Clinician tool

Superbill generator

A fillable, printable superbill for clients seeking out-of-network reimbursement — provider and NPI details, diagnosis and service codes, per-line and balance-due totals that calculate as you type.

Stays on this device. Everything you enter here is saved only in this browser (IndexedDB) and is never sent to Meridian or any server — it works offline. Because entries can include client information, use a private, encrypted device, and clear or export to your EHR when you're done. This is a scratchpad, not the medical record of truth.

AI-assisted — clinician review required.Prompts, checklists, and any suggested language here are a scaffold, not clinical advice. Confirm accuracy, apply your professional judgment, and follow your agency's policies and NH statute before anything enters the record.

Superbill

Statement for insurance reimbursement

NPITax ID / EINLicense #Date

Client

Insurance

Give this superbill to the client to submit for out-of-network reimbursement, or attach to a CMS-1500.

Diagnoses (ICD-10)

Services rendered

Date	POS	CPT	Mod	Dx	Units	Fee	Total
							$0.00

Total charges$0.00

Amount paid$

Balance due$0.00

Provider signature & date

This superbill certifies that the services listed were rendered as described. It is provided for the client to seek reimbursement from their insurer and is not a bill for services already paid. Confirm NPI, Tax ID, CPT, and ICD-10 accuracy before issuing.

Pairs well with

CPT / ICD-10 quick referenceConfirm the service and diagnosis codes before you bill.

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