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Getting Started Guide: Insurance

Note: Download a PDF version of this guide here.

Getting started with the insurance process in SimplePractice doesn't have to feel overwhelming! This article 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.

Sections

  1. Setting up your profile - Solo practice
  2. Setting up your profile - Group practice
  3. Setting up your clients’ profiles
  4. Enrollments
  5. Creating and submit claims
  6. Tracking your claims
  7. Reviewing automated accounting / Adding insurance payments

1. Setting up your profile - Solo practice

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

Personal NPI

  • Go to My Account > Settings > Basic Info > Clinical Info > enter your personal NPI here.

Practice Information

  • Go to My Account > Settings > Practice Details.
  • Enter your practice name, phone number, address, and multiple office locations, if necessary.

Organization NPI (if any)

  • Go to My Account > Settings > Billing Services > enter your organization NPI here. If you don't have a group or organization NPI, leave this blank and Save.

Tax ID or SSN#

  • Go to My Account > Settings > Billing Services > Tax ID or SS# > enter your Tax ID 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.

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Taxonomy Code

  • Go to My Account > Settings > Billing and Services > Insurance > and edit the taxonomy code so that you have the correct one on file.
  • If you’re unsure what your taxonomy code is, go to www.npiregistry.cms.hhs.gov and run a search using your NPI so you can find it.

Billing Address

  • Go to My Account > Settings > Billing and Services > Insurance > and enter the correct billing address (or the address where you’d like the insurance payers to send insurance payments). Make sure the Individual option is selected unless you are billing as an organization.

Note: 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.

2. Setting up your profile - Group practices

Personal NPI

  • Go to My Account > Settings > Basic Info > Clinical Info >enter your personal NPI there. For your group practice, make sure every clinician in your account completes this step.

Practice Information

  • Go to My Account > Settings > Practice Details.
    Make sure you fill out your practice name, phone number, address, and multiple office locations (if necessary).

Organization NPI

  • Go to My Account > Settings > Billing and Services>and enter your organization NPI here.

Tax ID or SSN#

  • My Account > Settings > Billing and Services > Tax Id or SS# > enter your Tax Id 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 (group practices will usually have an EIN).

Taxonomy Code

  • Go to My Account > Settings > Billing and Services > Insurance > edit the taxonomy code so that you have the correct one on file.

Note: If you’re unsure what your taxonomy code is, go to www.npiregistry.cms.hhs.gov and run a search using your NPI so you can find it. The use taxonomy code for your group NPI.

Billing Address

  • Go to My Account > Settings > Billing and Services > Insurance > enter the correct billing address or the address where you’d like the payers to send you insurance payments.
  • Make sure the Individual option is selected unless you are billing as an organization.

Note: 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, as shown below.

 

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3. Setting up your clients’ profiles

Make sure every insurance client has all of the information below in their profile.

  • First and Last name, as shown on their insurance member ID card
  • Phone number
  • Address
  • Birth Date
  • Gender
  • Billing Type. Client's Billing Type must be set to Insurance. Here's how:
    • Go to the Billing and Insurance settings page.
    • Select Insurance as the Billing Type.


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The client's insurance information

  • Insurance Company
  • Member ID. Do not include any spaces or dashes in this field.
  • Client’s relationship to insured
    • If the client is under someone else’s plan, make sure you select the option that applies. Make sure you enter the information for the primary insured in this section

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FYI: We highly recommended uploading clients’ insurance member ID cards.

How to attach an image of a client's insurance ID card

  1. Go to the client's Overview page.
  2. Click on Edit client info next to the client's name.
  3. Click on the Billing and Insurance tab.
  4. Scroll down to the client's Insurance info. If you haven't added insurance information for the client, click on the + Insurance button to add the client's insurance information.
  5. At the bottom of the Insurance Information, you will see a box that says Front of Insurance Card with a blue document icon.
  6. Click on Browse to upload a copy of the ID card or drag the file to this box.
  7. You can upload either JPEG or PDF files. If you upload PDF files you won’t have a “preview” option but you’ll still be able to view the file by clicking on it.


