An enrollment is the process of informing an insurance payer that you plan to submit electronic claims and/or receive electronic Payment Reports (ERAs) through SimplePractice. Many payers don’t require claim filing enrollments, but all payers that we have Payment Report connections with require Payment Report enrollments.

Important: The enrollment process is separate from getting paneled or credentialed with an insurance payer. You’ll typically need to already be credentialed with an insurance payer for them to approve your enrollment. SimplePractice can’t assist with the credentialing. For more information, see The credentialing process. 

In this guide, we’ll cover: 

• Determining if an insurance payer requires an enrollment
• Submitting an enrollment to file claims and/or receive Payment Reports
• Manually adding a payer
• Removing a payer
• Sorting your insurance payers

Note: For answers to commonly asked questions about enrollments, see Enrollment FAQs. 

Determining if an insurance payer requires an enrollment

Most payers don’t require that you submit a claim filing enrollment to submit claims electronically. Payers that do require an enrollment to submit claims include Medicare, Medicaid, and some BCBS payers. 

A Payment Report enrollment isn’t typically required, but it’s recommended to automate your bookkeeping. For more information on the benefits of submitting a Payment Report enrollment, see ERAs in SimplePractice (Payment Reports).

To determine a payer’s enrollment requirements: 

• Navigate to Settings > Insurance
• Click Search available payers

• Search the payer ID or the payer’s full name as it appears on the client's member ID card

Note: For more information on choosing a correct payer, see Adding insurance payers and selecting the correct payer ID.

• Click + Add

The payer will now be added to your Payers page. The payer's enrollment requirements will be displayed in the Claim filing enrollment and Payment report enrollment columns. 

An Enroll option in either column means an enrollment is available. Click Enroll to begin the process of submitting the enrollment. For an overview of these steps, see Submitting an enrollment to file claims and/or receive Payment Reports.

An Enroll option in the Claim filing enrollment column means the payer requires you to have an accepted enrollment before being able to submit claims electronically. 

A green checkmark and Ready to file claims status indicates that no claim filing enrollment is required and you can start submitting claims right away. 

Important: Even though a payer says Ready to file claims in the Claim filing enrollment column, you’ll still need to be credentialed with them or be approved to file claims as an out-of-network provider. 

If there’s a green checkmark and Ready to file claims status in the Claim filing enrollment column, but a Not Supported status in the Payment report enrollment column, you’re able to submit claims to this payer electronically, but electronic Payment Reports aren’t supported.

For payers that don't support payment reports, we recommend manually adding insurance payments to keep your records up-to-date. 

Submitting an enrollment to file claims and/or receive Payment Reports

The billing information submitted on your enrollments needs to match what the payers have on file. Billing information required on enrollments includes: 

• The billing NPI that’s on file with the payer and that’s approved to file electronic claims
  • If you’re billing as an organization, this will be your group NPI
• The Tax ID or Social Security Number associated with your billing NPI
  • For group practices, this may be a unique number tied to your group NPI
• The full name (personal or organization) and address associated with your billing NPI

Important: If there’s any mismatch between the information the enrollment is submitted under and what the payer has on file, the enrollment can be rejected. To avoid longer processing times, confirm that the payer has your up-to-date billing information before submitting an enrollment. 

Once you have your information ready, you can submit an enrollment. To do this: 

• Navigate to Settings > Insurance
• Locate the payer
• Click Enroll

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• Confirm you’ve read the on-screen information and click Begin Enrollment

• If the payer requires a claim filing enrollment, you’ll be able to submit both enrollments (claim filing and Payment Report) from the Enrollment Type page

• Choose Type 1 Individual NPI if billing as an individual provider, and Type 2 Organization NPI if billing as part of an organization

• If you're submitting an enrollment under your Type 1 Individual NPI, the following billing information will be required

• If submitting an enrollment under your Type 2 Organization NPI, the following billing information will be required

Note: The PTAN field is only required for Medicare enrollments. If submitting an enrollment under your Type 2 Organization information, you may have a separate group PTAN. If you’re unsure what your PTAN is, contact Medicare directly. For more information, see What is "PTAN" on the enrollment page?

• Once the information is entered, click Continue to Signature
• Enter your electronic signature and click Continue to Review & Submit

• Review and confirm the information entered, and click Submit Enrollment

Typically, it takes between 2-8 weeks for insurance payers to process your enrollment request. You can view the status of all of your enrollments and enrollment requests in your Payers page. 

Note: For more information on the average enrollment approval times for each payer, see Average payer enrollment approval times. 

We'll email you when your enrollment has been completed or if there are any other steps needed from you to complete this process. Some enrollments will require additional documents to continue processing the enrollment, which will update the enrollment status to Document Required. For more information, see Why is my enrollment requiring additional steps?

Important: Payers will sometimes notify clinicians of enrollment approval without notifying our clearinghouse. If you receive a notice from the payer stating that they've accepted your enrollment, see What should I do if I receive an enrollment approval from the payer, but my enrollment still shows as Submitted? 

You'll see the status change to Ready to file claims and Ready to receive ERAs once accepted. 

Note: If your enrollment is Rejected, see Resolving rejected enrollments.

Manually adding a payer

If a payer you need to bill isn’t available, you can manually add them into SimplePractice. By manually adding a payer, you’re able to prepare and download your claims so they can be submitted outside of SimplePractice. 

Important: Manually adding a payer won’t make that payer eligible for electronic claim filing or Payment Reports. If a payer isn’t in our system, our clearinghouse doesn’t have an active connection with them. 

To manually add a payer: 

• Click Add payer manually

• Enter the Payer name and Coverage Type
  • If this is an EAP, choose Other for the Coverage Type

• Enter the address
• Click Save

Manually added payers will be marked as Manual in your Payers page and won't support either enrollment type. 

Removing a payer

The Payers page will list all insurance payers that you’ve added, as well as any that are currently assigned to at least one client. 

If you aren’t billing a payer anymore, a payer was added in error, or you’d like to manage this list, you can remove a payer at any time. To do this: 

• Navigate to Settings > Insurance 
• Locate the payer 
• Click Edit

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• Click Delete payer

A payer can’t be deleted if it’s assigned to at least one client. If you try to delete a payer that’s still assigned to at least one client, you’ll be blocked from doing so, and will be asked to remove the payer from the client’s Insurance Information. 

To determine which clients are still assigned to that payer: 

• Navigate to your calendar homepage > Clients 
• Enter the payer ID in question in the Insurance payer filter
  • You’ll see all clients who are actively assigned to that payer

• Click Manage > Edit Client Info next to the client(s) that appear

• Navigate to that client's Billing and Insurance tab
• Update the insurance payer under Insurance info

• Update the Insurance payer to the client’s current payer

• Click Save 

If you don’t have a client’s updated insurance information or they‘re now self-pay, you can click the trash icon to remove the payer.

Note: If you’re no longer seeing a client, you can mark them as Inactive. This will allow you to keep their insurance payer records in their profile while deleting the payer from your account. For more information, see Making a client inactive.

Repeat these steps until all clients are unassigned from the payer in question. You can then return to your Payers page to delete the payer. 

Sorting your insurance payers

You have the ability to sort your Payers list as you add payers and submit enrollments. To do this: 

• Navigate to Settings > Insurance
• Click the Sort filter 

The Most recent filter sorts the payers based on the order they were added.

The Priority filter sorts the payers based on the following order: 

• Document Required
• Rejected
• Enroll
• Submitted
• Ready to receive claims / ERAs
• Payers that don’t require enrollments
• Manually added payers

Tip: The Priority filter lists enrollments that require action first. This makes it easy to determine which enrollments haven't been completed.