🖥️ For practice admins using Practice HQ on the web. You need the Billing permission, and the sections you see depend on the billing features turned on for your practice.
This article walks you through getting billing ready for your whole practice: who can use the Billing tab, practice-managed versus provider-managed billing, the billing overview, payment processing, your insurance IDs and payer enrollment, client billing settings, responsibility collection, and auto-billing.
In this article
1. Who can use Practice HQ billing
Billing in Practice HQ is controlled by a staff permission and by the billing features your practice has.
You need the Billing permission ("Manage billing, claims, invoices, and insurance."). It's listed under Operations in Permissions.
The owner, admin and biller roles have it by default. Anyone else needs it granted. See Roles and permissions.
Without it, Billing doesn't appear in your Practice HQ sidebar.
Payroll is a separate permission. Having Billing doesn't give you Payroll, and the other way round. See Using payroll.
Which parts of Billing you see depends on what's turned on for your practice: practice billing (your practice collects card payments through its own Stripe account) and practice insurance (your practice bills insurance under its own group NPI and Tax ID). If a section you expect is missing, contact Oasys support.
If your practice is set up in Charter School mode, the Billing tab isn't available.
2. Practice-managed or provider-managed billing
Your billing model decides whose Stripe account receives client card payments and who manages payers.
Practice-managed billing
If practice billing is on for your practice:
Client card payments for every provider go to your practice's Stripe account. All providers share one account.
Providers can't connect their own Stripe account. In their own Billing → Billing setup they see "Payment processing is managed by your practice".
Until your practice's Stripe setup is finished, providers can't create standalone invoices in their Manage invoices ("Finish payment setup for this practice to create invoices.").
If your practice also bills insurance under its own NPI and Tax ID, you manage the accepted payers here. Providers see "Accepted payers are managed by your practice. Contact your practice administrator to add or change payers."
Provider-managed billing
If practice billing isn't on, each provider connects their own Stripe account from their own Billing → Billing setup, and their client payments go to that provider's account. See Setting up billing in the Provider Guide.
💡 Tip: If your practice is on Fully-managed RCM, the Oasys billing team works your insurance claims for you. See Fully-managed RCM. To switch between self-serve and fully-managed billing, contact your Oasys representative.
3. The billing overview
The overview is your starting point for all practice billing work. Open it from Practice HQ → Billing; the page is titled Practice billing, "Manage billing across your entire practice".
Summary tiles: Monthly revenue (money received this month), Cash outstanding, Insurance outstanding, and Total outstanding (cash plus insurance).
Attention strip: for example "3 items need attention", with one button per kind of exception: Claims needing attention, Overdue invoices, Sessions that cannot be billed, and Payers awaiting enrollment action. Each button opens the exact tab that holds that work.
Recent activity: a feed of payments received, invoices sent, claims submitted, and remittances received across your team. Only claims that were actually sent appear as submitted; saved drafts don't. Use View details on a payment, invoice, or remittance to open it.
The attention total is the same number as the Billing card on the Practice HQ Dashboard and the badge next to Billing in the sidebar. Claims that are simply ready to submit are normal queue work and aren't counted.
Quick actions
Quick action tiles are grouped by the job you're doing:
Setup: Client billing (or Patient billing, depending on your terminology setting), Claim rules, Billing setup.
Create charges: Bill sessions, Manage invoices, External payments, Manage superbills.
Insurance workflow: Eligibility checks, Manage claims.
Payments & reconciliation: Payment remittances.
If your practice doesn't have the quick actions grid, the overview shows ERA list, Claim rules, and Billing setup buttons instead.
Moving around
Inside any section, the breadcrumb at the top (Practice billing › section name) takes you back to the overview.
Your browser's Back button steps back through the sections, claims, and remittances you opened. Changing filters, sub-tabs, sorting, or pages doesn't add a Back step.
4. Connecting payment processing
With practice-managed billing, connect one Stripe account so your practice can accept client card payments. This applies only if practice billing is on for your practice.
Open Billing → Billing setup → Payment processing.
