Before you start

• Who does this: the account Admin or Admin Lite (billing lead).
• How long it takes: 20 to 40 minutes, depending on how many payers you bill.
• Plan needed: Teams. Some options need the Billing add-on.
• Have ready: each payer's supervision and modifier requirements, and what each payer authorizes per discipline (visits, units, days and POC length).

Billing add-on features: some options described here only appear, or only take effect, when your team has the Billing add-on enabled. Without it, they're hidden or turned off. The billing features are powered by ClaimMD, which needs its own ClaimMD account and subscription (separate from MyTherapyWizard).

👣 Step 1: Add insurance rules by therapist

1. Under Insurance rules by therapist, click New rule.
2. Choose the therapist(s), then the payers. Leave payers empty to apply to all payers.
3. Add procedure codes, or leave empty to apply to all codes.
4. Choose a rule type:
   • Co-sign required: sessions need a co-signature before they can be finalized.
   • Co-sign required for documents: selected report types need a co-signature before they're finalized.
   • Payer excluded: blocks assigning clients with this payer to these therapists.
   • Modifier required: automatically adds a modifier to the claim line, for example adding CO when an OTA bills certain payers.
5. Add notes and click Save rule.

Which rule wins? The most specific one: therapist + payer + procedure code beats therapist + payer, which beats therapist only.

👣 Step 2: Add insurance limits

1. Under Insurance limits (payer rules), click Add limit.
2. Choose the insurance and discipline, and check how this payer authorizes: units, visits, days, dollar amount or other.
3. Fill in only the limits that apply: days until an evaluation expires, max units and visits per day, max days for an authorization, max POC length, max units, visits or dollars per POC, and days until a provider order expires.
4. Click Save. Use the copy icon to clone a limit set to another payer or discipline, then edit it.

Limits warn, they don't block. Therapists see a warning when a plan of care exceeds what the payer allows, so they can adjust before it's denied.

👣 Step 3: Set your payer network

1. Under Payer network, enter each payer you're in network with: payer ID, payer name and an optional label (for example, to tell apart several plans under one payer).
2. Keep In-network checked and click Add.
3. During eligibility checks, secondary payers that aren't on this list are flagged COB-OON (out of network). You'll choose how flags are handled in Step 8.

▶️ Watch: Flow and Lifecycle Stages Setup

💡 Why it matters

This is clinical intelligence protecting your revenue. Rules you set once are applied to every session, document and claim, so a co-sign or modifier is never forgotten and a plan of care never quietly exceeds what a payer will pay.

✅ How you'll know it worked

• Each rule shows on the rules list with the right therapist, payers and rule type.
• Creating a plan of care that exceeds a payer limit shows a warning.
• An assistant's session under a co-sign rule waits for a co-signature before it's finalized.