The Complete Guide to Superbills
November 9, 2022
A one-stop shop for knowledge about superbills. Learn how to make claims using a superbill for insurance. Download a free superbill template.
A superbill is a crucial part of out-of-network healthcare billing. Have you ever seen an out-of-network (OON) healthcare provider like a therapist, dietitian, or chiropractor? If so, you may have received a superbill. Superbills can be a bit confusing, so we’ve tried to gather all the helpful information we could into one guide.
Whether you’re using superbills as a provider or a patient, this post is chock full of useful tips. It has FAQs and explainers on how to submit medical superbills to health insurance, and how to create superbills as a provider. We also put together a free printable superbill template for providers to download. At the end there’s a brief quiz to review what you’ve learned, but don’t worry! We won’t be keeping score…
Common Questions and Misconceptions About Superbills
If you’re completely new to superbills, start with our introductory post What Is a Superbill?. That post breaks down a sample superbill line by line, so you can see how each essential part functions. Here are some common questions and misconceptions about superbills:
Superbills are not really bills.
The name superbill is a little misleading. Superbills are more like itemized receipts, issued after a service is paid for. They list the names and costs of your health expenses. But be careful: don’t throw your superbills away with your other receipts! You will need your superbills to file out-of-network health insurance claims.
Well then, what are superbills?
In literal terms, a superbill is a document an out-of-network provider gives a patient after they’ve paid for services. Sometimes they are called “encounter forms”. A superbill for insurance shows the provider’s ID, the patient’s diagnosis, and service(s) rendered. It also records their cost, the amount paid, and the patient’s name and address.
For an analogy, think of superbills as a vehicle. Superbills transport medical data from a doctor’s office to an insurance company. The data is written in a universal language of medical codes, so that both the provider and insurer are on the same page. These codes, called ICD and CPT codes, are essential knowledge for any out-of-network provider’s billing specialist.
What does a superbill look like?
Superbills vary from provider to provider. They are usually generated by a provider's electronic health record (EHR) software. Or, a provider can manually create them. If you want to see what a superbill looks like, check out our Intro to Superbills post for an example. Near the bottom of this post is a free fillable superbill template for providers who need to create superbills.
Why are superbills used?
When a healthcare provider or facility is in-network, it means they accept your insurance. The provider files an insurance claim and the insurer pays the provider directly. This isn’t the case for out-of-network services.
When a provider is out-of-network, they don't accept your insurance. The patient pays for the services up front. The patient needs detailed information to submit information to their insurance to file a claim. The insurer then reimburses the patient, not the provider.
Out-of-network providers record the services they provide and the patient’s payment into a superbill. This helps the patient submit a claim and get reimbursed. Again, the insurer can only reimburse a patient for services they have already paid for. Learn more in our Complete Guide to Out-of-Network Reimbursement.
Which specialists typically issue superbills?
Many types of healthcare providers use superbills for at least part of their practice. These include but are not limited to:
- Clinical social workers
- Psychologists and psychiatrists
- Speech language pathologists
- Lab testing clinics
- Pain management clinics
- Plastic surgeons
- Optometrists and ophthalmologists
- Family physicians
- Lactation specialists
- Fertility clinics
- Physical therapists
- Occupational therapists
- Massage therapists
- Physicians and physician assistants
- Nurse practitioners
What is SuperBill, the company?
We’re so glad you asked! SuperBill is a company that makes out-of-network reimbursements easy. We work with both patients and providers to get you the maximum allowed reimbursement from your insurance. Just upload your superbills to SuperBill’s portal, and we’ll file and track your claims.
Insurance claim rejections are increasingly common. The good news is, after we submit claims to your insurance for reimbursement, we’ll correct and refile them if they’re rejected. We fight tooth and nail to negotiate the best possible reimbursement. We also offer benefits checks, claim tracking, and support from insurance experts.
How do I submit superbills to SuperBill?
All you have to do is upload your superbills to our online portal, and we’ll take care of the rest. Patients can upload their own superbills, or providers can upload them on their patients’ behalf.