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4. Enrollments

Some insurance payers require you to submit an enrollment in order to file insurance claims electronically via SimplePractice. Enrolling in claim filing is not the same as being paneled with the payer or getting credentialed. Enrollments simply let payers know that you will be using SimplePractice to file claims and receive Payment Reports (also known as EOBs or ERAs).

There are two types of enrollments:

  1. Claim Filing, and 
  2. 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 in 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.

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 but this shouldn’t stop you from filing claims.

Submit your enrollments

After you have 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: Go to My Account > Settings > Insurance Providers > Enrollments > +Enroll.

Important: Make sure the information in the enrollment form matches what the payer has on file for you. If it doesn’t, the payer will reject your enrollment. After you submit your enrollment, you’ll see its status change to Submitted. We will email you when your enrollment has been completed or if there are any other steps needed from you in order to complete this process.  

 What do the enrollment statuses mean?

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  • Not Required - This is great news!  It 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 the +Enroll button 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.
  • PR's 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. 
  • No Clients on File - You must have at least one client using the payer in order to enroll.  Please add the insurance company to that client's profile and then return to this page to enroll.
  • Paid Account Required - In addition to at least one client using that insurance payer, you must be on a paid account with SimplePractice in order to enroll.  During your free trial, you can submit any claims electronically where enrollment is not required. Once you sign up for a paid account, you can then submit your enrollment right away!   

Note: Remember that even if you are 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.


5. Creating and submitting claims

Once your Claim Filing Enrollments are accepted (or if they’re not needed), you’re ready to begin filing claims. Follow these steps:

  1. Add at least one session to your calendar for your insurance client.
  2. Add a diagnosis code to your client’s profile. 
  3. In order for the diagnosis code to show, it needs to be pre-dated to when the appointment occurred. When you edit the diagnosis, you will have the option to edit the date.
  4. Example: If the appointment was on 6/1/17 at 4pm, the Diagnosis will need to be dated at least 1 minute prior (6/1/17 at 3:59 pm) for the appointment to show up on a claim form, Superbill or note.

Note: You can add multiple diagnoses if needed

Create a claim
From your client’s Billing page, click the +Create button and select the Claim/CMS 1500 option.SP-HelpCenter-Screenshots_securemessaging_copy_6.pngSubmit the Claim
The claim is created in Edit mode, so you can make adjustments if necessary. Most of the time, you won’t need to make any edits so click Submit.
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6. 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:

  • Go to Billing > Insurance > Claims.

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

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7. Reviewing automated accounting / Adding insurance payments

Insurance payments can be entered manually and automatically.

  • If you have submitted a Payment Reports (PR) Enrollment and the enrollment was accepted, the payments will be entered automatically for you.
  • If your Payment Reports (PR) enrollment has not been accepted (or if the payer doesn’t provide PRs) 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 and automatically record the insurance payment in your account and apply the correct amount to each client’s profile.

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

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

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

  1. From a client’s Billing page. 
    Here's how: Go to a client’s Billing page and click the blue Add Insurance Payment button.
  2. From the insurance billing page. 
    Here's how: Go to Billing > Insurance > Add Payment.

Once you are on the Add Payment page:

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

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Allocating the payment

Using the EOB sent with your payment, enter:

  1. The amount paid for each session in the Ins. Paid field.  
  2. If the EOB indicates that the client owes something different from what you charged, enter in the client's responsibility for each session in the Co-pay field. The client’s Co-Insurance goes here as well.
  3. 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 will not be receiving additional reimbursements from insurance.
  4. Click Save.

Important: Once you have allocated the entire payment, the Unallocated amount should always equal $0. 

Once you have allocated the entire payment, the Unallocated amount should always equal $0. 

  • If you have an Unallocated amountgreater than $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.

Congratulations you just went over the entire claim filing and accounting process through SimplePractice!

Note: Download a PDF version of this guide here.

Tip: Interested in never having to worry about insurance again? Learn more about our in-house medical billing service, SmartBilling Pro here.

Have more questions? Submit a request