Creating Invoices

Creating Invoices

zHealth allows an easy way to create an invoice for patients visiting for the first time or for follow-up visits. Multiple providers under the same account who wish to create an invoice must be assigned the system administrator role to create an invoice.

A. Creating an Invoice for the First Visit

1. Log in to Patient's Chart. There are three ways to access the Invoice tab:

a. By editing the "Note" that has been created for the patient being checked. The "Edit" button will be there only if the provider has not signed the Note.

b. From the "Patient Billing" tab.

c. From the Billing Center. Hover the cursor over your name on the top right corner. Click "Billing Center" from the drop-down. 

2a. If you "Edit" the Note, it will open the SOAP note. Browse through the options on the left side and click on the ‘Invoice’ option.

2b. If you click "Patient Billing", you will see the Invoice created for the first visit. Click on the "Invoice" button.

2c. If you want to access it through the Billing Center, search for the patient name. Once you find the invoice created for the patient, click on the "Invoice" button as shown here.

Once you click the "Invoice" button, the Invoice window will open. The Invoice page consists of the Diagnosis code, CPT code, Supplement Code, and Misc Items.

4. Add Diagnosis Codes
a. Under the Diagnosis section, just enter the first few letters of the diagnosis description and the system will auto-populate all results. For instance, just type 's' or ‘sub’ for subluxation and our software will auto-generate all ICD-10 codes for different subluxations. 
Note: Any 'inactive' ICD-10 codes (for example: M54.5) will be shown in red in color and have
| inactive" written after the code.
Tip: Set up diagnosis code favorites to manage code entry when creating a new invoice.
4b. Select the code relevant to the patient’s condition and then click ‘Add’ to enter the code.
4c. To add more diagnosis procedures, repeat the above step as necessary.
4d. Once all diagnosis codes have been added, review the Diagnosis section and make any necessary changes.
Note: If you're creating an invoice for subsequent visits, you can import previous diagnoses codes into the current invoice. To bring in the previous diagnosis codes, simply click on the "Import Previous" button. For instance, if you've previously added 12 diagnosis codes to a prior invoice, clicking "Import Previous" will transfer all of these codes into the current invoice you're working on.

5a. Selecting the most specific codes relevant to the patient’s diagnosis and putting them in the right order is crucial for correct invoice creation. When you report additional diagnosis codes, you need to determine their proper order and rearrange the list of ICD-10 codes accordingly. To reorder the procedure lines in the list:

5b. Click the ‘
Four Arrows’ icon and drag the procedure code up and down as needed.

5c. To remove a procedure code, click the ‘
Delete’ icon.

6. Add CPT Code

a. Under the CPT Code section, just enter the first few letters or numbers of any CPT code and the system will auto-populate the results for you. Select the right CPT code relevant to the service rendered to the patient.
b. Enter DOS from
c. DOS to
d. POS, Units and *UOM
e. Diagnosis Pointer
f. UOM*
g. Charges

To remove a CPT code, click the ‘Delete’ icon.
 and click the ‘
+’ icon to enter the code. Then hit the ‘Save’ icon. To remove a CPT code, click the ‘Delete’ icon.
To add more 
CPT codes for the given patient visit, repeat the above two steps as necessary.

Once all CPT codes have been added, review the CPT Code section and make any necessary changes.

Tip: Set up CPT code favorites to manage code entry when creating a new invoice.

*Note: UOM means Units of Measure and Codes. UOM defines how much and in what unit the quantity is expected. zHealth lists the following UOMs:

UN = Unit
F2 = International Unit
MJ = Minutes

7. If you sell any supplements to patients, you can charge them and add the charges to the invoice. Click here to find out  how to add a supplement code to the invoice.

8. Add Misc Items and Supplements
a. Providers selling supplements can add items under the Supplements section.

Providers selling additional supplies or non-billable services can add items/services under the Misc Items section.

9. Enter Invoice Payments
At the bottom of the page, you will find the Invoice Payments option. There are three modes of Invoice Payments:
Payment paid by the patient through zHealth Pay* - Enter the Amount Paid, Adjustment Amount, Paid By, Payment Type as zHealth Pay/Terminal, and click "Add". 
Payment paid by the Insurance** - Enter the Amount Paid, Adjustment Amount, Paid By as Insurance, Payment Type, and click "Add".
Payment paid by the patient through credit card, debit card, check, cash, gift card, or EFT - Enter the Amount Paid, Adjustment Amount, Paid By, Payment Type as Cash/Check***/Credit/Debit/EFT/Gift Card***, and click "Add".

***Note: In case of Gift Card Payment or Check Payment, you can enter any Note related to the Gift Card or Check Number.

*Note: If the patient co-pay has been paid via zHealthPay, you will be able to see the Payment Type as ZH-PAY along with the Transaction ID in brackets. You can look up this Transaction ID using the zHealthPay Advanced Transaction Search Report to get more details about the transaction made, such as transaction date, funding date, name and last 4 digits of the person for this transaction.

