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The Policies page is where all payer information for a patient is entered and managed. Every date of service requires an active policy covering that date before a clinical document can be completed and charges submitted. This includes commercial insurance, Medicare, Medicaid, workers comp, liability, attorney cases, self-pay, and financial arrangements. Navigate to the Policies page from within a patient’s case: Patient Menu Bar > Patient Info > Policies.
Access: All staff can view the Policies page.

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Adding a Policy

Complete patient demographics first. The Add a new policy or payer button does not appear until the patient’s last name, first name, date of birth, gender, and treating therapist have been entered. Complete the patient’s demographic information before attempting to add a policy.
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Ready to add a policy? See the step-by-step Add a Policy guide.

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Self-Pay vs. Insurance Billing Rate

Every case in StrataEMR begins as a self-pay case. When a non-self-pay insurance policy is added, the case permanently switches to insurance-rate billing. This distinction matters because it determines how StrataPT invoices the practice for reimbursements collected each month — self-pay cases and insurance-rate cases are billed at different rates. StrataEMR makes the current billing rate visible in two ways on this page: Case header badge: A badge at the top of the case displays whether it is currently a self-pay or insurance-rate case. This is visible to all staff. Billing rate alert (Practice Admins and Business Owners only): Users with a Practice Admin or Business Owner role see an alert on the Policies page that explains the case’s current billing rate and how StrataPT will invoice the practice for reimbursements collected on this case. There is a separate version for self-pay cases and for insurance-rate cases.
If you are unsure which policy type to use, check with your Practice Admin or StrataPT Customer Success team before adding a policy. Switching a case from self-pay to insurance rate is not reversible from the Policies page. See Add a Policy for guidance on what to do instead.

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Payer Types

The payer type you select determines how StrataEMR handles billing — it controls claim submission format, billing order, and how patient responsibility is calculated.

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Medical Policies

Standard commercial and government insurance — Blue Cross Blue Shield, Aetna, UnitedHealthcare, Medicare, Medicaid, and others. Enter the subscriber ID, policy start and end dates, and upload the insurance card. Policy start and end dates matter for charge submission. If a patient’s policy has a start date of June 1 and you need to complete documentation for a May date of service, StrataEMR will not allow document completion until a valid policy covering that date is present. Correct the start date or add an appropriate policy to cover the gap. If a patient has multiple active policies, the order they appear on the Policies page determines billing priority. StrataEMR bills them in order — primary first, then secondary, then tertiary. Contact your Customer Success team through the Get Help area if you need help changing the policy order.

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Medicare Policies: Replacement Plans and Dual Eligible

Two Medicare-specific configurations come up frequently when loading policies, and they’re easy to confuse. Using the wrong setup affects how StrataEMR routes and formats the claim.
If a patient’s insurance is a Medicare Advantage plan, enter the policy as Medical (Primary). When the New Policy form opens, locate the Is this a Medicare Replacement Plan? field and select Yes. This tells StrataEMR to bill the Advantage plan directly and formats the claim accordingly. Medicare Advantage plans can also be referred to as Advantage plans. Medicare Supplement plans are different and should be entered as Medical (Secondary), not flagged as a replacement plan. Because Medicare Advantage cards look like standard commercial insurance cards, they’re easy to misidentify — when in doubt, confirm with the patient or look for a Medicare contract or plan name on the card.
Dual eligible patients have both Medicare and Medicaid coverage, processed by the same payer.Enter the policy as Medical (Primary) and navigate to the Benefits tab. Set the Dual Eligible Plan field to Yes. StrataEMR will automatically generate the Medicaid secondary — do not manually add a second policy.If the Medicare payer does not process the Medicaid portion, enter the primary policy as Medical (Primary) and set Is this a Medicare Replacement Plan? to Yes. Then load the Medicaid processor separately as Medical (Secondary).
ScenarioPolicy Setup
Patient has a Medicare Advantage planMedical (Primary) → set Is this a Medicare Replacement Plan? to Yes
Patient is dual eligible; payer processes both Medicare and MedicaidMedical (Primary) → set Dual Eligible Plan to Yes on Benefits tab; system auto-generates secondary
Patient is dual eligible; Medicare payer does not process MedicaidMedical (Primary) → set Is this a Medicare Replacement Plan? to Yes; load Medicaid processor as Medical (Secondary)
Patient has traditional Medicare onlyMedical (Primary), no additional fields needed

