Overview

While Cerbo does not connect directly to a clearinghouse and you cannot submit insurance claims directly via the EHR, there are various tools for insurance billing built in, and several options for how practices that bill insurance directly would submit their claims. 


Note that you also always have the option to generate an insurance invoice/ superbill for patients to submit for reimbursement if you do not bill insurance directly, but want patients to have that option.


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Details

Regardless of the way you will be submitting insurance claims, the first step within Cerbo is that the provider or front desk staff adds the relevant charges and payments to the patient's encounter note, in the Charges/ Payments box at the right of the note text area. If a charge is:

  1. Marked as being an insurance-billable charge (checkbox) AND
  2. Insurance versus pt allocation is enabled for your build

then you will be able to specify the patient's responsibility (co-insurance or co-pay, for example) versus the insurance company responsibility for each charge. The patient's balance on the note would include only the amounts allocated to patient responsibility.


For practices that allocate between patient and insurance responsibility, the amount due from insurance is tracked on a practice-wide level under Billing > Go to Billing Reports > Insurance Payments tab.


For submitting claims to insurance, there are several options:

  1. Billing option 1 – manual entry/ submission.

    The biller will log into the EMR and go to the Reporting > Financial Reports, then click on the Insurance Billing Summary. That document shows practice-wide insurance billing info for the specified time period specify, and gives the option to generate HCFA's as needed.  Then, when payments come in from insurance companies, they would apply those payments to each charge with an insurance-billable amount outstanding in the Insurance Payments tab under Reporting (no need to go into each patient chart individually).

  2. Billing option 2 – EDI electronic download/upload.

    The biller would log into the EMR and go to Reporting > Insurance Payments, and export/ download an electronic claims file. They would then log into a billing clearinghouse that accepts EDI files (like Office Ally, but there are many others), and upload the EDI file to automatically populate and generate HCFA forms that can be submitted via the clearinghouse’s interface. Then, when payments come in from insurance companies, they would apply those payments to each charge with an insurance-billable amount outstanding in the Insurance Payments tab under Reporting (no need to go into each patient chart individually). *Please contact Cerbo to have this option enabled.

  3. Billing option 3 – automatic sync to external insurance billing software.

    We can automatically sync information over to certain third party insurance billing services (more full service): 
  • Enter Health
  • PPM
    And insurance billing platforms (would be used by a biller in your office or third party biller that you work with): 


If you use one of these services for your insurance billing, your account can be configured so charges are entered into an encounter note are automatically sync over to the insurance billing service, who submits the claims to insurance. This option may be set up so that the charge amounts for insurance-billable charges that are added to patients' charts in Cerbo are $0 in the EHR, then the billing service applies the appropriate charge in their system. In this setup, there would not be any need to manually apply payments received from insurance to outstanding balances in Cerbo.


We do not charge for using any of these options, but if you are using an external service (OPS, HealthBiller)/ clearinghouse (Office Ally, other)/ or biller, you would be responsible for paying their fees directly.


Regardless of the option used, insurance payment information does not sync back into Cerbo.