Automatically Adding Charges to Draft Invoices
The Auto-charge option helps practices reduce manual billing steps by automatically adding eligible charges to a patient’s open draft invoice.
When enabled, SigmaMD handles where charges go based on the patient’s membership and existing invoices. When disabled, billing works exactly as it does today, with charges added manually.
This article explains how Auto-charge works, what happens when it’s disabled, and how you can adjust invoices before charging the patient.
Where to find the Auto-charge setting
Auto-charge is available in Billing Settings.
- Go to Billing → Settings.
- Under Retail Charge Items Invoicing, toggle Invoice automatically.
This setting applies at the practice level.
How Auto-charge works
When Auto-charge is enabled, SigmaMD automatically adds charge items to a draft invoice when any of the following actions happen:
- A lab or imaging order marked as Pay in clinic is created.
- A medication is dispensed.
- A vaccine is administered.
Charges are added following the workflow below.
How SigmaMD selects the invoice
When an eligible charge is created, SigmaMD checks:
- Is the patient associated with a membership? (Including non-paying dependents)
- If Yes: Charges will be added to the membership draft invoice
- If No: Does the patient already have an open draft invoice?
- If Yes: If multiple invoices exist, the nearest due invoice is selected
- If No: SigmaMD creates a new invoice.
By default a charge is added to a draft invoice rather than issued. Some charges can also be issued on their own invoice right away — see When a charge gets its own invoice below.
Changing the invoice before charging
Even with Auto-charge enabled, you stay in control.
While the invoice is still a draft, the final step of the ordering or dispensing flow includes a Change invoice option.
From there, you can:
- Move the charge to another existing draft invoice.
- Create a new draft invoice (for example, end-of-day billing instead of a membership invoice).
This makes it easy to adjust billing without removing and re-adding charges.
When charges are actually billed
Unless one of the immediate-issue conditions applies, Auto-charge only adds items to draft invoices.
To charge the patient:
- The invoice must be reviewed and issued.
- Issuing the invoice is what triggers payment using the patient’s payment method.
Until the invoice is issued, no payment is collected.
When a charge gets its own invoice
Some charges should not wait on a draft until the billing cycle closes. Under Immediately issue a separate invoice when: you can have SigmaMD issue a separate invoice right away when:
- The membership cycle isn’t monthly — a quarterly or annual patient does not wait months for the charge.
- Any charge item has employer coverage — employer-covered charges stay on their own document.
- Total charge amount is above an amount you set.
Each condition works on its own — meeting any one of them is enough. The conditions are only shown while Invoice automatically is on.
When a charge cannot be issued immediately
If the invoice cannot be issued at that moment, the charge is not lost. You will see Unable to issue invoice immediately, and the charge is added to the next draft invoice instead — the same place it would have gone without the rule.
What happens when Auto-charge is disabled
When Auto-charge is turned off, SigmaMD keeps the current behavior:
- Lab, imaging, and medication charges are not added automatically.
- Charges must be manually added to an invoice. See here how to do it.
This option is ideal for practices that prefer full manual control over billing.