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Workers Comp

Workers comp cases require a date of injury in addition to standard policy fields. Workers comp notes also typically require time in/out on each visit. Confirm your state and payer requirements with your account manager when setting up a new workers comp case.

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Liability / Auto

Used for auto accident and general liability cases. Claims are sent with clinical documentation automatically. In many liability cases, a patient will also have a commercial backup policy to cover treatment if liability benefits are exhausted — add this as Medical (Primary Backup).

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Attorney

Use Attorney when the attorney is the sole responsible party. Use Attorney (After Medical/Liability) when the attorney should only be billed after other payers have processed first. For example, a patient with Allstate auto insurance and a BCBS commercial backup who also has an attorney would be entered as:
  1. Liability / Auto — Allstate
  2. Medical (Primary Backup) — BCBS
  3. Attorney (After Medical/Liability) — Attorney name

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Self-Pay

Self-pay can be configured with a flat rate per visit or a rate per billing charge. The amount to collect displays automatically on collection tasks based on the rate entered. Self-pay is appropriate for patients with no insurance who are receiving standard PT services billed through CPT codes. For cash services that fall outside CPT billing, such as wellness visits or massage, use Point of Sale charges instead.
Self-Pay is not the same as Financial Arrangement. Self-pay is used when the patient has no insurance and is paying the full rate. Financial Arrangement is used when an insured patient has a negotiated reduced rate applied after their insurance processes. Do not use Self-Pay as a workaround for cash-pay patients who have insurance — this will affect how claims are submitted.

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Financial Arrangement

A financial arrangement is a negotiated rate that gets applied to the patient’s balance after all other policies have processed. It is not billed directly — it caps how much the patient owes out of pocket on dates of service covered by the arrangement. Common use cases include:
  • Patients with high deductibles or high co-insurance who have financial hardship
  • Patients where the practice has agreed to a flat rate regardless of insurance outcome
  • Cases where the practice wants to ensure a patient is never billed more than a set amount
For example: A patient’s insurance processes a date of service and leaves $100 in patient responsibility. The practice has a financial arrangement for $50 per visit. StrataEMR automatically adjusts the patient balance to $50 — the statement will never reflect the higher amount. Financial arrangements can also be set to No Responsibility / Settle Balances if the practice does not want the patient invoiced at all. StrataEMR runs a nightly process to apply adjustments — balance changes from a newly entered arrangement will not appear until the following day.
Financial arrangements supersede flat rates. If both a flat rate and a financial arrangement are in place, the financial arrangement takes precedence. Coordinate with your StrataPT Customer Success team when setting these up to ensure the configuration is correct.
The Policies page also displays the StrataPT Recommended Amount — the per-visit collection amount calculated from the patient’s benefit verification. This value is set by StrataPT based on the patient’s copay, co-insurance, or deductible status, and updates automatically as claims process. If a financial arrangement is in place, the recommended amount is automatically adjusted so the collection task never prompts for more than the agreed arrangement amount. If your practice prefers to collect a different amount, enter it in the Your Preferred Amount field on the Policies page. This value takes precedence over the StrataPT recommended amount for all future collection tasks.

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Policy Start and End Dates

Every policy must have a start date that covers the dates of service being treated. If a policy end date has passed or a start date is in the future relative to a date of service, StrataEMR will prevent document completion for that date. If a gap exists in a patient’s coverage history, the appropriate policy or a self-pay arrangement must be added to cover that date range before the document can be completed and charges submitted.