Billing Tags

This page provides an overview of the billing tags used in Retool, explaining when to use them and a summary of how they relate to billing. Retool billing tags are designed to categorize and track different types of transactions, ensuring accuracy in reporting, auditing, and client invoicing. Understanding these tags is essential for efficient financial management and maintaining consistency across our billing practices.

Each tag serves a specific function, allowing us to differentiate between various services, billing stages, and client types. By adhering to the tagging guidelines outlined in this document, you will help streamline our financial processes and support accurate, real-time billing insights.
  • CHARGING_OM
    - Original Medicare plans -> no supplemental or secondary insurance
    - 80% coverage
    - Ex. Medicare Part A, Medicare Part B

  • CHARGING_OMS
    - Original Medicare plans with a supplemental -> supplemental is not letter labelled/unknown
    - Typically 100% coverage, but won't know if supplemental picks up rest until Medicare bills them (after the session)
    - Ex. supplemental: Tricare for Life or AARP plan J (both full coverage)

  • CHARGING_OMSG
    - Original Medicare plans with a supplemental -> plan g
    - 100% coverage

  • CHARGING_OMSF
    - Original Medicare plans with a supplemental -> plan F
    - 100% coverage

  • CHARGING_OMSN
    - Original Medicare plans with a supplemental -> plan N
    - 100% coverage

  • CHARGING_OMSK
    - Original Medicare plans with a supplemental -> plan K
    - 50% coverage of coinsurance
    - Medicare still pays for 80% but the client will have to pay for 50% of the coinsurance (the remaining 20%)
    - The client owes half of the 20% coinsurance

  • CHARGING_OMSL
    - Original Medicare plans with a supplemental -> plan L
    - Plan L pays 75% coverage of the coinsurance that Medicare doesn't pay for
    - Medicare still pays for 80% but the client will have to pay for 25% of the coinsurance (the remaining 20%)
    - Example: A client has an Original Medicare (Part A and Part B) and they have a supplemental plan L - their coverage would be $7 per session with an LCSW and $9 per session with a Psychologist

  • CHARGING_CASHPAY
    - Client does not have insurance or has an insurance we are not in network with (An HMO plan that is not INN)
    - They would like to proceed with the CASH PAY
    - Initial Session (PSYC): $179
    - Initial Session (LCSW): $134
    - See rates: Rate Sheet

  • CHARGING_INN
    - Medicare Advantage HMO plans or PPO plans with only INN coverage
    - This client may only book with a provider that is IN NETWORK
    - Insurance plans include but are not limited to:
    • United Healthcare
    • Cigna
    • Aetna
    • Blue Cross Blue Shield (Interstate vs. Intrastate)

  • CHARGING_INNQMB
    - Medicare Advantage HMO plan with a Qualified Medicare Beneficiary (QMB)
    - Please ask the client for their Medicaid ID number and put on file.
    - They may NEVER be charged a cash pay for anything (no credit card on file)
    - This client must be booked with a provider that is IN NETWORK
    - ONLY BOOK IF THEY HAVE:
    • United Healthcare
    • Cigna
    • Aetna
    • Blue Cross Blue Shield (Interstate vs. Intrastate)


  • CHARGING_MA
    - Medicare Advantage PPO plans
    - This client may be booked with an in-network or out-of-network provider
    - This is any Medicare Advantage plan labelled as a PPO
    - If booking with an OON provider, look at OON coinsurance or copay
    - If booking with an INN provider, look at INN coinsurance or copay

  • CHARGING_MAQMB
    - Medicare Advantage PPO plan with a Qualified Medicare Beneficiary (QMB)
    - These are clients with a Medicaid that we require on file
    - They may NEVER be charged a cash pay for anything (no credit card on file)
    - This client may be booked with INN or OON provider

  • CHARGING_OMQMB
    - Original Medicare plan with a Qualified Medicare Beneficiary (QMB)
    - We require secondary insurance on file (Medicaid)
    - 100% covered
    - No credit card required on file

  • CHARGING_SCAN
    - These are clients with a SCAN insurance
    - Only live in California
    - 100% coverage no matter the results on retool
    - Must be booked with a SCAN provider licensed in CA

  • Disqualified
    This tag should be used in two different situations:
    1.     If we have a ZocDoc client that has insurance that we will not be able to accept or we are unable to contact them and have to cancel their initial session.
    2. If we have an existing client that has switched insurances to a plan that we do not accept and have to cancel their upcoming sessions.