Click Connect Stripe account.
Complete Stripe's onboarding with your practice's business and bank details.
Check the Practice payment account card back in Oasys. It shows Active or Setup in progress, with checks for Accept payments, Receive payouts, and Account details.
Click Continue in Stripe if anything is missing, then use the refresh button (Refresh account status) to update the status.
All providers in the practice share this account.
Payouts from card payments go from Stripe to the bank account on your practice's Stripe account. Use the Stripe dashboard button to see payouts and manage your bank details in Stripe.
Your payout schedule is set in Stripe, not in Oasys. See Stripe's payout schedule guide.
5. Your practice and provider insurance details
Your group billing identity, provider NPIs, and payers all live under Billing → Billing setup, not in Settings.
If your practice bills insurance, Billing setup has these tabs:
Practice Information: your group billing details.
Provider information: each provider's individual billing identity.
Payment processing: your practice's Stripe account (only if practice billing is on).
Accepted payers: the insurance companies you bill. This tab stays locked ("Practice information required") until your practice information is complete.
If your practice has practice billing but not practice insurance, Billing setup shows only payment processing.
Practice Information
These details appear as the billing provider (Box 33) on the CMS-1500 claim form.
Required: Organization Name, Group NPI, Tax ID (EIN) (exactly 9 digits), Contact Name, Contact Email, Contact Phone, and the practice address (Street Address, City, State as a two-letter code, ZIP Code).
Also on this tab: Provider taxonomy code and Accept Assignment (accept the Medicare-approved amount as payment in full).
Provider information
The list shows each provider with their NPI, supervisor, and a status of Ready, Needs setup, or Inactive.
Click View on a provider to open their Provider billing identity: provider type, display name, NPI, Tax ID, Tax ID type, provider taxonomy, contact details, billing address, and whether they accept Medicare assignment. You can edit these details from the same panel.
These identities are used for eligibility checks and claims.
To bill a particular payer under a provider's own NPI instead of your group's, use a claim rule with the action Bill as individual. See Claim rules.
⚠️ Important: Changing your NPI or Tax ID after enrollments already exist may mean those payer enrollments need to be re-submitted. Oasys warns you with "Enrollments may need updating" when you save.
6. Adding payers and enrolling
Add the insurance companies you bill, then enroll with each one for the transactions you need.
Save your Practice Information first.
Open Accepted payers and click Add Payer. Search by name or payer ID and add one or more payers at a time.
Click Enroll on a payer's row. The Select Enrollment Type dialog lists only the types that still need enrollment: Enroll for Claims (CMS-1500), Enroll for Electronic Remittance Advice (ERA), and Enroll for Eligibility Verification.
Follow any steps the payer asks for (see below).
Medicare payers show an optional Medicare PTAN field (4 to 10 letters or numbers). You can find it on your PECOS record or your Medicare contractor's approval letter.
ERA enrollment moves that payer's remittances. Once it's active, all remittance advice from that payer is routed through Oasys's clearinghouse, and your previous clearinghouse stops receiving ERAs for that payer.
Tracking an enrollment
While an enrollment is pending or needs action, the row shows View Details.
If a payer needs something from you, open View Details, click View enrollment steps, and complete them. Then tick I've completed these steps and confirm. The payer is then notified to finalize your enrollment.
Open View Enrollment History from the row's three-dot menu to see past attempts.
A Rejected or Canceled enrollment shows its Rejection Reason or Cancellation Details in the history. The payer goes back to needing enrollment, so you can click Enroll again.
A badge on Accepted payers (and on Billing setup) shows how many payers need an enrollment action from you.
💡 Tip: Enrollment is processed through our clearinghouse and typically takes 2 to 30 days per payer, and Medicare can take longer. Each payer is reviewed on its own, so it's normal to see payers at different stages at the same time.
Payer-specific things to know
Enrollment that looks stuck: if a payer stays pending well past 30 days, look for an Action Required step in Accepted payers. A payer often needs a signed enrollment packet before it can finish.
