Staying on top of insurance billing processes is a full-time job that requires continuous education and certifications. Many practices handle insurance billing on their own early in their practice’s lifecycle. 

As your practice grows, it’s important to spend more time on client care, and less time on managing insurance billing. That’s why SimplePractice offers a managed billing service for in-network insurance billing.

In this guide, we'll cover: 

• Learning more about managed billing
• Setting up your account for managed billing
• Locking and signing progress notes
• Navigating the insurance dashboard
• Reviewing clients’ insurance benefits
• Uploading EOBs
• Tracking claim progress with Billing Notes
• Using claim support to communicate with managed billing
• FAQs

Learning more about managed billing

Managed billing is a best-in-class insurance billing solution that’s fully integrated with SimplePractice. Managed billing takes care of your in-network insurance billing to not only give you time back, but also to make sure that you get insurance claims paid faster and more successfully. Additionally, you won't have to deal with rejections, denials, or appeals - we’ll handle all of those completely on your behalf. 

Our managed billing team consists of billing specialists, revenue cycle experts, and engineers dedicated to making insurance billing easier for customers.

If you’re eligible for this service, you’ll receive an email from SimplePractice with information on how to start the process of working with our managed billing team.

Note: Practices must be on the Plus plan to be eligible for this service. If you’d like to learn more about managed billing, click here to schedule a 15-minute exploratory call. 

Setting up your account for managed billing

Because managed billing only handles in-network insurance claims, you’ll now have the option to mark insurance clients as in-network or out-of-network. 

While onboarding with managed billing, all insurance clients will be pre-selected as In-network insurance for their billing type. Before your go-live date, you’ll want to go through your client list and make sure any Out-of-network insurance clients are properly denoted. 

Tip: Filtering your Clients list by insurance payer can help when searching for any out-of-network clients.

When creating new clients, you’ll be able to select their correct billing type. 

Locking and signing progress notes

After reaching your go-live date, our team will manage the full process of creating, submitting, and managing claims. Managed billing will only submit claims if a appointment's progress note is locked and signed.

After you lock and sign the progress note for an appointment, a claim will be created, and the managed billing team will manage the claim throughout the adjudication process, as well as handle any rejections, denials, or resubmissions.

Note: Once the claim is created, you won’t be able to make any edits to it.

If a clinician in your practice is under supervision, we’ll only create a claim once the progress note has been locked and signed by the supervisee and the supervisor. For more information, see Adding a Supervisor to review and sign notes.

To view any unlocked appointments: 

• Navigate to Analytics > Reports > Appointment status
• Click More and select Include Documentation

This will add a Progress Note Status column, which allows you to filter the report by Unlocked or No Note.

Note: Managed billing will only manage claims for appointments where the date of service took place after your go-live date. You’ll still be able to create, submit, and manage claims for dates of service that took place prior to your go-live date.

Navigating the insurance dashboard

Once you’ve gone live with managed billing, the Insurance dashboard will be the central page where you can monitor your insurance billing and take necessary actions. To access the dashboard, navigate to the Insurance tab. 

The dashboard highlights managed billing progress and any action needed on your part, including: 

• Viewing claims that are in progress
• Reviewing payments
• Reviewing clients’ insurance benefits
• Responding to and sending messages using claim support

Note: Our team is actively working on the Unbilled appointments and Payment posting summary snapshots. In the meantime, click View all on each snapshot to be taken to the Unbilled appointments and Insurance payments pages. 

Claims snapshot

The Claims snapshot provides a summary of managed billing claims that are In progress. Claims that are currently being processed are highlighted in yellow, and claims that require action from you are highlighted in red. Hover your cursor over a tile to display the sum of insurance fees in each category, and click on a tile to view the associated claims. 

To view all your claims: 

• Click View all in the Claims snapshot    

• Use the filters to locate a specific claim
• Select View 

Note: Claims that require action from you will have the Requires practice action status.   

Payments snapshot

The Payments snapshot provides an overview of your monthly insurance income. Hover your cursor over the tiles to see claims not covered by insurance, remaining client balances owed, and client and insurance payments received in the current month. 

You can click the Not covered by insurance tile to view the associated claims. Click the Client balances owed and Client and insurance collected this month tiles to view your Appointment status and Income allocation reports, respectively. 

To view your insurance payments, click View all in the Payment posting summary snapshot. 

At times, managed billing may require the EOB you received for a claim. If requested, click Upload paper EOB to upload an EOB. 

