Adding insurance payments

After an insurance payer processes your payment, you'll need to record that payment in SimplePractice to keep your account records up-to-date. To do this, you can either enroll to receive electronic Payment Reports (ERAs) to automatically record the payments, or you can manually add insurance payments.

In this guide, we'll cover:

• Adding an insurance payment
• Entering insurance write-offs
• Editing or deleting an insurance payment
• Manually confirming insurance payments
• Adding negative insurance payments
• Updating a client’s copay when adding an insurance payment
• FAQs

Adding an insurance payment

To manually add an insurance payment, you'll use the payment information outlined on the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) sent by the payer. You can add the payment by navigating to Insurance > Add insurance payment, or directly from a client's profile.

Important: You won't be able to add an insurance payment for a client unless their Billing Type is set to Insurance and their insurance payer has been added to their Insurance info settings. To make sure your client is set up properly, see Setting up insurance billing for your clients.

To add an insurance payment from a client's profile: 

1. Click Add Insurance Payment

2. Select the insurance payer from the Payer dropdown menu

• If you're adding an insurance payment from a client's profile, their primary insurance will automatically be selected as the payer
• If the payment you need to add is from a client's secondary insurance or another insurance payer that the client previously had, you can manually select the correct payer from the searchable Payer list

3. Enter the Payment Date 
4. Select the Payment Method and enter the Payment Number, if applicable
5. Under All Appointments, set the date range to include all of the appointment(s) associated with the payment
   • If no appointments display, see Why are there appointments missing when I try to add an insurance payment?

6. Select the client(s) name(s) from the All Clients filter
   • Only clients that have the selected insurance payer listed in their insurance information settings will appear
   • If you're adding an insurance payment from a client's profile, the client will already be pre-selected
7. Enter the total insurance payment amount in the Amount field

8. In the Insurance Paid column, enter the amount that covers each individual appointment

Important: The total of the amounts allocated to each appointment included in the payment must match the total payment Amount. If the amounts don't match, the difference will be listed as an unallocated amount. 

9. If the client responsibility needs to be updated, enter this in the Client Owes field
10. Click the wheel icon in the Write-Off column to automatically calculate the insurance write-off 

11. Click Save Payment 

When you return to the client’s Billing page, you’ll see the insurance payment and the write-off applied.

When the payment has been added properly, the claim's status will update to Paid. If you're not seeing this status, see Why won’t my claim status update to Paid?

Entering insurance write-offs

When you’re credentialed with an insurance payer, your contracted rate may be lower than your advertised session fee. The difference between your total appointment fee and the amount that you’re actually reimbursed is referred to as the contractual obligation, or insurance Write-Off.

Important: If you don't calculate the write-off amount when adding an insurance payment, the associated insurance claim won’t update to Paid.

When adding a manual insurance payment, click the wheel icon in the Write-Off column to have the system auto-calculate this and easily track the write-off amount for each appointment.

Note: If you're enrolled for Payment Reports, the write-off amount will already be calculated in the automated insurance payment.

Editing or deleting an insurance payment

If an insurance payment isn’t reflecting correctly, you can edit or delete the payment so that your insurance income reflects accurately. To do this: 

1. Navigate to your Calendar > Insurance
2. Click the Payments tab

3. Select the insurance payer from the All insurance payers dropdown box 
4. Use the date range to filter by the payment date
5. Click View to navigate to the payment 

To delete an insurance payment:

1. Click More > Delete Payment

2. Select Delete now in the confirmation window

To edit an insurance payment:

1. Click Edit

2. After you've made the necessary corrections, click Save Payment

Manually confirming insurance payments

There can be delays between when a claim receives an ERA/EOB stating its paid and when the payment is physically received. This is more common if the payment is sent in the form of a check.  

Manually confirming insurance payments allows you to keep track of payments that are fully accounted for, as well as those that require a follow-up. To do this:

1. Navigate to Insurance > Payments
2. Use the Payment Status dropdown to mark a payment as Received or Not Received

You can use the Payment Status filter to display payments that have or haven’t been received, as well as those that still need to be reviewed.

Note: Payments that aren’t updated to Received or Not Received are considered Unreviewed.

Adding negative insurance payments

Occasionally, payers will adjust, or clawback, a previous insurance payment. If you’re enrolled to receive Payment Reports, these clawbacks will be automatically recorded. 

Note: For an overview of handling insurance adjustments, see Managing insurance adjustments. 

If you need to manually record a clawback from an insurance payer, you can do so by adding a negative insurance payment. To do this:

1. Navigate to the client's Overview page
2. Click Add Insurance Payment
3. Enter the clawback amount as a negative insurance payment in the Amount and Insurance Paid fields

• The original payment will be listed as Other Payment

Note: The Amount field of an insurance payment should reflect the transfer of funds between you and the insurance payer. If the payer didn’t request that you return the funds for the retraction, enter $0 in the Amount field.

4. Click Save Payment

If you received an updated payment, add that as you would a normal insurance payment. 

Note: If the payer withheld the funds they initially paid you from the updated payment, only enter funds that were delivered for the updated payment in the Amount field. If all funds were withheld, enter $0 in the Amount field. 

To review the payments: 

1. Locate the claim in question
2. Click Claim Details under the client's name

3. Scroll to Payment overview

The appointment that had its payment withdrawn will have a credit amount balancing out what was initially paid.

If you added an updated payment, it’ll be listed in chronological order. 

