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Getting Started Guide: Insurance

Getting Started Guide: Insurance

This guide will break down the basic insurance process in SimplePractice, so you're equipped with the tools to start filing claims and managing insurance right away, even during your free trial.

Below, we'll cover:


The credentialing process

Becoming credentialed and accepted on a payer’s panel is the first step towards being able to submit claims to an insurance payer. When you join an insurance panel for the first time, you’ll go through a process called credentialing that allows you to become an in-network provider on the insurance panel.

SimplePractice cannot assist with this process, as it needs to be completed directly with the payer. A good starting point is to visit the insurance company’s website to locate information about getting credentialed with them specifically. 

Until you’re credentialed with a payer, you won’t be able to submit any claims or enrollments through SimplePractice. Credentialing can take several months, so we recommend beginning the process once you’ve determined you’ll be accepting insurance. 

If you're filling out your credentialing applications, fill them out as if you're not using SimplePractice and will be filing claims to that payer directly. The purpose of this is just to get you accepted into the payer's panel. Once paneled, you can enter your license and billing information into your account so you’ll be able to file claims electronically through our system. 


Entering your provider information 

Before entering your provider information into your account, you'll first want to verify what information the insurance payers have on file for you as a provider and that the information they have listed is still current.

This set of billing information that you’ll want to verify includes the NPI and Tax ID combination listed in your provider file that should be used for electronic claim filing. To do this, we recommend calling the payer directly for confirmation. 

Once you’ve verified your information, you can follow the steps below to enter the information into your SimplePractice account.

Important: The information you enter in the following sections of this guide will automatically populate your claims upon creation. If any required information is missing or listed incorrectly, your claims may be scrubbed or rejected

Solo practices

First, make sure you’ve entered the following information into your SimplePractice profile.

Personal NPI

  • Navigate to Settings > My Profile > Clinical
  • Enter your personal NPI here

individualnpi.simplepractice.clinical.png

  • Click Save Information

This NPI will populate the rendering provider section (Box 24j) of your claims. 

Taxonomy Code

A taxonomy code is a ten-character code that is specialty-specific. Certain payers require that this code be included on your claims. To enter this information: 

  • Visit the NPPES NPI Registry 
  • Enter your NPI number in the Registry to quickly search your taxonomy code 
  • Enter the speciality-specific code in your Clinical settings

taxonomycode.simplepractice.clinical.png

  • Click Save Information

This code won't appear directly on your electronic claim, but it's included in the backend data that's sent to the payer. See Rendering provider's taxonomy code: Box 24j for more information. 

Practice Information

Your practice information, including your practice name and phone number, need to be entered in the Details section of your account. To do so, you can: 

  • Navigate to Settings > My Practice > Details
  • Enter your practice name, practice email, and phone number
  • Click Save Information
  • Toggle to the Locations tab to list your office locations
  • Click Save to keep your changes

Organization NPI (if any)

If you're billing under an organization as opposed to under only your individual information, your type 2 NPI, also known as an organization NPI, will need to be entered. To do this:

  • Navigate to Settings > Billing Services
  • Enter your organization NPI
  • If you don't have a group or organization NPI, leave this field blank and click Save

organizationnpi.simplepractice.settings.png

Tax ID or SSN#

Every NPI is linked to either a Tax ID/TIN or a social security number. If you’re unsure which is associated with your NPI, contact the insurance payer for confirmation.

Important: The Tax ID/SSN entered here populates in Box 25 of your claims and must be the number associated with your billing NPI. The billing NPI is what appears in Box 33 of your claims and will be your individual NPI if submitting claims under your personal information, or your organization NPI if submitting claims under your organization information. 