After you create an account, you can visit the online portal to track the status of your claims, check your benefits, and view your reimbursements.
For Patients: How to Submit Superbills for Insurance Reimbursement
We don’t recommend patients submit superbills to insurance themselves. Why? Because it’s easier and more cost-effective to let SuperBill file your claims. But if you do decide to fly solo, we still want to help guide you. If you’re submitting your own (or your patients’) superbills for reimbursement, here are a few things to consider.
Understand your benefits.
Before you file an own out-of-network claim, it’s important to understand your OON benefits. The easiest way to do this is usually viewing your plan details on your insurer’s website. Or you can call your insurance company using the number on the back of your health insurance card. If you want to save time, use SuperBill’s FREE benefits calculator!
Review the submission instructions on your insurer’s website.
Submission protocols differ from one insurance company to another. Sometimes it’s as simple as uploading a claim, but some companies want you to fax or mail them. Pro Tip: SuperBill’s health insurance claims forms database is a good place to start your search!
Double-check your information.
Review the information you input on the claim form, especially your insurance ID numbers. More claims get rejected due to simple data errors than you might think.
Questions you may want to explore include:
- Do you have out-of-network benefits? If so, what is your out-of-network deductible?
- Have you met your deductible?
- Does your insurance plan cover the specific services you received? Some plans have exclusions to what is covered.
- What is your coinsurance rate, or the portion of the bill that is your responsibility?
- What percentage does your insurer cover? This is the amount you may be reimbursed.
It’s easy to answer these questions with SuperBill’s reimbursement calculator.
Review the CPT and ICD codes in your superbill.
To be extra thorough, you can double-check the medical coding in your superbill. Hopefully you have been successful getting a reimbursement for your superbills for the same type of services in the past. If so, compare your current superbill with past ones. Ask your provider if you notice discrepancies or missing codes. Medical coding mistakes are one of the most common reasons insurers reject superbill claims.
Prepare to refile.
Even if you handle all of the above steps with care, it’s still possible your insurer will reject your claim. After all, insurance companies have an army of employees whose sole job is to save the company money. But rejection is not the end of the line! You can correct and refile your claims. In fact, you should refile if you think you’re entitled to the reimbursement.
For Providers: How to Create a Superbill
If you are an out-of-network provider, your patients can benefit from receiving a superbill for your services. If you use EHR software for your practice, it can most likely generate superbills for your patients automatically. If this is the case, use that feature! If not, see our superbill template below.
The Importance of Accuracy in SuperBills
The main point probably goes without saying: double-check your medical coding. Your patients reimbursement claims can be denied if there are errors in your coding. ICD-11 is on its way, but it still hasn’t been phased in completely. ICD-9 is out and will not be accepted by insurers. Instead, prepare your superbills using ICD-10 codes. Review ICD-10 codes and CPT codes carefully to make sure they’re free of errors. If you want to go deeper on this subject, read our CPT and ICD-10 Coding Tips.
If you are a provider who does not have a system that automatically generates superbills, don’t fret. With a little effort, you can create your own superbills. To make this easier, download and customize this free printable superbill template.
Review: Test Your Superbill Knowledge
Which of the following is not found on a superbill?
- ICD-10 Codes
- Patient’s Name and Address
- CPT Codes
- Patient’s Medical History
Where do you find information about how to submit a superbill to your insurance?
- Your EOB
- Your Insurer’s Website
- The Bottom of Your Superbill
- Ask Jeeves
SuperBill handles ____________.
- Negotiations with Insurers
- Verifications of Benefits
- Out-of-Network Reimbursements
- All of the Above
The answers are at the bottom of this page.
Do you want to simplify your out-of-networks claims? Let us take a load off your shoulders. SuperBill is on a mission to save patients and providers time and money. To learn more about how to create an account and submit a claim, read Getting Started As a Patient or Getting Started As a Provider.
Test Answer Key: D, B, D