2026 comparison
TherapyNotes is Established US EHR for mental and behavioral health. Strong on insurance billing and electronic claims; conservative on UI and AI features. SignalEHR is the AI-first clinical intelligence + practice management platform — $199/practitioner/month, all-inclusive, dual-country (US + Canada), with Amelia AI receptionist and real-time emotion analysis built in.
Best for: Therapists who want one platform that handles AI clinical notes, dropout prediction, AI receptionist, full practice management, and dual-country insurance billing — at $199/practitioner/month all-inclusive.
Trade-off: Newer to market than incumbents; native mobile apps still in development.
Best for: Established US practices that prioritize stability, deep insurance-claim tooling, and a familiar interface over modern UX. Especially common at group practices already running TherapyNotes for years.
Trade-off: TherapyNotes' UI hasn't substantially changed in years — therapists who tried it after using Notion or modern SaaS tools often describe it as 'powerful but dated'. AI features are limited to a paid Therapeutic Notes add-on with no emotion analysis, no dropout prediction, and no AI receptionist. No Canadian insurance support.
Pricing: Solo: $59/practitioner/month. Group practices: $59 for the first clinician + $30/month each additional. Telehealth, electronic claims, and patient portal included. AI scribe (Therapeutic Notes) is an additional charge.
| Capability | Signal | TherapyNotes |
|---|---|---|
| Real-time voice emotion analysis | Yes — sub-200ms latency, per-speaker, mapped to clinical indices. | No. |
| AI clinical notes | 8 formats (SOAP/DAP/BIRP/GIRP/PIRP/SIRP/PIE/custom), modality-aware, included. | Therapeutic Notes AI add-on — transcription + format, no clinical-index mapping. |
| AI receptionist (chat + phone) | Amelia — web chat + SMS included; phone $99.99/mo per clinic. | No. |
| Dropout / no-show prediction | 8-factor model with per-session updates and intervention suggestions. | Basic reminders only. |
| Insurance billing (US) | Unlimited claims via Stedi, 3,400+ payers, ERA/835 auto-posting. | Yes — built-in electronic claims, ERA posting. Mature tooling. |
| Canadian insurance billing | TELUS eClaims direct billing to 29+ Canadian insurers. | Not supported — US-only. |
| Couples therapy with dyadic analysis | Dual-channel emotion, per-partner indices, EFT/Gottman-specific note engines. | Generic couples appointment — no dyadic analysis. |
| Native telehealth video | Yes — built-in, no plugin, screen share, waiting room. | Yes — TherapyNotes Telehealth is built in and HIPAA-compliant. |
| Open API + webhooks | 800+ API endpoints + webhooks + open-source SDKs (Python + TypeScript). | No public API. |
| Pricing for a 3-practitioner clinic + AI notes | $597/month all-inclusive. | $59 + $30 + $30 = $119 base + AI add-on (~$30/seat) = roughly $209/month — but no clinical intelligence and no Canadian billing. |
Yes. Signal matches TherapyNotes on the practice management essentials (scheduling, charting, electronic claims, telehealth, patient portal) and adds the modern AI layer TherapyNotes doesn't ship: real-time emotion analysis during sessions, 8 AI clinical note formats, dropout prediction, AI receptionist (Amelia), and Canadian insurance billing. For US clinics that are happy with TherapyNotes' billing depth but frustrated by its dated UI and lack of clinical AI, Signal is the natural next step.
Both platforms handle US electronic claims well. TherapyNotes has been doing this for 10+ years and has mature workflows around ERA posting, denial chasing, and payer-specific quirks. Signal uses Stedi for clearing-house connectivity (same underlying network most modern EHRs use), with unlimited claims included in the $199 base price. Signal also adds Canadian TELUS eClaims direct billing — something TherapyNotes does not support at any tier. For a US-only solo practice, billing capability is roughly equivalent; for a cross-border practice, Signal is the only option.
Per-seat, TherapyNotes is cheaper for small US-only practices ($59/seat) than Signal ($199/seat). The trade-off is what you get for the difference: Signal includes AI clinical notes (8 formats, modality-aware), real-time emotion analysis, dropout prediction, AI receptionist (Amelia), and Canadian billing — none of which TherapyNotes ships at any price. If you'd pay extra elsewhere for an AI scribe ($35–99/mo) and a chat receptionist ($50–150/mo), Signal usually nets cheaper.
Two things, honestly. (1) Maturity — TherapyNotes has 15+ years of customer-support depth, established billing-staff training programs, and a stable feature set that doesn't change month to month. If your clinic prioritizes 'never breaks, never surprises us', TherapyNotes wins. (2) Price-per-seat for US-only solo practices — at $59/seat with no AI, it's the cheapest serious EHR on the market. Signal is the right pick if you want clinical intelligence and Canadian billing in the same platform; TherapyNotes is the right pick if you want the minimum-viable EHR at the lowest US-only seat price.
Yes. Signal has a TherapyNotes CSV importer that brings over client demographics, diagnoses, insurance information, intake-form responses, and appointment history. Past session notes can be uploaded as PDFs and attached to client charts. The migration typically takes a few hours; group practices often run TherapyNotes and Signal in parallel for one billing cycle to verify nothing was missed before cancelling.
Full features, no commitment. Most clinics finish migrating from TherapyNotes inside one billing cycle, and Signal's migration tools handle client roster, intake forms, and insurance data automatically.