Cigna: needs at least one claim submitted to it before its remittance (ERA) enrollment can complete.
Medicare: has an extra provisioning stage. Even after the clearinghouse accepts the enrollment, claims can't be submitted until provisioning finishes, which can take longer than other payers.
Coming from another clearinghouse: enrollments don't carry over. Each payer has to be re-enrolled here.
7. Client billing settings
Client billing is where you set up how each client in your practice is billed. Open Billing → Client billing (or Patient billing): "Manage insurance, cash pay, and automations for every client in your practice."
The client list
Each row shows the client's provider, payment method, automations, status (Ready, Missing info, Unavailable, or Not configured), and credits.
Filter by provider, billing type (Insurance, Cash pay, Not billed), and status, or search by name.
Change a client's billing type right from the row.
Payer not matched appears when a client's insurance payer isn't one of your accepted payers. Click Configure to jump to Accepted payers with that payer already searched.
Insurance rows also let you run an eligibility check. See Verifying eligibility.
The client billing workspace
Click a client to open their billing workspace, the same layout providers see in their own Billing tab:
Activity: Unbilled, Invoices, and Claims for this client.
Credits: the client's credit balance.
Documents: Superbills and GFEs (Good Faith Estimates).
Settings: Billing settings, Pricing rules, Insurance, and Prior auth (when available).
Activity and Documents show this client's records from every provider in your practice. Actions on a record follow the provider it belongs to. Practice billing permissions and provider setup requirements still apply.
Billing settings
Auto-Billing: turn auto-billing on or off for this client. This switch only appears when the client's provider has auto-billing turned on.
Billing Contact: bill the client (or parent or guardian) directly, or an alternative payer such as a family member.
Click Add contact to add an alternative payer. Adding a payer doesn't make them the billing contact; choose Set as Billing Contact from their menu when you're ready.
From a payer's menu you can also Manage Payment Methods or Remove billing contact. Removing the payer who is the current billing contact switches billing back to the client.
Adding and removing alternative payers needs the Billing permission ("You need practice billing permission to add an alternative payer.").
Auto Superbills (cash-pay clients)
Turn on Auto Superbills and choose Superbill Delivery.
Send consolidated monthly summary: sent on the 1st, covering paid sessions from the previous month.
Send immediately when invoices are paid: can take up to 5 minutes after the payment is confirmed. Sessions marked paid externally or paid with credits need a manual superbill.
Auto Superbills stays blocked until the required provider and client details are complete. The card lists what's missing, and Go to Provider Settings takes you to fix provider details.
Pricing rules
Pricing rules override a service's default rates for one client. Open Settings → Pricing rules and click Add Rule (or Add Pricing Rule).
Choose the Appointment type, Effective from, and optionally Expires after (leave blank for no end date).
If the appointment type is offered in all modes, you set telehealth, in-person and phone prices separately (leave phone blank to use the telehealth price). Otherwise you set one Regular session price.
For each mode you can set the price, a No-show fee, a Late-cancellation fee, and a CPT override. Leave a field blank to inherit pricing.
Tick Waive no-show fee or Waive late-cancellation fee to charge nothing for that outcome.
Late-cancelled and no-show sessions are billed at the fee these rules calculate, or at the service's default fee when no rule applies.
Deleting a rule deactivates it. Uninvoiced and unclaimed sessions then use the remaining rules; existing invoices and claims don't change, and the inactive rule stays in pricing history.
8. Collecting estimated client responsibility
For insurance clients, Oasys can collect the client's estimated share (copay, deductible, coinsurance) before the claim is paid, if your practice uses it.
Practice-wide settings
Open Billing → Client billing and click Responsibility settings.
Choose when the client's share is billed: After the payer responds (nothing is collected when the claim is submitted, and the client is billed the exact amount once the ERA posts) or Up front, as an estimate (an estimate is collected right after the claim is submitted, or earlier from Bill sessions).
If you collect up front, choose What the estimate includes: Copay, Deductible, and Coinsurance.
Optionally turn on Re-check eligibility before collecting and pick Re-check when older than: 7, 14, or 30 days (30 days is recommended).
