Insurance billing

Mediyn’s insurance and billing tools let therapists and clinic staff manage patient coverage, submit claims electronically, and generate compliant billing documents from a single platform. Insurance records are structured and validated before claims or superbills are created, reducing rejections caused by missing or misformatted data. Patients can manage their own coverage details through the patient portal, keeping records current without staff intervention.

Insurance Record Management

Practices can store structured primary and secondary insurance for each patient, including carrier, member ID, group number, subscriber name, copay, and prior authorization number.
Each insurance card displays a color-coded coverage status: green for active, amber for inactive, and red for expired.
You can set an expiration date on any insurance record; Mediyn automatically marks it as expired when that date passes and notifies the care team.
Guardian contact fields appear automatically when the “Is minor” toggle is enabled on a patient record. A separate guarantor section is available for all patients to record the financially responsible party.
Insurance records can be added, updated, or removed individually without affecting other patient data.
The subscriber name, along with separate first name, last name, and gender fields, is accepted and stored correctly when editing a patient’s insurance record.
Patient biological sex is correctly reflected in submitted insurance claims.
Clinic administrators can update their practice’s billing NPI (Type 2 NPI) from Settings → Clinic Info after completing signup.
Therapist profiles and member settings expose a provider taxonomy code field for editing.

Therapist Onboarding and Credentialing

During the clinic invitation onboarding wizard, therapists are prompted to enter their taxonomy code, license state, and tax ID before submitting insurance claims.
The taxonomy code field suggests the correct value automatically based on the entered credential type, while still allowing a custom entry.
Any formatting issues with these fields are flagged immediately with a clear error message.

Payer Search and Network Status

You can search for insurance payers by name or payer ID anywhere you enter insurance information, submit claims, or manage clearinghouse enrollments. Typing a partial name surfaces matching payers ranked by similarity; pasting an exact payer ID returns that payer at the top of the list immediately.
When selecting a patient’s insurance, you can see whether the assigned therapist is in-network, out-of-network, or pending credentialing with each payer. In-network payers are grouped at the top of the list for quick identification.
Network status information is for guidance only and does not block claim submission — you can choose any payer regardless of status.
A clinic’s accepted insurance plans are visible on its public booking page, so patients can confirm coverage before scheduling. Each therapist’s individually accepted plans are listed alongside the clinic-wide summary.
Patients, clinic staff, therapists, and billers can query accepted insurances through the authenticated API.

Patient Self-Service Insurance

Patients can add, update, and remove primary and secondary insurance records directly from their Mediyn patient portal profile without contacting their therapist.
Patients can select their insurance carrier from the same structured payer list used by clinic staff, both when logged in to the patient portal and during the pre-account booking flow. This replaces the previous free-text carrier entry field.
Changes take effect immediately; any new clinical documents or billing records reflect the current insurance on file.
Therapists and clinic staff are automatically notified whenever a patient updates their insurance details.
The patient self-service insurance form includes subscriber address fields required for CMS-1500 submission.

Insurance Eligibility Verification

Mediyn supports insurance eligibility checks, including copay and deductible status, before an appointment to catch coverage issues in advance.
Eligibility checks initiated from a patient’s profile reflect the insurer’s real-time response. Verified coverage automatically unlocks claim submission for that patient.
Eligibility verification works correctly for all clinic types, including group practices, and for all clinics and therapists using Office Ally as their clearinghouse.

Electronic Claim Submission

Mediyn supports electronic insurance claim submission directly to payers through the Office Ally clearinghouse, eliminating the need to manually submit CMS-1500 PDFs.
Claims submitted through Mediyn are tracked from submission through adjudication, with payer decisions and patient-responsibility amounts reflected automatically in the billing workflow.
Superbill finalization for clinic-billed sessions does not require a therapist tax ID; the practice billing NPI is used instead.

Superbill Creation and Validation

Before a superbill can be created or finalized, Mediyn validates that the patient’s insurance record contains all fields required for CMS-1500 submission, including subscriber date of birth, group number, subscriber name, relationship to subscriber, and subscriber address.
If any required field is missing, the superbill cannot be created until the insurance record is updated; you are guided directly to the patient’s chart to fill in the missing information.
If a patient’s primary insurance is expired or inactive when you create a superbill, you will see a clear prompt with a direct link to update their insurance before proceeding.
Patients paying out of pocket are not affected by insurance validation requirements.
Superbill generation draws insurance information exclusively from the structured insurance records maintained in Mediyn, ensuring that any updates to a patient’s insurance are reflected accurately on the next superbill.
You can edit diagnosis codes, procedure codes, or billed amount on any draft superbill from the superbill detail screen and save without voiding and starting over.

Superbill Content and Downloads

Finalized superbills include all fields required for CMS-1500 out-of-network reimbursement: patient sex (Box 3), provider address and phone number (Box 33), and the patient’s relationship to the insurance subscriber (Box 6).
A CMS-1500 PDF is available to download from both the therapist portal and the patient portal as soon as a superbill is finalized. The PDF includes provider information, diagnosis codes, and procedure codes.
Patients can use the downloaded CMS-1500 PDF to submit claims directly to their insurance provider for out-of-network reimbursement.
If an older superbill is missing required fields or had a previously broken download link, re-finalizing it generates a fresh PDF with complete information.
Superbill records returned by the API consistently include currency and creation timestamp fields across all endpoints.

Mobile: Insurance Records on iOS

Therapists can view and manage insurance records directly from a patient’s detail page in the Mediyn iOS app.
Each record shows the insurer name, plan, member ID, group number, and whether coverage is primary or secondary.
Records can be added, edited, or removed without leaving the patient profile.

Good Faith Estimates

Mediyn automatically generates a Good Faith Estimate draft when a self-pay or uninsured patient schedules a session.
Therapists receive in-app alerts when a Good Faith Estimate is approaching or past its required delivery deadline. The practice dashboard displays an overdue GFE count for quick identification.
Patients can view a fully itemized Good Faith Estimate in their intake experience, including service descriptions, CPT codes, units, and per-line costs.
Patients can request a Good Faith Estimate at any time through the patient portal; their therapist is notified to fulfill the request.
Therapists and clinic staff can view a complete history of Good Faith Estimates sent to each patient, including current status and acknowledgment dates. Estimates that need correction can be voided and replaced, maintaining a clear record of every estimate issued.
When an invoice is issued that exceeds a prior Good Faith Estimate by $400 or more, both the patient and therapist are automatically alerted. The patient’s invoice includes information about their federal dispute rights under the No Surprises Act.
A rights-notice disclosure is displayed in the patient portal and on intake pages explaining what patients are entitled to under federal law.