Resolving rejected enrollments

Submitting an enrollment to receive Payment Reports and/or file claims is an important step to start billing insurance through SimplePractice. During this process, you may receive an enrollment rejection. If this occurs, you can contact the insurance payer and follow the steps below to resubmit.

• Viewing a rejected enrollment
• Resubmitting an enrollment
• Completing additional steps

Note: For more information about submitting enrollments, see Submitting enrollments to file claims and receive Payment Reports.

Viewing a rejected enrollment

When an enrollment is rejected, you’ll receive an email notification, and the enrollment’s status will update to Rejected on the payer’s enrollment page. To view the enrollment status:

1. Navigate to Settings > Client billing and insurance > Payers
2. Locate the payer
3. Click View Details

4. Review the enrollment's status in the Enrollments section

5. Click Manage and select the enrollment type to view the rejection reason

For more information on enrollment statuses, see Viewing enrollment statuses.

Resubmitting an enrollment

If your enrollment is rejected, you can resubmit it. Before resubmitting, contact the payer to confirm that the following information on file is accurate:

• The billing provider NPI approved to file electronic claims
  • If billing as a group, this is typically the organization (Type 2) NPI
• The Tax ID or Social Security Number associated with the billing provider NPI
  • Group practices may use a unique tax number tied to the group NPI
• The full legal name and address associated with the billing provider NPI

Note: You must be credentialed with the payer before an enrollment can be accepted. For more information, see The credentialing process.

To resubmit your enrollment:

1. Navigate to Settings > Client billing and insurance > Payers
2. Locate the payer
3. Click View Details

4. Select Manage and choose the rejected enrollment type

5. Review the Payer’s rejection message

Note: Some rejection messages include instructions for confirming your information with the payer or request a Change of Vendor (COV) letter. For details, see Completing additional steps.

6. Select Resubmit Enrollment
7. Click Yes, I want to resubmit

8. Select the enrollment type(s) to resubmit
9. Click Continue to Billing Information
10. Select Type 1 Individual NPI or Type 2 Organization NPI based on the payer’s records

11. Enter your billing provider information
12. Click Continue to Signature
13. Enter your signature and select Continue to Review & Submit
14. Review your details and click Submit Enrollment

After submitting, the enrollment status will update to Submitted while processing continues.

Completing additional steps

A Payment Report enrollment may be rejected if you’re already receiving ERAs through another clearinghouse. You may see instructions to “submit the COV (change of vendor).”

To resolve this, you’ll need to submit a Change of Vendor letter, which our clearinghouse will forward to the payer.

Note: Only submit a COV letter if the rejection message specifically requests one.

Your COV letter must include:

• Your name, address, and today’s date
• A short paragraph stating:
  • “Please update my enrollment with [INSURANCE PAYER] to receive Payment Reports through SimplePractice. Below is the requested information:
  • TIN (tax ID number):
  • NPI:
  • Payer Name:
  • Payer ID (found in your Payers page)
  • Clearinghouse / Company Name / User ID: Eligible, Inc. GATE0164”
• Your printed name and signature

When your letter is ready, submit a help request with the COV letter attached. Our team will submit it to the clearinghouse.

If your enrollment updates to Info required after resubmission, this means the payer needs additional steps completed outside of SimplePractice. For more details, see Why is my enrollment requiring additional steps?

Important: If these required steps aren’t completed, the payer may reject or stop processing your enrollment.