This guide covers billing as a solo therapist — from setting up payment processing and insurance, to understanding how sessions become billable, managing claims, and handling payments.
In this article:
1. Setting up payment processing
To collect credit card payments from clients, connect Stripe.
Where to find it: Go to the Billing tab → Setup → Billing Setup → Payment Processing.
Click Connect Stripe Account.
Complete Stripe's onboarding — business info, banking details, and tax ID. Takes about 5 minutes.
Once complete, you'll see a green Active status with checkmarks for Accept Payments, Receive Payouts, and Account Details.
⚠️ Important: This is not the same as your Oasys subscription. Payment processing (Billing tab) is how you collect money from clients. Your subscription (Settings → Subscription & Fees) manages your platform plan.
2. Setting up insurance billing
Before submitting insurance claims, configure your provider information and accepted payers.
Provider information
Where to find it: Billing → Setup → Billing Setup → Provider Information.
Provider type — Individual or Organization/Group
NPI — your 10-digit National Provider Identifier
Tax ID — your 9-digit EIN or SSN (organizations must use EIN)
Accept Assignment — whether you accept Medicare's approved amount as full payment
Contact information — name, email, and phone for billing inquiries
Billing address — must be a valid US street address (no PO boxes)
💡 If you've already filled out your therapist profile, some fields will be pre-filled automatically.
Accepted payers
In the Insurance Billing section of Billing Setup:
Click Start Setup (or Manage if already configured).
Search for insurance companies by name and add them.
For each payer, enroll for the transaction types you need:
1500 (Claims) — submit CMS-1500 claims electronically
ERA — receive Electronic Remittance Advice (payment notifications)
Eligibility — verify client insurance coverage online
Enrollment is processed through our clearinghouse and may take 5–15 business days per payer.
3. Entering client insurance information
Each insured client needs their insurance details entered before you can bill claims.
Where to find it: Billing → Client Billing → select a client → Settings → Insurance.
The wizard walks through 5 steps:
Insurance information — provider, Member ID, Group Number, subscriber relationship, optional card photos, optional secondary insurance.
Client information — first/last name (must match insurance card exactly), gender (required for verification), date of birth.
Subscriber information — only if the client is not the primary subscriber (spouse, child, etc.). Includes subscriber name, DOB, gender, and address.
Client address — must be a valid US address matching insurance records. No PO boxes. Optional referring provider NPI.
Review and verify — Oasys automatically runs an eligibility check to confirm coverage.
4. Running eligibility checks
Verify a client's insurance coverage before submitting claims. Checks run automatically during the insurance wizard (Step 5), and you can run them manually anytime.
An eligibility check returns:
Coverage status — active or inactive
Network status — in-network, out-of-network, or unknown
Mental health benefits — sessions allowed/used, copay, coinsurance, prior auth requirements
Deductible info — individual and family, in-network and out-of-network, year-to-date and remaining
Out-of-pocket info — maximums and remaining amounts
You can run eligibility checks for clients who haven't signed up to Oasys yet — the wizard supports draft insurance data.
💡 Each eligibility check costs $0.15.
5. How billing works after a session
💡 Key concept: You do not need to manually create claims or invoices. When a session is completed, it automatically becomes billable and appears in the Bill Sessions tab.
Here's the flow:
You complete a session (or mark it as a no-show).
The session automatically appears in Billing → Bill Sessions under the Ready tab (if all info is present) or the Incomplete tab (if something is missing).
If auto-billing is on: at your cutoff hour (default 11 PM), Oasys automatically submits the claim or sends the invoice.
If auto-billing is off: you go to Bill Sessions, select the ready sessions, and send them out yourself.
⚠️ About standalone items: You cannot create insurance claims as standalone items — claims always come from completed sessions. You can create standalone invoices for charges not linked to sessions (e.g., late cancellation fees), but this is rare.
6. The Bill Sessions tab
Where to find it: Billing → Bill Sessions.
Ready tab
Sessions with all required information, ready to be billed. Select one or more and choose to submit a claim (insurance) or send an invoice (cash pay).
Incomplete tab
Sessions that can't be billed yet. Each shows the specific reason:
Insurance setup not complete — finish your provider info in Billing → Setup → Billing Setup.
Missing insurance payer — update the client's insurance in Client Billing.
Missing diagnosis codes — add them in the client's clinical information.
Missing CPT code — update the service type or edit the session.
Missing service charge amount — set a price on the service type.
Incomplete client insurance details — complete the client's insurance profile.
Missing provider taxonomy — add it in Billing → Setup → Provider Information.
Unsigned clinical notes — sign the note first, then bill.
Claim validation errors — specific error shown.
Awaiting supervisor approval — blocked until supervisor approves (shown as "Blocked").
Session not showing up at all?
