Getting started with insurance billing

This guide outlines the process of setting up your account for insurance billing in SimplePractice. By following these steps, you’ll be equipped to file claims and document insurance income through your SimplePractice account.

Below, we'll cover:

• The credentialing process
• Entering your billing information
• Adding payers and submitting enrollments
• Setting up your clients’ profiles
• Creating and submitting claims
• Documenting insurance income 
• Additional support

The credentialing process

Credentialing is the process of being verified and accepted into an insurance company’s network as an in-network provider. This involves working with the payer to confirm your credentials and is required before you can start submitting claims. 

While waiting for the credentialing process to be complete, you can enter insurance billing information in your account. However, until you’re confirmed to be in-network with an insurance payer, you won’t be able to submit claims or enrollments to them through your SimplePractice account.

Entering your billing information 

Claims are created using practice information entered across different parts of your account. In this section, we’ll cover how to enter the following required information: 

• Practice name, email, and phone number
• NPI and Tax ID/SSN
  • If billing as a solo provider, you’ll only need your Individual (Type 1) NPI. 
  • If billing as an organization, you’ll need your Individual and Group (Type 2) NPIs.
  • Your Tax ID/SSN should be the one associated with your NPI. If billing as an organization, this may be a unique ID specifically associated with your group information.

• Taxonomy code
  • This is a code specific to your specialty. You can find your taxonomy code by searching your NPI in the NPPES NPI registry.
• The billing address where you see clients 
  • A physical address is required for claims even if you only see clients virtually. This can be a registered business address or home address and should match what the payer has associated with your NPI. If using a home address for claims, you can hide it from client-facing pages, such as your Client Portal. 
  • Payers require a place of service (POS) code for each billing location. The most common are 02 for Telehealth, and 11 for a physical address. 

Note: If you’re not sure what information a payer has on file, such as the specific Tax ID/SSN or address where you see clients, we recommend reaching out to them for confirmation or reviewing your credentialing details. 

Once you have this information ready, navigate to the Billing hub and click Claim filing info to open a flyout where you can enter your information. 

Use the Practice, Billing, and Clinician details links to enter your information in the following areas of your account: 

• Practice details and location information
• Insurance billing information
• Clinical information

Return to the Billing hub and click Claim filing info at any time to review and adjust your settings if needed.

Adding payers and submitting enrollments

Enrolling with a payer in SimplePractice allows you to submit claims electronically and receive Payment Reports (ERAs) in your account. There are two enrollment types in SimplePractice:

• Claim filing enrollment
  • Most payers don’t require a claim filing enrollment. When required, however, the enrollment must be accepted before you can start submitting claims electronically through SimplePractice. 
• Payment Report enrollment
  • Most payers offer Payment Report enrollments. These aren’t required in order to submit claims, but they’re recommended, as they allow Payment Reports (ERAs) to be posted to your account. Payment Reports record insurance payments, show client responsibilities, and update claim statuses to Paid, Denied, or Deductible. 

Note: You must already be credentialed with a payer to submit an enrollment through SimplePractice. 

To submit an enrollment: 

1. Navigate to Settings > Client billing and insurance > Payers 
2. Click Add enrollments 

3. Follow the on-screen prompts to select which payers you’ll be enrolling with and submit your information to them. For a full walkthrough of the enrollment process, see Submitting enrollments to file claims and receive Payment Reports. 

Note: When adding payers and submitting enrollments, you’ll see several payer IDs and plan names associated with a single payer. Choose the payer name that you’re credentialed with and we’ll route the enrollment to the payer ID with the most direct connection. For more information, see Understanding insurance plans and payer IDs.

Setting up your clients’ profiles

Claims populate with billing information entered across your account as well as demographic and insurance information from clients' profiles. When submitting claims, make sure insurance clients have the following information listed in their profile: 

• Demographic information, including:
  • Address
  • Contact information
  • Date of birth
• Their Billing type set to Insurance

• Insurance payer and member ID
  • This information is found on the client’s insurance card, which can be uploaded in their profile or from the Client Portal.
  • Insurance cards typically list additional plan or group IDs. While these can be saved in a client’s profile for reference, only the primary member ID is required for electronic claim submission.

Note: Sending the demographic form through the Client Portal as part of the client intake process is a helpful tool for collecting insurance information. 

Click Edit client under the client’s name in their profile and enter their demographic and insurance information across the Client Info and Billing and Insurance tabs.  

Click + Insurance info in the Billing and Insurance tab to enter the required Insurance payer and Member ID fields.