To enter a Tax ID or Social Security number:

  • Navigate to Settings > Billing and Services and enter either your Tax ID or Social Security Number here
    • If you’re using a SSN, enter it in this format: XXX-XX-XXXX
    • If you’re using an EIN, enter it in this format XX-XXXXXXX
    • Click Save

Note: A Tax ID will be listed on other billing documents, such as superbills and invoices. If you're using a SSN and it's entered in the correct format, you'll have the option to hide it from these billing documents: 

displaySSN.simplepractice.settings.png

 

Billing Provider Info (Box 33)

Box 33 contains your billing information. Solo and group practices must complete this section, as it shows insurance payers whether you're billing as an Individual or as an Organization. To complete your billing information: 

  • Navigate to Settings > Billing and Services > Insurance
  • Choose the Individual or Organization option:

individual.simplepractice.insurance.png

Billing Address

Your billing address is typically the address where insurance payers send payments. To enter this: 

  • Navigate to Settings > Billing and Services > Insurance 
  • Enter the correct billing address
  • Click Save

Tip: Click Use practice default if your insurance billing address is the same as your client billing address. This information will populate automatically based on your Locations settings. 

If your billing address is different from the address where you perform your services, make sure you also turn on the Service Facility Location (Box 32) option. This information is rarely required, but if you have multiple locations in which you provide services and want this specified on your claim form, here’s how:

servicefacilitylocation.simplepractice.insurance.png

Taxonomy Code

Your taxonomy code will populate Box 33b of billing provider information. If billing under your individual information, enter the same code you entered in your Clinical settings. To do this:  

  • Navigate to Settings > Billing and Services > Insurance  
  • Enter the taxonomy code so that you have the correct one on file
  • See How do I find my taxonomy code? if you’re unsure what your taxonomy code is

Group practices

When submitting claims as part of a group practice, the following information must be entered.

Personal NPI

If you’re part of a group practice, make sure that every clinician in the account enters their personal NPI. To do this: 

  • Navigate to Settings > My Profile > Clinical  
  • Enter your individual NPI there
  • Click Save Information

Taxonomy Code

Enter the taxonomy code associated with your individual NPI. To do this:  

  • Visit the NPPES NPI Registry 
  • Enter your NPI number in the Registry to quickly search your taxonomy code 
  • Enter the speciality-specific code in your settings
  • Click Save Information

Practice Information

Your practice information, including your practice name and phone number, need to be entered in the Details section of your account. To do so, you can:   

  • Navigate to Settings > My Practice > Details
  • Enter your practice name, practice email, and phone number
  • Click Save Information
  • Toggle to the Locations tab to list your office locations
  • Click Save to keep your changes.

Organization NPI

When billing under an organization as opposed to under only your individual information, your type 2 NPI, also known as an organization NPI, will need to be entered. To do this: 

  • Navigate to Settings > Billing Services
  • Enter your organization NPI
  • Click Save

organizationnpi.simplepractice.settings.png

Important: Unlike the individual NPI, which is specific to every clinician’s account, there can only be one organization NPI entered at a time. The organization NPI entered in this section will populate on all claims that are submitted under the group practice. 

Tax ID or SSN#

Every NPI is linked to either a Tax ID/TIN or a social security number. If you’re unsure which is associated with your NPI, contact the insurance payer for confirmation. 

Important: The Tax ID/SSN entered here populates Box 25 of your claims and must be the number associated with your billing NPI. The billing NPI is what appears in Box 33 of your claims and will be your individual NPI if submitting claims under your personal information, or your organization NPI if submitting claims under your organization information. 

To enter a Tax ID or Social Security number: 

  • Navigate to Settings > Billing and Services and enter either your Tax ID or Social Security Number here
    • If you’re using a SSN, enter it in this format: XXX-XX-XXXX
    • If you’re using an EIN, enter it in this format XX-XXXXXXX
  • Click Save

Note: A Tax ID will be listed on other billing documents, such as superbills and invoices. If you're using a SSN and it's entered in the correct format, you'll have the option to hide it from these billing documents: 

displaySSN.simplepractice.settings.png

Billing Address

Your billing address is typically the address where insurance payers send payments. 

  • Navigate to Settings > Billing and Services > Insurance 
  • Enter the correct billing address
  • Click Save

Tip: Click Use practice default if your insurance billing address is the same as your client billing address. This information will populate automatically based on your Locations settings. 

