Superbill Template (PDF with Fillable Fields)
This superbill template is perfect for psychotherapists and mental health professionals looking for an easy-to-use PDF with fillable fields. Superbills are used for submitting claims to insurance when the provider is out-of-network with the insurance company. Using a template can help make creating superbills easy and fast.
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What is a superbill?
A superbill is an invoice for psychotherapy services provided by a therapist to a client. A superbill may be requested by a client when the mental health therapist is not in network with the client’s insurance company. The client can then submit the superbill to their insurance company for possible reimbursement. Most psychotherapists use a mental health superbill template to make creating superbills easier.
Superbills for insurance are used when:
- The therapist is not in network with the client’s insurance
- The therapist does not bill the client’s insurance directly
Superbills are provided by the therapist to the client, usually upon the client’s request. The client can then submit the superbill to his or her insurance company. When completing a superbill, it is important to include all of the information required by each insurance company and to check for typos, as any omissions or errors can cause the claim to be rejected.
Below we will look at what components make up a superbill, based on the standard information required by insurance companies.
Superbill Template (PDF)
Sections of this superbill template
Let’s go over each section included in this insurance superbill.
The main sections of the superbill are: practice information, provider information, client information, a list of charges, and signatures.
Practice information
Practice information should include:
Provider information
Provider information should include:
- Provider’s name
- License number
- Provider NPI (NPI-1)
Client information
The patient’s information should include:
- Client’s name
- Date of birth
- Address
- Phone number
- ICD-10 Diagnostic Codes.
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List of charges
The list of charges section usually includes a table with the following information for each session:
- Date of service
- Number of units
- CPT Code with modifiers and description
- Place of service code
- Amount paid (by client)
- Fee (charged by provider)
- Totals for the amount paid and the fees are usually included at the bottom of this table
Signatures
Last but not least, a signature block should include signatures for both the provider and the patient or client.
Using a superbill template
While filling out a superbill may seem complicated, a template can help to make the process simple and uniform by guiding you through all of the sections so that you don’t miss any important information.
Download my superbill template
Superbill Template (PDF)
Credits
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