Note: The Copay/Coinsurance amount listed in this flyout determines what the client will be responsible for in your account, but isn’t required on claims. 

Some of the most common claim errors stem from missing or incorrect client information. If claims are being rejected, we recommend reviewing the client’s profile using information in the rejection message. For more information, see Resolving rejected claims.

Creating and submitting claims

In addition to entering your client's insurance information, the following are required before you can create and submit a claim: 

• At least one appointment for your insurance client
• At least one diagnosis code in your client’s profile

Once those are entered, you’re ready to create and submit claims. This can be done at the client-level, or in batches for multiple clients. 

To create claims for a single client:

1. Navigate to their profile and select the Billing page
2. Click New > Claim/CMS1500

3. Select up to six appointments to be included on the claim. If past appointments aren’t listed, try expanding the date range.

4. Click Create Claim 

The claim will be created in the Prepared state. You can review the information, click Save so it can be downloaded, or click Submit to submit it electronically.

To create claims for multiple clients at a time:

1. Navigate to the Billing hub
2. Select the Claims > Appointments to file tab

3. Review the unbilled appointments, select which clients you’d like to create claims, for and click Submit claims
   • This page lists all appointments with billing types set to Insurance that don’t already have claims created for them

For a more detailed walkthrough of using this page, see Submitting and monitoring claims from the Billing hub. 

As claims are submitted, they’ll receive statuses informing you of their progress. If a claim is successfully submitted to the payer, it'll receive one of the following statuses:

• Accepted
• Received 

The following statuses indicate the claim wasn’t successfully submitted, typically due to errors or incorrect/missing information: 

• Rejected 
• Scrub

Claims that are Accepted or Received will then be processed on the payer’s end, where they’ll be paid, denied, or applied to a client’s deductible.

Important: Enrolling to receive Payment Reports (ERAs) allows you to receive additional statuses, such as Paid, Denied, and Deductible, in your SimplePractice account. If not enrolled, claims won’t move past Accepted or Received, and the payer will notify you of how a claim was processed by sending an Explanation of Benefits (EOBs) outside of SimplePractice.

For more information about claims and their statuses in SimplePractice, see:

• Understanding claim statuses
• Filing secondary insurance claims  
• Understanding Payment Reports (ERAs)
• Resolving claim rejections
• Resolving scrub errors

Documenting insurance income 

After a payer has finalized a claim, they’ll send reimbursement outside of your SimplePractice account. 

Note: SimplePractice isn’t involved in any aspect of the transfer of funds between payer and provider, including setup and delivery.

The most common forms of reimbursement are by check or Electronic funds transfer (EFT). While the payments themselves don’t pass through your account, it’s important to document them so your insurance balances and income reporting are accurate. 

Insurance payments can be documented automatically or manually. 

• If you’ve submitted a Payment Report enrollment and the enrollment is accepted, insurance 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 a Payment Report enrollment has been accepted, SimplePractice will automate the bookkeeping for claims submitted to that payer. This includes recording the insurance payment and updating the client responsibility to match the information provided by the payer. 

To review a Payment Report (ERA) that was received:

1. Locate and open the claim in question from your Claims filed tab or the client’s profile 
2. Click Status details
3. Scroll down to review the Insurance payment report (ERA) section

Note: For more information, see ERAs in SimplePractice (Payment Reports).

When adding payments manually, use the Explanation of benefits (EOB) issued by the payer after they’ve finalized the claim. This will record the income for your reporting and update the claim from Accepted to Paid. 

You can add insurance payments individually from a client’s profile by clicking Add insurance payment in their sidebar.

You can also add insurance payments that cover multiple clients by navigating to the Billing hub and clicking Add insurance payment.

For a detailed walkthrough of this process, see Adding insurance payments. 

Additional support

You can reach out to our team with questions about insurance billing using the ? icon on the bottom right of your screen. 

Click Ask questions to open the chatbot, which you can use to either start a live chat or submit an email support request. 

Please note that while our team can help with questions related to your account, the following are best resolved by contacting the payer:

• Claim denials
• Clients’ coverage and benefits
• Reimbursement rates
• Claims taking a while to process

Additionally, we offer several live live Q&As and on-demand classes, many of which are specific to insurance. You can view available classes and sign up here. 

Note: The Insurance Navigator upgrade offers additional support options, automatic benefits verifications, and AI-powered tools, such as Claim Assistant and payment autofill. These are designed to further reduce administrative burden and time spent working with insurance payers. To learn more, as well as how to sign up, see Introducing Insurance Navigator.