How do I create superbill when I am bound with Kareo?

Creating a superbill
Any user may create a superbill for a patient that has a
patient record number entered in their chart by following the steps listed below:

  1. Within a patient encounter, click the Actions menu in the top right corner.
  2. Select Add superbill.
  3. The superbill will open in a new tab.

Once you have opened the superbill, you will have the ability to add CPT codes, diagnosis codes, and modifiers. For each procedure added, a corresponding diagnosis code must also be selected. You can also add additional notes and edit provider/facility details.

Adding a procedure
1. To add a CPT code to the superbill, click Add procedure. Search for a procedure or select one from your list of frequently used and custom CPT codes. You may search by code or procedure description.


2. If you are unable to locate a particular code, you can create a custom code by clicking the blue Add custom code link at the end of the list of search results. Input the custom code and description, and click Save.

To add an existing custom CPT code to your bill, click into the Procedure field and beginning typing the procedure code. All custom codes will also be listed under the Custom codes sub-list.

3. You can add multiple CPT codes to a superbill simultaneously by continuing to search for and select additional codes. A notification will display in the top right corner, indicating how many procedures will be added to the superbill. Once you have selected the procedures, click Add. Alternatively, you can add each procedure separately using the Add procedure link each time.

Adding a diagnosis
You may associate up to 4 diagnoses per CPT code in the Practice Fusion superbill. While the official CMS 1500 claim form that your biller creates allows for 12 diagnoses to be documented *per claim*, only 4 diagnosis pointers can be associated *per CPT code*. To simplify and standardize the superbill process in Practice Fusion, we are limiting each CPT line to 4 diagnosis codes. Please note that the Practice Fusion superbill is not used as an electronic claim and can be adjusted to include diagnosis pointers and additional diagnoses after it has been submitted to your billing system for review.

1. To select a diagnosis, click Add a diagnosis below the selected procedure.

2. You can quickly select diagnoses from the patient’s encounter and diagnosis history by utilizing the Chart tab in the flyout pane on the left. In order for a diagnosis to display under the Encounter section, you must either add the diagnosis via the Assessment section of the encounter or add the diagnosis via the Diagnoses section of the encounter and check the Associate diagnosis with encounter box.

From within the flyout pane, you can also select a diagnosis from your customized My Dx list. Using our diagnosis search, you may also search for new diagnoses by:

  • ICD-9
  • ICD-10
  • Diagnosis description

3. Click into the Add new diagnosis search field to select a new diagnosis. As you begin typing, Practice Fusion will offer a list of potential diagnoses. Select the appropriate diagnosis from the dropdown menu.

If searching by ICD-9 code or description, selecting a diagnosis that maps to only one ICD-10 code will automatically add the diagnosis to the superbill. In some instances, an ICD-9 code may correspond to multiple ICD-10 codes and you will be prompted to select the specific ICD-10 code. Any diagnosis that maps to multiple ICD-10 codes and requires further refinement will display an orange alert. Use the Filter to narrow down the list of potential ICD-10 codes.


4. You can add multiple diagnoses to the procedure by continuing to search for and select additional codes. After adding all relevant diagnoses for the procedure (you can add up to four per CPT code), click Save. Once you’ve saved your diagnoses, you can reorder them within your superbill by clicking the 4 horizontal lines to the left of the diagnosis and dragging up or down. Diagnoses can also be deleted.

Editing patient, provider, and facility details and entering additional notes
The patient’s demographic information will auto-populate in the superbill. If you have edited any patient demographic information after creating your superbill, click the Refresh button to pull in the updated information.

Within the Other details portion of the superbill, you may review provider/facility information and enter any additional notes. Click Edit to update any fields.


Please be sure to follow the below directions before setting the bill to “Ready for Biller” if you have been integrated with Kareo before November 3rd, 2014. Please be sure that you’re selecting the provider’s name from under the “Billing System Providers” section within the Rendering Provider drop-down menu. Likewise, please also be sure to select from the “Billing System Facilities” menu from within the Seen at Facility drop-down menu. Both the “Billing System Provider and Facilities” lists are directly imported from your Kareo account. If you do need to add a provider or facility to appear on those lists, please do so within your Kareo account.

Completing a superbill
Once you have completed your superbill, you will have the option to select
Ready for Biller from the dropdown menu in the top-right corner of the bill. After the superbill has been successfully saved, it will automatically be sent to Kareo.