Adding negative insurance payments lets you preserve all details of the initial payment that you received, and allows you to keep an accurate accounting record for all insurance payments.

Updating a client’s copay when adding an insurance payment

In certain situations, a client's copay may vary from what's listed on their insurance plan. If you've already entered a client's default Copay/Coinsurance amount in their Insurance info settings, you can adjust this amount when adding an insurance payment by updating the Client Owes field. 

When this is saved, the billing details for the appointment will automatically be updated to align with the insurance payment.

Note: Insurance payments and coinsurance amounts will be automatically recorded if you're enrolled to receive Payment Reports from the payer. For more information on enrolling in Payment Reports, see Submitting enrollments to file claims and receive Payment Reports.

FAQs

• Why are there appointments missing when I try to add an insurance payment?
• Why won’t my claim status update to Paid?
• Why is there an existing payment for an appointment?
• Can I add multiple insurance payments for the same appointment?
• How can I tell the difference between manually added insurance payments and insurance payments that were automated by a Payment Report?
• Why is my insurance payment only allocating to one service code when there's multiple on the same date of service? 

Why are there appointments missing when I try to add an insurance payment?

If you’re adding an insurance payment and the appointments you expect to see aren’t showing up, check the following:

• Is the date range set correctly?
  • Check to make sure that the date range includes the date of service (DOS) for the appointment(s) you're looking for

• Is the appointment's billing type set to Insurance?
  • Navigate to the client's Billing page of their profile and click Manage > Edit details on the appointment in question to make sure that the Type is set to Insurance

• Is the appropriate insurance company assigned to your client(s)?
  • Find the client whose appointment isn’t showing up and check their Billing and Insurance settings to make sure the appropriate insurance company is listed under their Insurance info 

To make sure your client is set up properly, see Setting up insurance billing for your clients.

Why won’t my claim status update to Paid?

A claim’s Payment overview section is the best place to check for any payment errors that might be preventing a claim's status from updating to Paid. To view the Payment overview, navigate to the claim in question and click Claim Details below the client's name.

The Payment overview will show the payment status for each date of service included on a claim. These statuses will help you pinpoint if you need to make any corrections to the insurance payment. Below, we’ll cover each status.

Why is there an existing payment for an appointment?

If you try to add an insurance payment for an appointment and you see that there's a line under that appointment that states Other Payment with the insurance payer's name, it means that a payment was already entered for that appointment.

There are two reasons why there would be an existing insurance payment: 

• You or a team member in your account already entered the payment manually
• You're receiving Payment Reports from the insurance payer, and the payment was entered automatically by our system

If there's an Other Payment, click on it to view when it was added.

Can I add multiple insurance payments for the same appointment?

There are generally two scenarios in which you'd want to enter a second payment for the same appointment.

Insurance corrections

If the insurance payer made a mistake when they originally processed the claim and now they’ve sent you more money for the same session, you’ll have to enter a new payment to account for that additional amount. The reason you’re not adding that money to the original payment is that there wouldn't be a way to record the check number. 

By adding a new payment, you can enter a new check number that’s only for the amount of the second payment, while retaining a record of the original payment. For more information on how insurance adjustments should reflect, see Managing insurance adjustments. 

Secondary payments

When entering a secondary insurance payment, you'll need to create a new payment for a specific session. For details on how to enter secondary insurance payments, see Adding a secondary insurance payment.

How can I tell the difference between manually added insurance payments and insurance payments that were automated by a Payment Report?

There are two indicators for insurance payments that were added automatically from a Payment Report:

• If you open the insurance payment, you’ll see a notice that This payment was automatically generated followed by the date it was received

• On the Insurance > Payments page, payments that were automatically generated via Payment Report will have a question mark icon. 

Note: If you’re not seeing the insurance payment in question, expand the date range to include the insurance payment’s date.

Why is my insurance payment only allocating to one service code when there's multiple on the same date of service? 

Payment Reports in SimplePractice are only able to allocate an insurance payment for the first appointment for an individual client on the date of service listed on the Payment Report.  

If you’d like a payment to apply to more than one appointment for an individual client on the same day, you can manually edit the insurance payment and allocate the funds to the appropriate appointments. To do this:

1. Navigate to Insurance > Payments
2. Use the All Insurance Payers filter to choose the client's insurance payer
3. Sort the date range to include the date the payment was received
4. Click View next to the insurance payment

5. Click Edit in the upper right hand corner
6. Enter the amount listed on the Payment Report for that service code in the Insurance Paid column, next to the client's appointment that already has an insurance payment applied to it

7. Click the wheel icon next to the appointment under the Write-Off column
8. Click All Appointments

9. Select the All Clients filter and choose the client in question
10. Adjust the date range to include the date of service of the other appointment(s)
11. Enter the amount listed on the Payment Report for that service code in the Insurance Paid column, next to the client's appointment that doesn't have a payment applied to it

12. Check that the Client Owes is correct 
13. Click the wheel icon next to the appointment under the Write-Off column
14. Click Save Payment

Once you’ve successfully changed the Insurance Paid and Write-Off amounts for each of these appointments, the claim’s Payment overview will reflect Settled for each date of service. 

Note: When services are provided back-to-back by the same clinician, we recommend using our Unit Billing feature. This feature is designed with multiple same-day service appointments in mind and helps streamline your billing processes. For more information on Unit Billing, see Using Unit Billing and multiple service codes.