If your billing address is different from the address where you perform your services, make sure to also turn on the Service Facility Location (Box 32) option. This information is rarely required, but if you have multiple locations in which you provide services and want this specified on your claim form, here’s how:

servicefacilitylocation.simplepractice.insurance.png

Taxonomy Code

It’s possible that the organization NPI is linked to a different taxonomy code than the one linked to your personal NPI. To confirm this and enter it in your settings:

  • Go to the NPPES NPI Registry 
  • Enter your organization NPI in the Registry to quickly search your practice’s taxonomy code 
  • Navigate to Settings > Billing and Services > Insurance 
  • Enter the taxonomy code for your organization NPI
  • Click Save

Setting up your clients’ profiles

Before you can start billing insurance for a client, you'll need to make sure that all of their insurance information is entered properly in their profile.

You can refer to Setting up insurance billing for your clients for a complete walkthrough of the process.


Enrollments

Some insurance payers require you to submit an enrollment in order to file insurance claims electronically and/or register you to receive Payment Reports (also known as ERAs) through SimplePractice.

Please note that enrolling in claim filing is not the same as being paneled with the payer or getting credentialed. Enrollments simply let payers know that you’ll be using SimplePractice to file claims electronically and/or register you to receive Payment Reports (also known as ERAs) through SimplePractice.

Important: Payer IDs and payer names can be specific to the clearinghouse and the connection that a clearinghouse has established. Please review this guide prior to enrolling and selecting payer IDs for your clients: Adding insurance payers and selecting the correct payer ID.

There are two types of enrollments:

  • Claim Filing
  • Payment Reports

Claim Filing Enrollment

If the payer you're working with requires a Claim Filing Enrollment, you won't be able to file claims through SimplePractice until your enrollment has been accepted. We recommend that you continue to file your claims directly with the payer until your enrollment is accepted.

Tip: Medicare requires a Claim Filing Enrollment. If you’ll be submitting claims to Medicare, we recommend enrolling early so you can get the process started. See Enrollment FAQs for more information on submitting enrollments. 

Payment Reports enrollment

If you’re working with a payer that doesn’t require a Claim Filing Enrollment, you can start filing claims with them right away. You don’t need to wait for the Payment Reports Enrollment to be accepted. Until your Payment Reports Enrollment is accepted, the payer will continue to send you EOBs outside of SimplePractice. However, this won’t prevent you from filing claims.

Submit your enrollments

After you've entered your clients' insurance information into their profiles, you'll be able to submit your enrollments for any payers that require you to do so. To enroll: 

  • Navigate to Settings > Insurance 
  • Click Search available payers
  • Search for the payer and click + Add
  • Return to your My Insurance Payers page and click Enroll

Important: Make sure the information listed in the enrollment form matches exactly what the payer has on file for you. If there are any discrepancies, the payer will reject your enrollment. After you submit your enrollment, you’ll see its status change to Submitted. We’ll email you to let you know when your enrollment has been completed, or to let you know if there are any other steps needed from your end in order for the process to be successful.

Enrollments are tied to your billing information. Depending on if you’re billing as an individual or as part of an organization, you’ll have to enter your billing information accordingly. As part of the enrollment process, you’ll be asked to specify which NPI to enroll with: 

billinginformation.simplepractice.enrollments.png

What do the enrollment designations mean?

You’ll see several different designations in your insurance payers list. Here’s what each designation means:

  • Ready to file claims - This means you are not required to enroll for claim filing and can start submitting claims right away through SimplePractice, even in your free trial.
  • Enroll - This means that you will need to enroll with this payer for electronic claim filing (or Payment Reports). Simply click Enroll and fill out a quick application to start the process. Our clearinghouse will take it from there and you'll be notified as soon as the enrollment is accepted.
  • Document required - The payer requires that you complete additional information for the enrollment to process. Follow the instructions provided in the PDF and complete the steps.
  • Not supported - This payer does not provide the option to receive Payment Reports through SimplePractice. You can continue to manually add any insurance payments that you receive.
  • Credit Card Information Required - In addition to at least one client using that insurance payer, you must provide your credit card information to enroll. During your free trial, go to Settings > Subscription Information to provide your credit card information and you can then submit your enrollment right away. Please note that this will not result in a charge on your card and you'll still be able to enjoy the rest of your free trial.

Note: Even if you’re waiting for an enrollment to be accepted, you can still use SimplePractice to create, print, and then submit claims by mail to avoid any delay in payment.


