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 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
• Submitting multiple enrollments per payer
  
• Viewing enrollment statuses
• 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. 

A Ready to enroll status in either column indicates an enrollment is required. Click Manage 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.

A Ready to enroll status in the Claim filing enrollment column means the payer requires you to have an accepted enrollment before being able to submit claims electronically.

A 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 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 a payer has on file. This 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 typically 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 Manage

• Click Enroll

• 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

• Enter the required information 

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.

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 can view the status of the enrollments for a payer by clicking Manage beside the payer on the Payers page. You'll see the status change to Accepted once approved by the payer.

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

Submitting multiple enrollments per payer

Group practices typically submit claims and enrollments under an organization (Type 2) NPI. However, there are times when certain clinicians need to enroll with a specific payer using their own, unique billing provider information. In this case, you can submit multiple enrollments to the payer. 

Enrolling with multiple NPIs means that you can submit all claims for the practice and receive Payment Reports in one account, which reduces the need for adding insurance payments manually. 

Important: Only one enrollment can be submitted per NPI to a payer in SimplePractice. If you want to submit an enrollment already linked to another SimplePractice account, please submit a help request with the payer name, payer ID, and NPI for the enrollment. 

To submit multiple enrollments to a single payer: 

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

• Click Enroll

• Enter the clinician’s information and submit the enrollment following the steps in Submitting an enrollment to file claims and/or receive Payment Reports

You can review the status of all enrollments submitted to a payer on the payer’s enrollment page.

Note: If submitting multiple enrollments to a single payer, you can add corresponding billing profiles so that claims to that payer automatically populate matching billing information. Billing profiles are recommended if certain clinicians in a practice bill insurance using information that differs from your practice’s default billing information. For more information, see Managing billing profiles for insurance. 

Viewing enrollment statuses

Once an enrollment is submitted, its status will display on the payer’s enrollment page. To view an enrollment’s status:  

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

• Review the statuses in the Claim Filing and Payment Reports columns 

You can click Manage Enrollment to view an enrollment’s details, submit additional documentation for the Document required status, or resubmit Submitted or Rejected enrollments. 

Below, you’ll find a description of each enrollment status. 

You can review the billing information listed on an enrollment if it’s in the Submitted, Accepted, or Rejected status. To do this, click Review Enrollment Details on the Manage Enrollment page. 

Manually adding a payer

If a payer you need to bill isn’t available, you can manually add them to 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

• Click + Address to 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. 

You can remove a payer from this list at any time. To do this:

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

• Click Remove payer

A payer can’t be deleted if it’s assigned to a client. If you try to delete a payer that’s still assigned to a client, you’ll be prompted to remove the payer from the client’s Insurance information. 

To determine which clients are still assigned to a payer:

• Navigate to your calendar > 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 each client that appears

• Navigate to that client's Billing and Insurance tab
• Click Edit next to the 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 payers based on the order they were added.

The Priority filter sorts 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.