A superbill is a fancy name for a particular type of invoice. It’s not clear where this name came from, but all we’re talking about here is a specialized invoice that can be given to a client whose insurance plan is out-of-network.
The short answer is that it’s very similar to the things you’d find on an invoice. The superbill will have the therapist’s name, address, NPI numbers for the organization and the provider, and the tax ID for the therapist or mental health clinic. It will also have the statement date, the invoice ID, and other contact information such as email address, and phone number.
Below this section is the patient information. It should contain the patient’s name, address, and other contact information such as phone number and email address. It should also contain the patient’s date of birth and insurance information.
Next, there’s the line items. Each line item is for a service rendered. The line-item should include the date, the service provided including CPT code, the diagnosis in ICD-10 format, and the billed amount. The line-items should be summarized with a total amount and any amount paid.
Finally, there’s a signature line that includes the date.
Don’t put any information on a superbill that you wouldn’t put on an invoice. Only include the bare minimum information required to collect payment. This means don’t include notes or other documentation. If the payer requests additional information, wait for them to ask for it.
Since the therapist is being paid by the client directly at the end of each session (or at least in theory) the superbill will likely be submitted by the client to their insurer to be reimbursed for the payments made to their therapist. The general process for therapists to follow when dealing with out-of-network plans is:
This can vary from insurer to insurer so it’s best for a member to contact their insurer and find out the process for submitting them. It might need to be mailed, faxed or emailed. It’s possible that the member has access to a portal where they can upload a pdf of the superbill.
Superbills must be submitted within the timeframe allotted by the insurance company. Many insurance companies expect superbills to be submitted within 90 days of service. However, it might also be up to 180 days. Again, it depends upon the company so the member should contact customer service to find out.
Superbills can be denied for various reasons. The most common reasons are because the superbill is missing information or the plan doesn’t have any out-of-network benefits. If the superbill is just missing information, it can be corrected and resubmitted. If it is rejected because the member’s plan doesn’t have any out-of-network benefits, then there is nothing that can be done.