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Filing electronic claims out-of-network

Filing electronic claims out-of-network

As an out-of-network (OON) provider, there are a few ways to bill your insurance clients. This includes options such as submitting claims directly to the insurer or providing clients the necessary documentation for reimbursement.

Note: If you're not currently a SimplePractice customer and are considering signing up for an account, you can take a look at how we streamline insurance billing.

In this guide, we’ll cover: 

Important: To file claims electronically as an out-of-network clinician within SimplePractice, you may need to register ahead of time as a “non-participating provider” with that payer. This process usually involves filling out a W-9 form, although each payer may have a different requirement. We recommend you reach out to the payer directly to confirm you’re ready to start filing claims even if you’re out-of-network.


A superbill is a statement you can provide clients so that they can get reimbursed directly from their insurance company. This is the most commonly used option for out-of-network providers.

In this scenario, the client pays you the full appointment fee out-of-pocket. After they pay, you create and share the superbill with the client, so that they can submit it to their insurance company directly. The superbill details the service, diagnosis, and full cost of services rendered, as well as any other provider information the insurance payer requires to qualify for reimbursement. 



Note: For additional information, see Creating superbills.

OON billing

In this scenario, you file claims to the insurance payer. The insurance company pays you directly because the client has out-of-network benefits. You file these claims the same way you file in-network claims. The only difference is that you aren’t bound by a contract with the insurance company, so you don’t have to lower your rate.

We typically see that clinicians still get their full fee when doing OON billing. They usually collect whatever partial amount the insurance pays and the remaining amount is collected directly from the client. 

Note: For additional information about filing claims, see Getting started with insurance billing.

Single case agreement

Out-of-network providers can obtain a single case agreement to provide reimbursable appointments to a specific client. After an agreement is obtained, you can file to the insurance payer as if you are in-network and the appointment would be paid out based on the details of the agreement for that client. 

Note: SimplePractice does not help with the process of obtaining a single case agreement. You will need to contact the insurance payer directly to set this up.

Courtesy billing

In this scenario, the client pays you the full appointment fee, and you file claims to the client’s insurance company on their behalf. This informs the payer to reimburse the client directly instead of you. To set up a client for courtesy billing:

  • Navigate to the client’s Overview page > Edit > Billing and Insurance
  • Set the Billing Type to Self-pay 


Note: Appointments that are set to Self-pay won’t show up on the Unbilled Appointments page.

  • Scroll down to Insurance Info
  • Click + Insurance info
  • Select the Insurance payer 
  • Enter the Member ID 


  • Click Save
  • Scroll down to Insurance Claim/CMS Fields
  • Check Show additional claim fields 
  • Select No under Accept Assignment?


  • Click Save Client

After making these changes, the client’s future claims will automatically have box 13 unchecked and box 27 set to No. This informs insurance payers that payments for those claims should be sent directly to the client. 

Note: We don't recommend enrolling to receive Payment Reports through SimplePractice with payers that you only courtesy bill. If you have an accepted Payment Report (ERA) enrollment and experience discrepancies with an appointment or claim status, you can submit a help request so our team can further investigate.

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