A superbill is only as useful as the information on it. Collecting the right client and provider data at intake eliminates billing errors and prevents rejected insurance claims for your clients.
Client Information to Collect at Intake
- Legal name — Must match the name on the insurance card exactly. Preferred names are fine for clinical records, but the billing name must be legal.
- Date of birth — Used by insurers to verify member identity.
- Insurance company name — The carrier (e.g., Aetna, UnitedHealthcare, BCBS). Note the specific plan name if available (e.g., "Aetna Choice POS II").
- Member ID — Found on the front of the insurance card, usually labeled "Member ID" or "ID."
- Group number — Also on the insurance card, typically labeled "Group" or "Group #." This identifies the employer plan.
- Plan type — PPO, HMO, EPO, POS. PPOs typically have OON benefits; HMOs typically do not.
- Claims submission address — The mailing address for member-submitted claims. Different from the in-network claims address on the back of the card.
- Subscriber information — If the client is a dependent on someone else's plan, collect the subscriber's name, DOB, and member ID in addition to the client's information.
Provider Information Required on a Superbill
- NPI (National Provider Identifier) — Your 10-digit NPI number. Look it up at nppes.cms.hhs.gov if needed.
- EIN or Social Security Number — Your Tax ID for billing purposes. EIN is preferred for privacy; SSN is used if you have not obtained an EIN.
- License number and state — Your professional license number and the state that issued it.
- Taxonomy code — A 10-character code identifying your specialty. Common codes: 101YM0800X (licensed marriage and family therapist), 1041C0700X (licensed clinical social worker), 103T00000X (licensed psychologist).
- Practice address and phone — The service location address (or your registered practice address for telehealth).
Why Each Field Matters
Insurance systems are automated. A superbill with a missing NPI or wrong member ID will be rejected before a human ever reviews it. The ICD-10 code tells the insurer what condition was treated; the CPT code tells them what service was provided. Both must be present and consistent with each other.
Verifying Insurance at Intake
Instruct clients to check their benefits before their first session:
- Call the member services number on the insurance card
- Ask: "Do I have out-of-network mental health benefits?"
- Ask: "What is my OON deductible and what has been met this year?"
- Ask: "What percentage does the plan pay after the deductible for CPT 90837?"
- Ask: "Is prior authorization required for outpatient mental health therapy?"
Authorization vs. No Authorization Required
For OON therapy, most PPO plans do not require prior authorization — you can start treatment and submit superbills immediately. However, some plans require preauth for specific diagnoses (PTSD, eating disorders) or for more than a set number of sessions. When in doubt, verify before starting treatment.
Keeping Data Secure
Insurance card data is PHI. Store it in your HIPAA-compliant EHR or practice management system — not in a spreadsheet or personal email. Superbilled stores only what is needed to generate the superbill and processes all data in a HIPAA-compliant environment with a signed BAA.