Key takeaways
- Direct billing means the clinic submits the claim to the insurer and gets paid directly, leaving the patient responsible only for the balance.
- Most major Canadian extended health carriers are reachable through TELUS Health eClaims, while BC dental claims run through CDAnet and ITRANS.
- Verify coverage before treatment, collect the patient's balance at the desk, and reconcile claims weekly so rejections get fixed while the visit is fresh.
- Pet insurance direct billing usually requires pre-approval before treatment, so vet clinics should budget for a cash-flow gap.
- Solo practitioners can start with patient-pay-then-reimburse using only detailed receipts, and switch to direct billing when patients ask for it at the desk.
Direct billing to insurance means your clinic submits a claim to the patient's insurer and gets paid directly, so the patient only covers the balance. To offer it, you need an insurer or clearinghouse agreement, a claims workflow your front desk can run, and software that handles submissions and receipts. This guide walks through those steps for health, dental, and pet insurance, plus what it costs in software.
What is direct billing in health insurance?
Direct billing to insurance means your clinic submits the claim to the patient's insurer and gets paid directly, so the patient only owes you their portion (co-pay or uncovered balance). With patient-submitted claims, you collect full payment up front, hand over a receipt, and the patient chases reimbursement themselves.
Direct billing vs patient reimbursement
The operational difference is who does the paperwork and who carries the risk. Direct billing requires your software to transmit claims to each carrier, handle responses, and reconcile shortfalls. Patient reimbursement needs nothing more than a detailed receipt, which is why many small clinics start there.
Most major Canadian carriers are reachable through a clearinghouse: TELUS Health eClaims supports a range of carriers and health professions for electronic submission (TELUS Health eClaims provider documentation). If your current tool charges per seat for that capability, weigh it against a flat plan like BookNavio, which includes every feature in every seat.
How does direct billing work insurance step by step?
Step 1: verify coverage before the appointment
Run an eligibility check before the patient arrives: policy number, plan details, remaining coverage for the discipline. If the plan excludes RMT or caps physio at $500 a year, you want to know before the treatment, not after the claim bounces.
Step 2: capture the claim at point of sale
Chart the treatment, attach the right service codes and diagnosis codes, and submit from your charting screen. If intake forms are digital, the policy details are already in the patient record, so the claim takes seconds. Software priced per seat punishes you here: front-desk staff who only submit claims still count as a seat, which is why our ClinicSense comparison prices those logins at $0.
Step 3: adjudication and the balance
The insurer's system adjudicates the claim in seconds and returns an approved amount, a partial payment, or a rejection with a reason code. Whatever the insurer pays, the remainder belongs to you, not the patient's imagination. Collect the balance on the spot by card or e-Transfer, state it plainly ("approved $60, owing $25"), and record the rejection reason if the claim fails, because a missing referral or exhausted coverage is fixable at the desk while the patient is still standing there. A rejection you discover next Tuesday is a receivable you may never collect.
Step 4: reconciliation and receipts
Match each insurer payment to its claim, log the patient portion as paid, and issue an insurance receipt showing what was billed and what was covered. Reconcile weekly, not monthly, so rejected claims get resubmitted while the visit is fresh.
What does direct insurance billing for a dentist require?
Dentistry is the one discipline where direct billing to insurance is standard, and the plumbing is different from what a physio or RMT clinic uses. Canadian dental claims go through CDAnet, the electronic claim standard run by the Canadian Dental Association, which transmits to carriers through the ITRANS network rather than a generic payer portal. Operationally you need three things: enrolment as a provider with each carrier you want to bill, a practice-management system that produces CDAnet-format claims, and a reconciliation habit for the remittance advices carriers send back. Carrier rules vary; for example, Pacific Blue Cross documents its provider enrolment and direct-billing process for extended health in its provider resources. If you are a multidisciplinary clinic rather than a dental office, note honestly that most wellness-focused booking tools, including BookNavio, are built around extended health and paramedical claims, not CDAnet dental submissions.
How does pet insurance direct billing differ from human claims?
Pet insurance direct billing runs through veterinary clinics, not wellness practitioners, and the workflow is different in one big way: most carriers require pre-approval before treatment starts. You submit the treatment plan and estimated cost to the insurer, wait for a decision, then collect the client's share at checkout. Human claims, by contrast, are adjudicated after the appointment.
Pre-approval vs instant adjudication
Most pet insurance carriers do not offer real-time adjudication the way extended health insurers do for physio or RMT claims. That means the vet clinic often fronts the full invoice, bills the carrier, and waits days or weeks for reimbursement. If your clinic also treats animals, budget for that cash-flow gap.
The software implications differ too. Practice tools built for pet care handle pre-approval requests and claim status tracking alongside SOAP-style medical notes, which is a different workflow from human direct billing (https://www.booknavio.ca/features/).
Honest limitation: BookNavio is built for human clinics, so we do not support pet carrier pre-approval workflows today.
What is PBAS insurance direct billing and who uses it?
