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Session Details: How to Document a Session Efficiently

  • Updated

The Session Details page brings everything needed to complete documentation into one view. After a session, you can record the appointment details and progress notes with easy access to appointment and client context, billing details, diagnoses, and past notes. The layout emphasizes clarity and fewer steps.

Documenting a Session

After a session, open the Session Details page. Select if the session took place. From the Session Overview section, select View Appointment to review details about the appointment without leaving the page. This is useful for confirming time, type, or other logistics while you document. 

Helpful details about your client are visible in the right sidebar. This includes the client’s access type, the referral source, active dates, and recent assessments scores with month-over-month changes.

Billing

In the Billing section, you’ll see the primary coverage listed for the session. When billing on Tava, the CPT code, rate category, and an estimated payout will be automatically updated for your reference. For more detail about the client’s coverage method, choose View Details for full context without leaving the page. 

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When Billing Elsewhere, an estimated payout will not be shown. 

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Documenting

Enter the appropriate diagnoses. Each diagnosis is clearly marked as either primary or secondary.

Generate your note using Tava Scribe, or compose your own progress note. If you need context from prior visits, you can flip through the Past Progress Notes panel for reference.

Submission

When finished, submit your note. After submission, you have the ability to edit your session note before a claim is submitted for the session (72 hours after insurance sessions), or before the payout deadline for non-insurance sessions billed through Tava. After this deadline, details such as duration, date, diagnoses, coverage, and CPT code are locked. Contact therapist-support@tavahealth.com if you need to edit the Progress Note.

If the session did not occur, set “Did the session happen?” to No.

FAQs

  • Can providers edit the CPT code? No. The CPT code is assigned automatically when billing through Tava.
  • Can providers change the coverage for the session directly from the Session Details page? No. Providers can review coverage by clicking View Details for more information, but cannot switch coverage in this view.
  • Can providers edit a note after it’s been locked (past the billing deadline)? Providers may contact therapist-support@tavahealth.com to edit the Progress Note. Other session details (duration, date, diagnoses, coverage, CPT code) cannot be edited.