If a completed session doesn't appear in either tab, check:
$0 service type — sessions with no charge are filtered out.
Client pricing rule override — a client-specific rule is set to $0.
Client set to "not billed" — change the billing type in Client Billing settings.
7. Auto-billing
Auto-billing processes all ready items each night at your cutoff hour (default 11 PM). It handles all three billing types:
Cash-pay invoices — sends invoices for completed and no-show sessions. Charges the card on file if available.
Insurance claims — submits claims for ready insurance sessions.
Client responsibility invoices — after ERAs show a client balance (copay, deductible, coinsurance), creates invoices for the client's share.
To enable: Go to the Billing tab and toggle Auto-Billing on. Optionally backfill past unbilled items.
Only fully ready items are included — incomplete sessions stay in the Incomplete tab.
💡 If auto-billing is off, sessions still appear in Bill Sessions as Ready. You just need to go there and send them out yourself.
8. Insurance claims after submission
Track submitted claims in Billing → Manage Claims.
Claim statuses
Draft — created but not yet submitted. Review and submit from the claims queue.
Submitted — sent to the clearinghouse. Wait for acknowledgment (1–2 business days).
Acknowledged — clearinghouse validated the format. Waiting for payer (5–30 days).
In Review — payer is actively reviewing. Monitor for updates.
Pending Info — payer requesting additional information. Respond promptly.
Paid — payer has fully paid. Details appear in Payment Remittances.
Partial — payer paid part. Remaining may be client responsibility or billable to secondary insurer.
Rejected — clearinghouse rejected due to formatting error. Fix and resubmit from the Denied tab.
Denied — payer denied the claim. See denial code in the Denied tab. Correct, appeal, or write off.
Validation Failed — system error before submission. Review and retry.
Submission Failed — technical error during submission. Retry.
Voided — original claim cancelled. Replacement may be resubmitted.
Closed — administratively closed. No further action.
Manage Claims sub-tabs
Submitted — in-flight claims. Highlights claims aging beyond 30 days.
Secondary — claims ready for secondary insurance after primary partially paid.
Denied — rejected and denied claims. For each: correct and resubmit, appeal, or write off.
9. Payment Remittances (ERAs)
When an insurance payer processes your claim, they send an ERA — viewable in Billing → Payment Remittances.
Each ERA shows:
Payer name, check/EFT date, and check number
Total payment amount and number of claims
Claim-by-claim breakdown: billed, allowed, paid, and client responsibility
Adjustment codes and reasons
If the ERA shows client responsibility, you can create an invoice for the client's share — or if auto-billing is on, this happens automatically.
10. Manage Invoices
Where to find it: Billing → Manage Invoices.
Invoice statuses:
Draft — created but not sent
Sending — being delivered
Open — sent, awaiting payment
Paid — payment received
Overdue — past due date
Void — cancelled
Uncollectible — payment failed permanently
Actions: Void (cancel), Resend (payment reminder), Request Payment Method (ask client to update card).
11. Manage Superbills
Superbills are statements clients submit to insurance for out-of-network reimbursement. They're different from invoices (direct payment) and claims (you submit to insurance).
Where to find it: Billing → Manage Superbills.
Click Create Superbill.
Select a date range and clients.
Review eligible sessions: date, amount, CPT code, diagnosis codes.
Preview the PDF, then create.
You can create individual superbills (one per session) or consolidated superbills (multiple sessions in one PDF). Send via email — clients receive a PDF to submit to their insurance.
12. Custom pricing per client
Override your default rates for specific clients:
Open the client's billing settings in Billing → Client Billing → [Client] → Settings → Pricing Rules.
Add a pricing rule for a specific service type.
Set a custom price and/or CPT code.
Client-specific pricing takes priority over default service rates.
Frequently asked questions
Do I need to create an invoice or claim manually?
No. When a session is completed, it automatically becomes billable and appears in Bill Sessions. From there, you either let auto-billing handle it or send it yourself.
What's the difference between a claim, invoice, and superbill?
A claim is submitted to insurance for payment. An invoice is sent to the client for direct payment. A superbill is a statement the client submits to their insurance for reimbursement.
Why isn't my completed session showing in Bill Sessions?
Check for: $0 service type, client pricing rule set to $0, or client billing type set to "Not Billed."
How long does it take to get paid on a claim?
After submission: acknowledgment in 1–2 days, payer decision in 5–30 days. Timelines vary by payer.
What should I do with a denied claim?
Go to Manage Claims → Denied. Review the denial code and reason. You can correct and resubmit, file an appeal, or write it off.
Does auto-billing only handle cash pay?
No. Auto-billing handles cash-pay invoices, insurance claims, and client responsibility invoices — all three.
Can I create a standalone invoice?
Yes, from Manage Invoices → Create Standalone. But this is rare — most billing happens automatically through Bill Sessions.