PBAS refers to Pacific Blue Cross, the BC carrier whose provider portal lets physio, RMT and chiro clinics submit claims on a patient's behalf and get paid directly. Clinics in BC on Pacific Blue Cross plans use it; clinics elsewhere submit through carrier portals instead.
Carrier portals Canadian clinics actually use
Two names cover most submissions: TELUS eClaims, which routes claims to participating carriers in one login, and Teleplan, BC's provincial portal for MSP and supplementary benefit claims. Dentists submit through CDAnet, the standard that carries claim data from your practice software to insurers, documented by the Canadian Dental Association.
| Portal | Who submits | Typical users |
|---|---|---|
| TELUS eClaims | Participating carriers | Physio, RMT, chiro |
| Teleplan | MSP and BC carriers | BC clinics |
| CDAnet | Dental insurers | Dentists |
Your software needs to export claim-ready data for whichever portal applies. BookNavio supports direct billing workflows in every seat at $49.99/month with 0% commission, and we compare how that stacks up against per-practitioner pricing on our Jane App comparison page.
Can small clinics offer direct billing without an insurer contract?
Yes, but you start with the simpler version: the patient pays, you hand them an insurance receipt, and their insurer reimburses them. No contract, no portal, no clearinghouse fees. Most solo practitioners and small clinics run this way for years.
The middle option is partial direct billing for insurers that accept it without a formal agreement, where you submit the claim and the patient covers only the balance. That works for some plans but not others, so front desk staff need to check coverage before each visit.
The honest trade-off: patient-pay-then-reimburse means you carry no claim admin, but patients who cannot float the cost may skip appointments. If your book is mostly extended-benefit plans, receipts are usually enough. If your patients ask for direct billing at the desk, that is the signal to look at a contract or a software add-on.
What should patients be told when you bill insurance directly?
Tell patients up front that direct billing is a convenience, not a coverage guarantee. The claim can be declined for reasons outside your control: plan limits reached, the service not covered, or the insurer flagging the submission. Make it clear the patient is responsible for any balance the insurer does not pay, and collect a card on file or a signed agreement before the appointment so the balance conversation is not a surprise at the desk.
The clearest example of why this matters is pet insurance: Trupanion's documentation on direct vet billing explains that pre-approval checks eligibility before treatment, and that the clinic still needs to handle any portion the policy excludes (https://www.trupanion.com). The same logic applies to your physio or RMT claims. Say plainly what was submitted, what was paid, and what the patient owes, and keep those notes in the chart alongside your SOAP notes.
What does direct billing cost you in software and add-ons?
Most per-seat platforms treat insurance billing as a paid extra. Jane App and ClinicSense both price per practitioner, and features like insurance billing or scribes can stack on top of the base fee. With 5 to 8 practitioners, those line items compound monthly, and a front-desk staffer who only checks the schedule still counts as a seat on some plans.
Flat-fee alternatives change the math. BookNavio charges $49.99/month for the first seat with every feature included and 0% commission, so insurance receipts and direct billing workflows are not an add-on tier. On the site's own comparison, that lands roughly 35% below Jane App and ClinicSense on average for 1 to 10 full-time practitioners, and the pricing calculator only charges for staff who actually log in.
Running the same criteria against BookNavio
By the standards this article set, BookNavio is honest about its gaps. It is newer than Jane App, so it has a smaller community of charting templates and fewer third-party integrations. Assisted data migration covers the switch, but if your clinic depends on a specific integration BookNavio has not built yet, the flat fee will not fix that. Check that list before you move.
FAQ
Which Canadian insurers can I direct bill as an RMT or physiotherapist?
Most major extended health carriers are reachable through a clearinghouse rather than one at a time. TELUS Health eClaims routes claims to participating carriers in a single login, and BC clinics on Pacific Blue Cross plans can use that carrier's provider portal directly. Verify the patient's plan covers your discipline before treating, since coverage caps and exclusions are the most common reason claims bounce.
Can I do direct billing to insurance with Cliniko or Jane App?
Both platforms price per practitioner, and insurance billing capabilities can sit on a paid tier above the base fee, so a front-desk login may still count as a seat. BookNavio takes a different approach: $49.99/month for the first seat with every feature included and 0% commission, so direct billing workflows are not an add-on. Check each tool's current pricing page before committing.
What happens when a direct billing claim is declined after the appointment?
The insurer returns a rejection with a reason code, and the balance becomes the patient's responsibility. That is why you collect a card on file or signed agreement before the visit. Common causes, like a missing referral or exhausted coverage, are fixable at the desk while the patient is still there, which is why weekly reconciliation beats monthly.
Is direct billing worth it for a solo practitioner?
Often not at first. Patient-pay-then-reimburse needs nothing but a detailed receipt, carries no claim admin, and requires no insurer contract, which is why many solo practitioners run that way for years. The signal to switch is patients asking for direct billing at the desk, or bookings dropping because clients cannot float the cost up front.