After you create a claim in SimplePractice, its status will automatically update based on:
- The claim's history in your account
- Status updates received from the payer
- The payment status of the appointments billed on the claim
- Electronic Payment Reports (ERAs)
Important: If you're not enrolled to receive Payment Reports from a payer, a successfully submitted claim will only update as far as Accepted in SimplePractice. To receive additional claim status updates, we recommend enrolling to receive Payment Reports from the payers you work with.
In this guide, we’ll cover:
- Viewing claim statuses
- Understanding claim statuses
Note: For an overview of creating and submitting claims, see Filing primary claims in SimplePractice.
Viewing claim statuses
To view the current status of any claim you've created:
- Navigate to Insurance > Claims
- Filter by date, insurance payer, client, claim type, or claim status to locate the claim
- Review the Status column
To navigate to the claim, click View.
Here, you can review the claim’s status and any associated error messages.
You can click Claim Details to review any Payment Reports sent by the payer. These may contain additional information for certain claim statuses, such as Denied or Paid. For more information, see Reviewing the Claim Details page.
Understanding claim statuses
In this section, you’ll find an overview of each claim status and potential next steps. Depending on a claim’s status, you may need to reach out to the payer for additional information. To reference a claim with a payer, you can provide them with the Payer Claim number. Alternatively, you can provide the client’s member ID and the date(s) of service on the claim.
After you create and save a claim in SimplePractice, it’ll update to the Prepared status. This indicates that the claim was successfully created and stored in your account, but it hasn't yet been submitted or downloaded.
If a claim has the Prepared status, it hasn’t been submitted to the payer. You can submit the claim electronically through SimplePractice by clicking Submit in the claim. For more information, see Creating and submitting claims.
Note: If electronic claims aren’t available for a payer, you can download a claim to submit it outside of SimplePractice.
This status appears when a claim is downloaded to your computer. It indicates that you plan to file it outside of SimplePractice. For a walkthrough of downloading a claim, see Creating and printing a CMS 1500 (HCFA) claim form.
If you edit a claim in the Downloaded state, it’ll return to the Prepared state. This indicates that the information on the claim has been updated and this new version of the claim hasn't yet been submitted or downloaded.
Note: Box 31 on a claim populates with the date a claim is created. If a claim is downloaded, the date it was downloaded will populate in box 31 of the downloaded claim.
When you click Submit on any claim created in SimplePractice, it’s automatically reviewed for any errors that could trigger a claim rejection from the payer.
If an error is detected, the claim won’t be submitted and will receive a Scrub status. When viewing the claim, you'll see a message at the top of the page outlining exactly what needs to be corrected, and the field(s) causing the error will be outlined in red.
Note: Because a scrub error takes place before a claim is submitted to the payer, you won't be charged for a scrubbed claim.
A scrub error acts as a safeguard to prevent unnecessary claim rejections and allows you to make the corrections before submitting the claim to the payer.
Navigate to the claim to review the specific errors that require attention before the claim can be submitted.
To resubmit a scrubbed claim, delete the claim, make the necessary changes in your account, and create a new claim for the appointment(s). For steps on resolving common scrub errors, see Scrub errors when trying to file insurance claims.
This status appears when submitting batch claims but due to a momentary connection error with our clearinghouse, one of the claims couldn’t be submitted. The claim will still be created, and since the connection error is only momentary, you can submit the claim again from your Claims page. To do this:
- Navigate to Insurance > Claims
- Click View next to the claim with the Error sending status
- Click Submit at the top of the claim
Note: You won’t be charged for the first submission attempt. Only when the claim is successfully submitted will you incur a claim fee.
When a claim is successfully submitted to the payer, it'll update to the Submitted status. A claim will generally update past the Submitted status within a couple days.
Note: Claim filing fees will apply for any claim that is successfully submitted. For more information, see SimplePractice pricing and subscription FAQs.
Allow the claim a couple of days to move past the Submitted status. If the claim remains in the Submitted status for a prolonged period of time, you can submit a help request so our team can investigate if there's an issue on the payer's end.
This status update occurs when the payer acknowledges that they’ve received the claim.
Important: Processing times can vary by insurance company. On average, most claims are typically processed within 30 days.
Payers vary in the amount of information they share with our team, and the status updates that you receive may differ depending on which payer you're submitting claims to. After a claim is Received, certain payers will send an additional status update to indicate that the claim was Accepted, while others don't and will use these two statuses interchangeably. If your claim remains in the Received status, this doesn't necessarily indicate that there's an issue with the claim.
If a payer generally sends an Accepted status, but certain claims to the same payer remain in the Received status for a prolonged amount of time, it can indicate that there's an issue with the claim(s).
We recommend contacting the payer for a status update if you haven't received an update for a claim that was submitted and has been in the Accepted or Received status for more than 30 days. For instructions on this scenario, see What should I do if my claim is stuck in the “Received” or "Accepted" state?
