Every step of billing. Editable end-to-end.

Billing starts before the first session, with a clean intake.

Every billable therapy episode starts with a client profile that holds up under payer scrutiny: demographics, legal guardian, responsible party, insurance cards (primary and secondary), referral source, ordering physician, HIPAA and telehealth consents, financial responsibility agreement, and the clinical intake questionnaires your discipline requires.

MyTherapyWizard runs this as a digital intake workflow: forms are sent to the client or family via secure link, completed on phone or desktop, e-signed, and attached to the client record as structured data (not scanned PDFs buried in a folder). Insurance card photos are captured on both sides; the policy fields auto-parse into the eligibility engine. Every signed consent carries a timestamp, an IP address, and a document version, so a consent collected in 2024 can be distinguished from the updated version collected this year.

If a piece of intake is missing or expired (a consent over a year old, an insurance card from a prior plan, a guardian signature never captured), the client surfaces in Needs Action before eligibility or scheduling can proceed. The rest of the lifecycle assumes this foundation is clean.

Verify coverage before the client walks in. Or the moment plans change.

Real-time eligibility checks via ClaimMD, runnable per-client or in batch. Results return copay, coinsurance, deductible status, prior-auth requirements, and therapy-specific benefit limits as structured fields, not as a PDF your biller has to squint at.

Eligibility responses are captured as structured records and attached to the client. Any time a plan changes (new employer, new year, new payer), a fresh eligibility check is one click, and the result is diffed against what was on file. The claim engine uses the most recent verified eligibility when generating professional claims, so CPT pricing, units, and modifier rules reflect the plan that's actually in effect.

The claim doesn't exist until the session is clinically complete.

A session has to be documented (not just scheduled, not just attended, but actually documented) before a claim can be generated. The Billing Readiness Indicator is the gate: signed note, valid CPT(s), correct units, active authorization, current eligibility, matched diagnosis pointers, required modifiers.

Everything that fails the check surfaces with the specific reason and a one-click path to fix it. No more end-of-month surprise: "we can't bill fourteen of last week's sessions because the notes aren't signed." You see the gap the day it happens, while the session is fresh and the correction is cheap.

Claims that assemble from clinical data, and stay editable.

Once readiness is green, the system builds the claim: CPT lines from session capture, modifiers from session flags, units from documented time, diagnosis pointers from the plan of care, pricing from the verified eligibility, billing provider and rendering provider from the session, place of service from the appointment.

Every line is editable. CPT, modifiers, units, DX pointer, pricing override, narrative. Edits are captured with a user, a timestamp, and, where required, a reason code. The clinical record stays the source of truth; the claim is the billing-side presentation of it, with room for the inevitable payer-specific exceptions.

Claims are reviewable in a cursor-paginated list (filter by status, payer, provider, date, or dollar threshold), and every claim opens to the same detail page with editable lines, attached session evidence, and the full audit trail.

Catch the denial before it's a denial.

Before submission, every claim runs through the scrub engine: payer-specific rules, NCCI edits, modifier compatibility, units-per-day caps, duplicate-line detection, POS validation, authorization match, therapy-minutes thresholds, CPT-to-DX appropriateness.

Issues are returned as structured findings with severity (block / warn / info) and a plain-English explanation. Blocks hold the claim and route it to Needs Action. Warnings surface but don't stop submission. Everything is fixable in place: you don't leave the claim to go fix the thing the claim depends on.

Submit via ClaimMD, with a handshake, not a hope.

MyTherapyWizard integrates directly with ClaimMD for electronic submission. Every submission produces a claim-control number, a submission timestamp, and a status that updates as the clearinghouse and payer acknowledge receipt.

Front-end rejects return in minutes. The rejected claim surfaces in Needs Action with the specific edit reason from the clearinghouse, and because the claim is still fully editable, you fix the line, re-scrub, resubmit. No voids, no duplicate claim IDs, no Saturday-morning reconciliation.

Remittances post themselves. Exceptions raise their hand.

ERAs (835s) flow in from ClaimMD and auto-match to their originating claims on control number and line identifiers. Payments, adjustments, patient-responsibility transfers, and CARC/RARC reason codes are applied to the claim record automatically.

Unmatched remits, partial payments, and denial-coded lines don't fall into a black hole: they surface in Needs Action. Every posting is reversible. If an auto-match was wrong, you can re-route it, and the reversal is audit-trailed alongside the original post.

Denials are a workflow, not a filing cabinet.

When an ERA or clearinghouse response codes a line as denied, MyTherapyWizard creates an appeal case automatically. The case carries the denial reason, the original claim, the session evidence, the auth (if any), the plan of care, and any prior correspondence.

Appeal packets generate from templates (cover letter, narrative justification, and supporting documentation pulled from the session and POC) and are editable end-to-end. Send, log, track the outcome, reopen if reversed, and roll the lesson into your scrub rules. Denial analytics aggregate across payers, codes, and providers so you can see which denials are systemic and which are one-offs.

Secondary insurance: an automated handoff, not a retype.

Coordination of Benefits is often the hardest manual step in a billing workflow: the biller opens the primary EOB, copies amounts into a secondary claim, attaches the EOB, and prays the secondary payer accepts the format. MyTherapyWizard makes COB a system behavior.

When primary payment posts, the system assembles the COB secondary claim automatically. Primary paid amount, allowed amount, adjustments, and CARC/RARC codes all carry over. The secondary claim supports both COB-IN (primary and secondary same network) and COB-OON (different networks) pricing logic. Every field is editable for the edge cases payers keep inventing.

Patient-side billing, from the same record.

Once insurance has paid (or hasn't), whatever remains as patient responsibility flows into an invoice. Superbills, patient statements, receipts, and payment-plan tracking all pull from the same claim record: same CPT lines, same dates, same diagnoses, same pricing.

Invoice numbers are sequenced per organization following the configured rule. Invoices are sharable via the patient portal or exportable as PDF. Payments post back to the claim. Refunds, write-offs, and adjustments are captured with a reason and a user, because patient accounting has to be audit-ready too.