Reviewing superbills
You can view all your superbills in the
Reports section using the Billing Report. Use the dropdown at the top to filter results by Draft, Ready for biller, Archive, or Error. To make it easy to find a bill, you can search for a specific bill, or sort by any of the columns by clicking the header once to sort ascending and again for descending order.

Frequently Asked Questions

When appointments are scheduled in PF, will they transfer to Kareo automatically or do we need to enter into Kareo as well?
Currently, no. Appointments made in PF will not transfer over to your Kareo scheduler. However, we understand that this will provide a more streamlined experience and will be working on this.

Will Kareo function on other operating systems other than Windows?
Kareo requires a Windows operating system to run the application. It is possible to run Kareo on a Mac using additional virtualization software (i.e. Parallels or VMWare). For additional details please visit
Kareo's help forum.

Will Kareo create a new patient from a PF superbill if not already in the Kareo system?
Yes. There are a series of data points that Practice Fusion will look for first to make sure the patient doesn't already exist in Kareo. If no match is found, a new patient record is created in Kareo. If a patient is matched, Kareo will update the patient record with what is supplied in the superbill.

Will the superbill handle situations such as if insurance information doesn't match exactly?
The insurance policies are matched based on the policy number and the effective date. All policies sent in the superbill must match a patient case in Kareo. For example, if a superbill is sent with a primary and secondary policy and the patient case in Kareo only records the primary policy, this is not considered a match, even if the primary policy is a match. The patient case would need to contain both primary and secondary policies with the correct precedence ("Sequence" in the superbill response). If the patient case is not matching to one that already exists in Kareo, the integration will create the new insurance case based on the insurance information (sequence) in the superbill.

I only enter insurances through Kareo. If I keep doing this, can I attach the insurance in Kareo?
Correct. If you leave the insurance information empty in PF and do not send over any insurance data, Kareo will create the encounter with an empty patient case. It will be required for the user to go in and manually select a patient case in Kareo before they can approve the encounter.

Why do I see two lists (Billing system & EHR) under the rendering provider and facility dropdowns in the superbill?
If you are a legacy user of the Practice Fusion/Kareo interface, we specially enabled this functionality to mirror your previous workflow. When you see two lists in your dropdown, please select the from the
Billing system list.

Can I default Rendering Provider and Facility in the drop-downs of the superbill?
Yes, this may be something to consider if you are a solo physician practice. To enable the defaulting behavior, please:

  1. Go to Reports > Billing Report > Integrate Billing (button to the right of screen) > Select Kareo from list > Enter the information on the form > Submit
  2. Please do not proceed to step #3 until you receive confirmation that your Kareo integration request was processed
  3. Log into your Kareo PM > Settings > Options > Integration Options > Remove your Practice Fusion Identifier > Save

Note: if you follow above steps, you will lose the dropdown functionality for Referring Providers

Is billing provider required for the superbill?
“Billing provider” is not a required field in order for Kareo to accept the superbill into their system.

Can you add referring provider?
Yes, the superbill’s referring provider list should reflect the referring providers you have setup in Kareo.

Can you add authorization numbers on the superbill?
Yes, there is a field on the superbill for the authorization number. Please note that Kareo is not currently ingesting this information from the superbill, however, this may be something they choose to accept in the future.

How do I fix superbill errors in Practice Fusion (e.g. “We couldn't find a valid provider”)?
Please refer to our Kareo error help guide for troubleshooting instructions:
Kareo error message guide

Are there any reminders for an encounter that you have not submitted or created superbill for?  
Yes, as soon as an encounter SOAP note is created, a task will display in the
Tasks section of the EHR. The superbill-related tasks can be found by filtering Tasks to “Unsubmitted superbills.”

How do I know if the superbill successfully crossed over to Kareo?
If the superbill crossed over successfully to Kareo, that superbill should be in your
Archive report (Reports > Billing Report > Archive) and you should see the following message in the View History link: “S01 Kareo has received this Superbill.”

You can also find this superbill under Encounters > Draft in your Kareo PM.

Can a superbill be edited once it has been sent as Ready for Biller?
If a superbill was sent as Ready for Biller and was successfully received by Kareo (S01 message in the View History), the superbill should not be edited or resent. If you receive an error on the sent superbill, you absolutely can edit the superbill in Practice Fusion. You can find superbill errors under Reports > Billing Report > Error section, or you can see individual superbill errors in the superbill
View History link.

Can I edit an encounter in the Kareo PM?
Absolutely, all superbills that were sent from PF to Kareo successfully can be found and edited in the Kareo PM under Encounters > Drafts.


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