Creating and submitting claims

Once your Claim Filing enrollments are accepted (or if they’re not needed) and your client's insurance information is entered, you’re ready to begin filing claims. Follow these steps:

  • Add at least one appointment to your calendar for your insurance client.
  • Add a diagnosis code to your client’s profile.

Note: You can add multiple diagnoses if needed.

To create and submit a claim, follow these steps:

  • From your client’s Billing page, click New > Claim/CMS 1500

newclaim.simplepractice.overview.png

  • Check the box next to the appointment(s) you want to include on the claim, and click Create Claim.

selectappointments.simplepractice.createclaim.png

Note: You can include up to six appointments on a single claim. 

  • The claim is created in Edit mode so you can make adjustments if necessary
  • When you've reviewed the claim, click Submit.

submitclaim.simplepractice.insurance.png 


Tracking your claims

Now that you’ve submitted your claim, you can easily track its status as it goes from Prepared to Paid.

Here's how to check your claim status:

  • Navigate to Insurance > Claims

allclaims.simplepractice.claims.png

Once submitted, a claim can go through several statuses. These range from Accepted and Paid, to Denied or Deductible. See Checking a claim status: The different phases of an insurance claim for a breakdown of what each of these statuses mean.

Note: You'll also receive an email each time a claim status is updated.   

There are several filters you can use to locate a specific claim. These include searching for a client by name, searching by insurance payer, by claim status, and setting a date range to include all claims filed within a certain period of time.

paidstatus.simplepractice.claims.png

To view a claim's details, such as when it was submitted and its payment information: 

  • Click on the client’s name
  • Click Claim Details

claimdetails.simplepractice.claim.png


Reviewing automated accounting / Adding insurance payments

Insurance payments can be entered manually and automatically.

  • If you’ve submitted a Payment Report Enrollment and the enrollment was accepted, the payments will be entered automatically for you.
  • If your Payment Report Enrollment hasn’t been accepted (or if the payer doesn’t provide payment reports), you can enter your payments manually.

If Payment Reports enrollment has been accepted:

Our system will completely automate the bookkeeping for claims with this payer. We take information from the payment reports, automatically record the insurance payment in your account, and apply the correct amount to each client’s profile.

If a payment report (ERA) was received, you can view it in the claim’s details:

paymentreport.simplepractice.claimdetails.png

If Payment Reports enrollment hasn’t been accepted (or if the payer doesn’t provide payment reports):

You can add the insurance payments easily. You’ll need the EOB (Explanation Of Benefits) you received from the insurance payer to ensure you’re doing this accurately.

Tip: See Adding insurance payments for a detailed walkthrough of this process.

You can enter an insurance payment in two places in SimplePractice:

  • From a client's file, click Add Payment

addpayment.simplepractice.overview.png

  • From the expanded payment window, click Add Insurance Payment

addinsurancepayment.simplepractice.overview.png

You can also add insurance payments from your insurance billing page. To do this: 

  • Navigate to Insurance > Payments
  • Click Add insurance payment

addinsurancepayment.simplepractice.insurance.png

Once you're on the Add Payment page:

  • Enter the Check or Wire number.
  • Select the Date Range that includes the sessions associated with the payment
  • Set the Payment Date that's on the check/wire.
  • Enter the Amount of the payment

addinsurancepayment.simplepractice.payments.png

Allocating the payment

Using the authentic EOB you received from the payer with your payment, enter:

  • The amount paid for each session in the Insurance Paid field

Note: If the EOB indicates that the client owes something different from what you charged, enter in the client's responsibility for each appointment in the Client Owes field. 

  • If the amount paid by the client and the amount paid by insurance is less than the total amount you billed, you can enter the difference as a Write-off. This indicates that you won’t be receiving additional reimbursements from the insurance payer
  • Click Save

Important: Once you’ve allocated the entire payment, the Unallocated amount should always equal $0. See How to resolve unallocated insurance payment amounts for information on where unallocated payments stem from and how to resolve them. 

If the Unallocated amount isn't $0, see the two scenarios listed below:

  • If you have an Unallocated amount > $0, you did not allocate the full amount of the check/wire to all of the sessions the payment was intended to cover. If that happens, edit the payment and review the EOB once again.
  • If you have a negative Unallocated amount, you allocated more than you should have. Go back and make sure you’ve allocated the exact amount of the check/wire.

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