The insurance billing foundation is the first step toward submitting accurate claims, reducing denials, and ensuring smooth payment processing. This guide walks you through each Carepatron setup task so you can get started confidently.
In this article, we will cover:
Each section below builds on the previous one, so your claims are accurate and complete.
Credentialing and why it matters
Credentialing is the process by which insurance companies verify that your practice or individual providers are licensed, qualified, and authorized to provide services and bill for them.
Credentialing ensures:
Claims are accepted and processed correctly
Services are billed under the correct provider or organization
You avoid delays, denials, or rejections from payers
This process occurs outside Carepatron, typically with insurance companies, but it’s an essential prerequisite for submitting claims in the system. Make sure your NPIs, taxonomy codes, and credentialing status are up to date.
You can also check out our Insurance Credentialing 101: A Simple Guide for Healthcare Professionals blog.
Need help with credentialing? We credential and re-credential providers as part of our new RCM service. Learn more by simply sending us a message via your workspace or email rcm@carepatron.com.
Creating billing profiles
Billing profiles store the organization or practitioner information that appears on insurance claims. Accurate billing profiles prevent claim errors.
To create a billing profile:
Go to Settings → Insurance.
Click Set up your first billing profile if you are new, or click Add billing profile in the top right corner.
Enter your organization or practitioner name, NPI, tax information, and required details.
Click Save or Next at the bottom.
If you clicked Next, you can add payers to this billing profile on the next side panel.
Adding insurance payers
Adding your accepted insurance payers ensures claims are routed correctly. You can add electronic payers through our clearinghouse partner, Claim.MD, or add manual payers for tracking purposes.
To add a payer:
Go to Settings → Insurance.
Open the Payers tab.
Click Add payer.
Select Add new available payer to choose from the clearinghouse payers.
Click Save.
If the payer is not listed:
Select Add manually.
Enter the required information.
Click Create.
Enrolling in electronic remittance advice (ERA)
ERA enrollment allows you to receive electronic remittance advice, including payment details and claim outcomes, directly in Carepatron.
To complete your enrollment:
Go to Settings → Insurance.
Open the Payers tab.
Select an added insurance payer.
Click Start or Complete enrollment.
Under Enrollment progress, review Eligibility, Claim filing, and ERA payment reports.
Click Enroll.
You will be redirected to the Claim.MD enrollment documents. Follow the instructions provided.
In our new user interface, it will be easier to track your enrollment.
Enrollment status definitions
You may see the following statuses:
Not enrolled with payer
Enrollment has not been started or completed. Transactions cannot be processed.Partially enrolled with payer
Enrollment is in progress, but required steps or approvals are still pending. Transactions may be limited.Fully enrolled with payer
Enrollment is complete and approved. Full transaction processing is enabled.Not available with payer (manual payers)
Electronic enrollment is not supported. Transactions must be handled manually.
You can filter payers by enrollment status.
When a payer’s required enrollments have been successfully completed, the status will appear as shown in the example image below.
Important:
Enrollment requirements vary by payer.
Some payers automatically enroll you in ERA when you begin submitting electronic claims.
Other payers require enrollment for one or more services:
Eligibility
Claim filing
ERA payment reports
If a service shows Not available, no action is required.
Some payers may redirect you to a third party, such as Optum, to complete enrollment. This is normal. Continue the enrollment process as instructed.
Adding practitioner credentials
Practitioner credentials ensure claims are submitted under the correct provider.
To add or update practitioner details:
Go to Your team.
Select an existing practitioner or click New team member.
Enter their NPI, taxonomy code, and required credentialing information.
Click Save.
Configuring billable services
Billable services must include correct CPT codes and rates to generate accurate claims.
To configure services:
Go to Settings → Scheduling.
Open the Services tab.
Click Add Service or edit an existing service.
Enter the CPT code, rate, and required details.
Click Save.
Enabling client co-pay collection
Collecting client responsibility amounts at the time of service reduces outstanding balances.
To enable co-pay collection:
Go to Settings → Billing.
Under Payment settings, complete your Stripe setup.
Click Save.
You may choose to pass processing fees to the client if desired.
Insurance Guide Series
Our team will be available to answer any further questions you may have. Just reply via messenger through the Help channel in your workspace.