A superbill is a detailed, itemized receipt given to patients/clients by a healthcare provider when:
- The provider cannot or does not submit out-of-network claims to a patient’s payer
- A patient/client is self-pay for any reason
A superbill may be used by clients for Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), tax purposes, or to try to obtain reimbursement from their health plan. The superbill is different than a CMS 1500 form, which providers use to submit claims to payers (private or government health insurance) for services provided.
How It Works:
When a superbill is used, patients/clients pay for services upfront, the provider issues a superbill to the patient, and the patient can submit the superbill to their insurance along with a request for repayment or allocation towards a deductible. The superbill shifts responsibility to the patient for contacting the insurance provider.
A superbill does not guarantee an insurance provider will reimburse the patient for the services provided. The ability of a health plan member to obtain reimbursement from a health plan is dependent on individual member benefits and coverage, as well as health plan policies regarding member reimbursement.
Components of a Superbill:
A superbill is more than just a receipt or a standard invoice. It is the main source of information a payer (insurance, funds, programs) will use to create a healthcare claim, which will be used to determine reimbursement. Insurance companies require specific information be included in a superbill. (Note: The Internal Revenue Service may have additional documentation requirements for health care expenses for HSA, FSA, and other tax-favored health plans.)
At a minimum, a superbill should include the following:
- Provider’s name & credentials
- Patient's name and address
- Your National Provider Identifier (NPI)
- State license number, if applicable
- Your office address
- Your federal tax ID number (TIN)/Employer Identification Number (EIN)
- Date(s) of service
- CPT® code(s) and number of units of service (if applicable)
- ICD-10 code(s) provided by a physician or other provider qualified to diagnose
- Fee for the service