Click Save settings.
Available client credits are applied first and can't be skipped. The rest is charged to an authorized card or sent as an invoice.
When the claim is processed, Oasys compares the final responsibility with what was collected. If it's higher, the difference is billed as client responsibility. If it's lower, the extra is added to the client's credits.
An automatic re-check uses one eligibility check per client per collection window. If a re-check fails, collection can continue from the last usable check, and the review dialog shows that check's date.
Only a practice billing administrator can change these settings. Providers can review them but see Set by your practice.
⚠️ Important: Before collecting an estimated deductible or coinsurance, confirm your payer agreements permit collecting them before the claim is processed.
Settings for one client
Open the client from Client billing and stay on Settings → Billing settings. The Estimated responsibility collection card lets you:
Choose Up front, as an estimate or After the payer responds for this client, and narrow What the estimate includes to the components your practice allows.
Enter a client-specific Copay amount, Deductible remaining, or Coinsurance percent (a whole percent from 0 to 100).
Leave a field blank to use the value from the latest eligibility check's saved benefit selections.
A manual value, including $0 or 0%, isn't replaced when someone saves different selections or runs a new check.
The deductible is an "as of today" amount that goes down as claims are processed.
Turning collection off greys out the controls without deleting the saved values.
If your practice bills every client after the payer responds, the card shows Set by your practice.
9. Auto-billing for your providers
Auto-billing sends claims and invoices automatically each night. You manage it from Billing → Client billing → Auto billing (the button shows On or Off): "Auto billing handles your routine billing every night. Changes here take effect immediately."
The Auto Billing switch sets auto-billing for all your providers at once. It saves as soon as you flip it, and a message tells you how many providers were updated.
Providers who join the practice later get the practice setting too.
Open Override on a provider level to turn auto-billing on or off for individual providers. Each provider shows how many of their clients are excluded from auto-billing.
Providers can still change their own auto-billing setting afterwards.
Per-client exclusions are kept when you change a provider's setting.
Providers on Fully-managed RCM show Managed by Oasys and their switch is locked: "Their billing plan controls Autobilling, so practice changes do not affect them."
✅ Good to know: When auto-billing is on for a provider, it runs nightly at 11 PM in the provider's time zone and processes that day's eligible work: cash-pay invoices, insurance claims, and client-responsibility invoices once insurance has processed a claim.
10. Billing fees
For questions about pricing or fees, contact your Oasys representative.
Frequently asked questions
Can individual providers still manage their own billing?
Providers see the billing panel for their own clients. Practice-wide work, such as the billing queue across providers, remittances, accepted payers, and Stripe setup when your practice owns billing, happens here in Practice HQ.
Who can see the Billing tab?
Anyone with the Billing permission. Owners, admins, and billers have it by default. Grant it in Permissions.
Where do payer IDs and provider NPIs go?
Under Billing → Billing setup (Practice Information, Provider information, and Accepted payers), not in Settings.
Can I turn auto-billing on for all providers at once?
Yes. Go to Billing → Client billing → Auto billing and flip Auto Billing. Use Override on a provider level for exceptions. Providers on Fully-managed RCM aren't affected.
Is auto-billing a setting under Settings?
No. It's the Auto billing button in Client billing, and it needs the Billing permission.
Can a family member or someone else pay a client's invoices?
Yes. Open the client in Client billing → Settings → Billing settings, click Add contact, then choose Set as Billing Contact for that payer.
How do I set a different late-cancellation fee for one client?
Add a pricing rule for that client under Settings → Pricing rules and enter a Late-cancellation fee, or tick Waive late-cancellation fee.
Why is a payer enrollment stuck on "pending"?
Check Accepted payers for an Action Required step, such as a signed packet. Enrollment can take 2 to 30 days per payer. If it's well past that, contact Oasys support.
Where do payouts go?
If your practice owns billing, Stripe pays out to the bank account on your practice's Stripe account. Use the Stripe dashboard button in Billing setup → Payment processing to see payouts.