Note: Claims that aren’t covered by insurance will have the Not covered by insurance status on your Claims page. 

Reviewing clients’ insurance benefits

Once you’ve onboarded with managed billing, automatic insurance checks will run for clients with recently updated insurance information and for upcoming insurance appointments. This allows you to confirm that a client’s coverage is active before a claim is submitted. If our clearinghouse finds that a client’s listed coverage is inactive or needs review, you can make changes before the appointment takes place and reduce the likelihood of future rejections or denials.

To address a client’s coverage:

• Navigate to the Insurance dashboard
• Click View all in the Review client coverage section

Note: This page will only list clients whose coverage is inactive or needs review.

• Check the Details column for information regarding the client’s coverage
• Click Review to be taken to their insurance information

• Update the client’s insurance information as needed

After updating the client’s insurance information, a new Coverage Report will automatically be requested. If our clearinghouse is able to verify the client’s updated insurance information, it’ll be listed as Active in their profile.

Uploading EOBs

There are times when the managed billing team needs to view EOBs (Explanation of Benefits) you’ve received from insurance payers. These can be uploaded as business files and shared with the managed billing team for review. To do this:

• Navigate to Settings > Practice > Business files
• Click Upload documents and select the file to upload from your computer
• Click the three dots next to the uploaded document

• Choose Share from the dropdown

• Check the box next to Billers to give managed billing access

• Click Save

Tracking claim progress with Billing Notes

If a claim encounters an issue during processing, such as a rejection or denial, managed billing will determine the cause, make any needed corrections, and resubmit the claim. During this process, they’ll add Billing Notes so you can track the claim’s progress. 

To review Billing Notes for a claim: 

• Navigate to your Insurance dashboard
• Click View all in the Claims snapshot

• Select View next to the claim in question 
• Click Billing Notes

The Billing Notes tab summarizes the claim issue, outlines resolution steps, and provides an overview of the investigation. 

If you have questions about a Billing Note, you can click the back arrow on the Claim details page to contact managed billing directly through the claim using claim support.

Using claim support to communicate with managed billing

Once onboarded with managed billing, you can use claim support to send and receive secure messages about specific claims. Claim support can be used to contact managed billing for any claim that was created after your go-live date. Managed billing may also reach out to you directly through claim support if action is needed on your part to process a claim. 

To view new messages from managed billing: 

• Navigate to the Insurance dashboard
• Review the Claim support snapshot for any new messages
• Click on an unread message to go directly to the claim in question

You can view all claim support messages from the Claims page. To do this: 

• Click View all in the Claim support snapshot

• Use the Claim support filter to sort claims by message type

• Click the message icon to open a claim support thread

To start a new claim support thread: 

• Navigate to the Insurance dashboard
• Click Start new message in the Claim support snapshot

• Select View next to the claim in question
• Click Contact claim support on the top right corner 

• Choose a Category from the dropdown

• • Categories you can contact claim support for include: 
    • Payer ID issues
    • Inactive coverage
    • Incorrect NPI 
    • Incorrect client information
    • Missing information
    • Missing payment
• Enter your message and click Save to send it to our team

Our team will investigate and follow up shortly. You’ll see their response in your Insurance dashboard.  

Important: Claim support shouldn’t be used for non-claim issues. If you need to reach out to managed billing for a non-claim issue, please submit an email help request. 

FAQs

• What type of insurance filing does managed billing support?
• What's included with managed billing?
• What isn’t included with managed billing?

What type of insurance filing does managed billing support?

Managed billing only supports the management of in-network insurance claim filing. For out-of-network insurance claims, clinicians will need to continue to submit these independently.

What's included with managed billing?

Managed billing is a fully integrated service that includes: 

• Automatic insurance status checks
• Claim scrubbing and custom claim edits
• Electronic primary and secondary claim submission for in-network government and commercial payers
• Claim status management
• Rejection and denial management
• Accounts receivable (A/R) follow-up with insurance payers
• Insurance payment posting 
• Transparent and actionable reports
• Dashboard to track important tasks and insurance billing metrics 
• Real time claims tracking

What isn’t included with managed billing?

Services that aren’t offered with managed billing include:

• Credentialing
• Payer negotiations
• Accounts receivable (A/R) follow-ups for claims filed before your start of service date
• Prior authorizations
• Billing, invoicing, or A/R follow-up with clients
• Out-of-network and EAP billing