Our system will show a warning message - "You are attempting to apply for a payment that exceeds the balance of this invoice. Any amount greater than the balance will be applied to the patients credit. Would you like to continue?" - if you try add payment to the invoice that has no CPT codes in it. Check the second image on the right side for your reference.

**Note: If you select 'Paid By' as Insurance in the invoice payment, our system will show an alert (as a pop-up window) to make sure if you want to use insurance for the payment rather than using EOB/ERA interface to post payment.

If you click "Yes", the system will add the amount paid and adjustment under the name of the insurance in the Invoice Payment section. b. If you click "No", the pop-up window will close and you can continue to add the amount paid by the patient in the Invoice Payment section.

11. Change Dates

Before you learn how to make changes to the dates in the invoice tab, you need to know what are the different dates mentioned in our invoice. This is important as the Health Insurance Claim Form (HCFA) requires billers to provide the Date(s) of Service. 




Date of Injury

This is the exact date when the injury, incident or exposure happened with the patient.

Initial Treatment Date

This is populated once the first CPT code (charge) is added to an invoice. Once the initial treatment date has been entered (or first CPT code filled out), it SALTs over each time from there.

Acute Manifestation Date

 Acute Manifestation Date is required when CPT code is 98940, 98941, 98942, 98943, and CR2-08 (HCFA Box 10d) is "A" or "M" (RC183).

Accident Date

This is the exact date when the accident happened with the patient. This date is required in HCFA Box 15 (with qualifier 439) or the Additional Fields section when HCFA Box 10b is marked as ‘Yes'.


Check out our guide on HCFA form to know how these dates populate in the HCFA form.

Now let’s see how to make changes to the dates section while creating an invoice for first-visits.

12. Make Changes to Dates or Add Comments

On the invoice window, you will see Internal 
Comments and Dates

a. In the 
Internal Comments section, add any comment for the provider, staff, or biller.
b. Change the Visit Date if necessary.
c. You can change the dates of injury, accident, or acute manifestation if necessary.

Please note that our software (by default) pulls the Initial Treatment Date from the date of the appointment on the schedule.

However, when a new patient comes in, the initial treatment date on the invoice will be blank. 
The invoice will populate with the Date of the CPT Code or DOS (Date of Service). 

The Initial Treatment Date SALTs over each time from there, but it needs to be checked/corrected if you are adding CPTs on a day other than the initial visit.

Note: You can click "Import Dates" to import dates of injury, accident, or acute manifestation used in the previous invoice. To clear all dates, click "Clear Dates". However, Initial Treatment Date will not be deleted even after you click "Clear Date".

13. Click on Recalculate and Save. The new invoice dates will be saved on the invoice.

14a. Click on the blue "Print"  button to print the Invoice if you need to send it for Paper Claim Submission. Or print the invoice if you need to give a copy to the patient.
b. Click "Email" to send the invoice to the patient's registered email address.

15. Keep the Invoice Status as ‘Open’ if you want to send the invoice for claim submission. You can choose ‘Closed’ status when the invoice claim has already been sent to the clearinghouse.
Note: If you're a zHealth Pay user and the Invoice Status is "Open", you can see the Email and Text buttons right above the Invoice Status box. You can send the invoice via email or text it to the patient.

16. The patient’s invoice is now ready. You can submit the claim immediately after creating an invoice. Click the "Submit Claim" button on the left side of the screen.

17. Once the insurance payer sends an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of this claim, you can post the ERA or EOB right from the Invoice screen by:
a. Clicking the EOB button
b. Clicking the ERA button

B. Creating an Invoice for Follow-up Visits

1. To access the Invoice, you can either Edit the Note created for the patient for the follow-up visit or go to Patient Billing tab and click the Invoice.

You can even access the Invoice from the Billing Center as explained in the first and second steps of the "Creating Invoice for First-Time Visits".

2. Once you're on the Invoice window, you will see the "Diagnoses Codes/ICD-10 codes" have been carry forward from the previous invoice.

You can keep the diagnoses codes or change them based on the patient's current condition and treatment provided. To add more diagnoses codes, type the first few letters or numbers of the code and select the suitable one from the auto-populated results. Click "Add"

3. To import CPT codes from the previous Invoice, click the "Import Previous" button in the CPT code section.

If you want to add more CPT codes, search for the code in the search box and click "+".

4a. Next, you may want to add Supplements. Enter the supplement name and click add.

4b. Again, you can import Miscellaneous Items from previous Invoice. To add that, click "Import Previous" under the 
Miscellaneous Items section. You can add more by typing the name of the item and clicking "Add"

5. Next, go ahead and add the Invoice Payments from the patient. 

Note: Once you submit the claim to the insurance company and receive the payment from the insurer, you can add payment from the Insurance here.

6a. Check the Date of Injury, Initial Treatment Date, Acute Manifestation Date, and Accident Date. Change them if required. Then, click "Recalculate and Save".

6b. Now, you can submit the claim by clicking "Submit Claim" button on the left side.

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