đĽď¸ For practice admins using Practice HQ on the web. Billing policies need the Supervision and Settings permissions, and claim rules and claims need the Billing permission.
This article explains how supervision affects billing: the two supervision billing policies, what happens while a session waits for approval, billing under the supervisor's profile (incident-to), supervision modifiers, and why to set supervision up before billable work begins.
In this article
1. Supervision billing policies
This section shows how to set the two policies that control billing for supervised sessions.
In Practice HQ, go to Supervision and click Settings.
On the Billing policies card, click Edit.
Turn Allow billing before approval on or off: "Supervisees can create claims and invoices while awaiting supervisor review." When it's off, a supervised session can't be billed until it's approved.
Turn Bill under supervisor's profile on or off: "Use the supervisor as the rendering provider (Box 24j) on claims instead of the supervisee."
Click Save Changes.
Bill under supervisor's profile is the incident-to billing setting. If you're looking for "incident-to" or "Box 24j," this is it.
If your practice is set up in Charter School mode, the Billing policies card isn't shown.
2. When billing waits for approval
This section explains what you see when Allow billing before approval is off and a supervised note isn't approved yet.
The session shows Awaiting approval in the billing workspace, with the reason "Awaiting supervisor approval."
Clicking the fix action shows Waiting for supervisor approval and names the supervisor who needs to approve the note in Supervision.
If nobody can approve the session, you'll see No supervisor can approve this session. This usually means the supervisor the session was assigned to doesn't have an active assignment with that provider. Adding a different supervisor doesn't unblock it, because only the assigned supervisor can approve it. Restore that supervisor's assignment by creating it again in Supervision (see Setting up clinical supervision). If the session was never assigned to a supervisor, assigning any active supervisor to that provider unblocks it.
Auto-billing skips the session until it's approved, then picks it up.
â ď¸ Important: A practice admin can't approve a note on the supervisor's behalf. Only the supervisor the session is assigned to can approve it, and only while their supervision relationship is active.
3. Billing under the supervisor's profile
This section explains whose details go on the claim, and how to check what was sent.
With Bill under supervisor's profile on, the supervisor is the rendering provider (Box 24j) on that supervisee's claims instead of the supervisee.
With it off, the supervisee stays the rendering provider.
When a superbill carries a supervision modifier, it can also show the supervisor's name and NPI.
Checking the NPI and taxonomy on a claim
Open Billing â Manage claims and open the claim.
Find the Providers card on the claim's overview.
Check Billing entity and Rendering clinician, each with the NPI and Taxonomy sent to the payer.
A field shows Not sent if the claim went out without it, and Not available if the claim hasn't been sent yet.
4. Supervision modifiers
This section explains how supervision modifiers get onto claims and superbills. The modifier follows the supervisee's role and your setup, not their degree.
HO: services provided under supervision (master's degree level).
HN: services provided under supervision (bachelor's degree level).
HP: services provided under supervision (doctoral degree level).
On insurance claims
On claims, a supervision modifier comes only from your Claim rules. There's no fixed table, so you decide which modifier applies to which supervisee or role.
Open Billing â Claim rules and click New rule.
Add a condition such as Supervised is Yes, or Supervisee role is the role you want (for example, associate).
Add the action Add modifier and choose the modifier, for example HO.
Leave Rule is active on and click Create rule.
All of a rule's conditions must match before it runs. Its actions are then applied to the claim before it is sent.
A claim line can carry only one supervision modifier. Once one is selected, the others are unavailable.
On superbills
Superbills use your practice's earlier supervision modifier setup if one was saved. Otherwise they use the built-in defaults: associate â HO and intern â HN.
If Bill under supervisor's profile is on, these defaults aren't added to superbills.
đĄ Tip: Don't assume a fixed HO/HN/HP mapping by education level. Set the modifier you want for claims in Claim rules, and check with your payers which modifier they expect.
5. Set up supervision before billable work begins
This section explains why timing matters. Supervision routing (the review requirement, the billing modifier and incident-to rendering) applies going forward from when you configure the relationship and the role requirement. It isn't retroactive.
If a role is marked as requiring supervision after sessions have already been billed under the supervisee's own profile, those earlier claims aren't corrected automatically.
This can surface later as a confusing pattern of denials.
Set up supervision relationships before a new associate or intern starts seeing billable clients.
Frequently asked questions
Do billing modifiers apply automatically?
On insurance claims, yes, once you've set up a claim rule for that supervisee or role. The modifier reflects the setup you choose rather than a fixed table. Superbills use your practice's earlier supervision modifier setup if one was saved, otherwise the built-in defaults (associate â HO, intern â HN).
Where is the incident-to setting?
It's Bill under supervisor's profile, on the Billing policies card in Supervision â Settings.
A session says "Awaiting approval." Can I approve it so we can bill?
No. Only the assigned supervisor can approve the note. If you need to bill before approval, turn on Allow billing before approval.
Why does a session say "No supervisor can approve this session"?
Usually the supervisor the session was assigned to doesn't have an active assignment with that provider. Only that supervisor can approve it, so restore their assignment by creating it again in Supervision. If the session was never assigned to a supervisor, assign any active supervisor to that provider.
How do I check whose NPI went on a claim?
Open the claim in Manage claims and look at the Providers card for the Rendering clinician NPI and taxonomy.
Can payroll wait for supervisor approval too?
Yes. Turn on Supervisor approval under Payment Readiness in Payroll settings. See Using payroll.