For billing purposes, Connect and Coach enables you to prepare a CMS-1500 form.

Search for patient2

Select Patient
  1. Click on the Patients tab
  2. To locate a patient, you can search by First Name and/or Last Name. The smart search will populate all records with matching information until you narrow down the search to your patient.
  3. Click on View Patient Details to access the patient’s record

The Patient Information screen opens.

CMS1500

Select Form
  1. From the Reports drop-down box, select CMS- 1500 Form
  2. Click the button that reads Generate selected report.

 The1500 Claim Form screen opens.

CMS1500_2

Required Fields To Generate 1500 Claim form
  1. Select the appropriate session from the drop down list of all sessions.
  2. Enter the amount paid at the time of the visit, if any.
  3. Click Generate CMS-1500 Claim Form
A 1500 Health Insurance Claim Form is generated in PDF format. For billable sessions, Connect and Coach automatically populates the following:

  • 24D — The CPT code associated with the sub-session (sub-session and CPT code are defined by the administrator)
  •  24 F  – The unit for that sub-session (sub-session and unit are defined by the administrator).  IMPORTANT:  The total number of units is entered when you create the class and this task can be completed by an Admin or Educator when the class session is created (see screenshot below).
  •  24 G –  The price for the sub-session (price per unit is defined by the administrator)

Sample screenshot showing where to indicate the number of units for a visit:

units_saved

Entering the correct no. of units for a visit
  1. Choose a billable subsession from the drop down list of Subsession Name options
  2. Choose the No. of Units from the drop down list (Typically units are set in 15 minute increments)
  3. Click the green Add button to save your entries.

This document can be printed and faxed or uploaded to a clearinghouse to the insurer in accordance with your policies and procedures.

A sample completed CMS-1500 form is shown below.

1500_completed