Some payers will assign a claim the Pending status as an intermediate state. This indicates that they‘ll update the claim status soon.
We recommend waiting up to one week to allow the payer time to update the claim to its final status. If the payer doesn't update the claim after one week, we recommend calling the payer directly to determine what's causing the delay.
More Info Required
Payers will sometimes assign a claim the More Info Required status to indicate that a claim is still being reviewed. All claims are reviewed and audited by payers, but not all payers will share this intermediary status with us. This isn’t a finalized status, and it doesn't indicate that there’s an issue with the claim.
The payer will typically assign the finalized status of this claim within 7-10 business days. If the claim is Accepted, there won’t be further action required from you. If the claim is Rejected, the payer will let you know why so you can make corrections and resubmit.
If a claim remains in the More Info Required status for longer than 10 business days, we recommend contacting the payer directly to determine what's causing the delay.
This status is assigned to claims that were filed online through SimplePractice when they have been accepted into the adjudication process by the insurance company. This indicates that the claim has made it past any scrub errors or rejections and will be processed based on the client's insurance plan.
If you're not enrolled for Payment Reports with the insurance payer, this will be the last status sent to SimplePractice for the claim. If you receive a payment, you can manually add it to update the claim to Paid.
Note: A claim can also be denied after being accepted. If you're not enrolled to receive Payment Reports, the payer will notify you of the denial outside of SimplePractice.
If you're enrolled to receive Payment Reports from the insurance payer, the status of the claim will automatically update based on the Payment Report sent from the payer. If there was a payment, we'll automatically add it and allocate the funds to the individual appointments.
If you're enrolled for Payment Reports and a claim hasn't updated past the Accepted status after the expected processing time, there may be an issue on the payer's end. For next steps, see What should I do if my claim is stuck in the “Received” or “Accepted” state?
Note: If the claim is in the Accepted status and includes a message saying Entity code required, this is language used by the payer and doesn't indicate that there's an issue with the claim.
The Rejected status indicates that the claim was rejected by the payer or one of the payer's trading partners. This is often due to incorrect or invalid information that doesn't match what's on file with the payer. For more information on claim rejections and common causes, see Resolving claim rejections.
Note: A claim is rejected by a payer before entering into their system for processing. Because of this, a payer may not be able to locate a rejected claim in their system.
Navigate to the claim to review the rejection reason.
Once you've determined what needs to be corrected, delete the rejected claim, make the necessary changes in your account, and create a new claim for the appointment(s). If unsure how to resolve a rejection, submit a help request with the secure claim URL so our team can investigate further.
Important: Before deleting a rejected claim, download a copy of the claim and save the Clearinghouse Reference number for your records. For more information, see Recording claim reference numbers.
The Denied status indicates that the payer processed the claim but denied payment. This is often due to the way the claim was submitted or because it isn’t reimbursable based on your contract with the payer.
Note: Payers will sometimes send the Denied status for a deductible claim. For more information, see Claim reads "Denied" but the payer is saying it went to the client's deductible.
You can review a denial Payment Report to determine if the payer sent a denial reason. To do this:
- Navigate to the claim
- Click Claim Details
- Scroll the to the denial Payment Report
- Review if a reason was provided under Remarks
If the reason for denial can’t be determined, reach out to the payer directly for additional information and then resubmit the claim if appropriate. For more details, see Handling claim denials.
Note: Denied claims will often need to be resubmitted as corrected claims. For instructions on this process, see Submitting a corrected claim.
The Deductible status indicates that the claim was denied payment because the client hasn't yet met their deductible.
The client is responsible for the portion of the appointment fee that insurance doesn’t cover. If you receive Payment Reports for the payer, SimplePractice will automatically update the client responsibility for the appointment.
If you receive a Payment Report for a claim that was applied to a client's deductible, SimplePractice won't automatically record the $0 insurance payment. You’ll still need to manually add the insurance payment to record the insurance write-off. For a walkthrough of this process, see Using Payment Reports for a client with a deductible.
The Paid Pending status indicates the payer has authorized payment but hasn’t yet delivered the Payment Report. You'll only see this status if you're enrolled for Payment Reports.
Allow the payer more time to send the Payment Report. If you don’t receive the Payment Report, you can submit a help request so our team can investigate further.
The Paid status indicates that this claim has been processed and a payment has been received.
If you're not enrolled for Payment Reports with the payer
You'll see this state when you've manually added the insurance payment and each of the following conditions is met:
- The Client Owes plus Insurance Paid plus insurance Write-Off amounts for each appointment equal the appointment’s total fee
- An insurance payment is applied to every appointment on the claim
- The appointment fee(s) on the claim in box 24f match the appointment fee(s) on the client’s Billing page
If you're enrolled for Payment Reports with the payer
You'll see this status when the electronic Payment Report is delivered and an insurance payment is automatically generated for the claim. For more information, see ERAs in SimplePractice (Payment Reports).