Insurance Billing for Private Practice: A Step-by-Step Guide

Step 1: Get credentialed

Before you can bill an insurance company, you need a contract with them. Credentialing verifies your license and qualifications and can take weeks to months per payer, so start before you open your doors or add a payer.

Each payer has its own panel and rules. Track your applications and follow up — this is where practices lose months.

Step 2: Verify benefits before the first session

Always verify a client's benefits before their first appointment: coverage, copay, deductible status, session limits, and whether your service requires prior authorization.

Document the verification — the representative's name, date, and what was confirmed. If a claim is later denied, that record is your leverage.

Step 3: Document to support the code

The note you write determines whether you get paid. Document the session date, duration, modality, symptoms, interventions, and response, and use the correct CPT code for the time delivered (90834 vs 90837, for example).

Payers can audit notes months after payment. If the documentation doesn't support the code, they can claw it back.

Step 4: Submit the claim

• Submit electronically through your practice management software or a clearinghouse — faster and fewer errors than paper.
• Include accurate client, payer, diagnosis, and CPT codes.
• For clients paying out of pocket, provide a superbill they can submit themselves.
• Track every claim's status and follow up on anything unpaid after 30 days.

Step 5: Handle denials and appeals

• Read the denial reason — most are fixable: missing info, wrong code, or benefit limits.
• Correct and resubmit when allowed, or appeal within the payer's window.
• Keep a denial log; recurring reasons point to a fixable process gap.