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.

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 from the payer to allocate an insurance payment to the appointment(s) that it covers. This allows you to  keep track of which claims have been paid in your SimplePractice account. 

In this guide, we'll cover:

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

Adding an insurance payment

You can add a manual insurance payment by going to Insurance > Add insurance payment, or directly from a client's profile by clicking Add Insurance Payment in the right panel.

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 Information 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: 

• Click Add Insurance Payment

• Select the insurance payer you'd like to add a payment for from the Payer drop-down 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
• Enter the Payment Date and Payment Method
• 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?
• Select the client(s) name(s) from the All Clients filter
  • Only clients that have this insurance payer listed in their insurance information settings will appear
• Enter the total insurance payment amount in the Amount field

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

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

• If the client responsibility needs to be updated, enter this in the Client Owes field
• Click the blue spiral icons in the Write-Off column to have the system automatically populate this field

• Click Save Payment to add the insurance 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 update to Paid?

Entering write-offs

When you’re billing insurance companies for reimbursement, it’s likely that your contracted rate will be lower than your advertised session fee. The amount that is the difference between your total appointment fee and the amount that you’re actually paid is referred to as the 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 blue spiral icons 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 correctly. To do this: 

• Navigate to Calendar > Insurance 
• Click the Payments tab

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 Copay/Coinsurance amount in their Insurance Information settings, you can make adjustments to this amount directly when adding an insurance payment.

When adding an insurance payment, update the Client Owes field to reflect the client's responsibility for the appointment.

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. 

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, there are three things to check:

• 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 Information. 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?

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

The Payment overview will show payment statuses for each date of service included on a claim. Reading these statuses will help you pinpoint if you need to make any corrections to the insurance payment.

A payment status can be:

• Settled
  • This status means that the total Client Responsibility, Insurance Paid, and Write-Off amounts for an appointment are equal to the appointment fee. 
• Write-off too high
  • This status means that the insurance write-off amount exceeds the expected write-off. For example, if your session fee is $100, your client has a $20 copay, and the insurance is responsible for $60, the expected write-off for that appointment would be $20. Any amount over that would trigger this status.
• Pending
  • This status means that the payments entered from both the client and insurance company aren’t enough to cover the full fee of that appointment. This can often be the case if a payment hasn’t been added yet or if the write-off is missing. 
• Duplicate Payments 
  • This status means that the amount paid for this appointment by either the client or the insurance company exceeds the total appointment fee. If there are multiple payments listed, go through each one to locate the duplicate.

Why does my manually added insurance payment have an unallocated amount?

The Unallocated field on an insurance payment reflects the difference between the Amount field and the sum of the amounts in the Insurance Paid column.

Understanding unallocated amounts

The unallocated amount is the running balance used to keep track of a payment's available funds, specifically the amount still available for distributing to additional appointments. 

When you add an insurance payment with a designated Amount, you'll notice that the adjacent Unallocated field will initially match. In the example below, when entering $50 in the Amount field, the Unallocated field will also show $50.

When adding insurance payments, the unallocated amount should be $0. This signifies that the entire payment amount is accurately accounted for. 

As you start allocating payments to appointments, the unallocated amount goes down by the amount you allocated to each appointment. In the example below, when $50 is allocated to the first appointment, the amount in the Unallocated field decreases to $0.

Why do I have a negative unallocated amount?

A negative unallocated amount happens when more money is allocated to the sessions than the full amount of the payment received. In the example below, there’s a payment of $50, but $70 is allocated, resulting in a negative unallocated amount of $20.

Because the goal is to have $0 in the unallocated field, only the payment amount should be allocated to the appointment.

Note: Unallocated amounts on insurance adjustment payments are expected and a correct way of reflecting your income. For more information, see Reviewing unallocated amounts on adjustment insurance payments.

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 only 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 new payment. 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 the payer sent you this second time while having a record of the original payment as well. 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?

Insurance payments that were added automatically because you received a Payment Report include an indicator that can be seen in two different places.

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

• From your SimplePractice calendar, navigate to Insurance > Payments. From there, you'll be able to see all of the insurance payments that have been added for any specific date-range you select. Payments that were automatically generated via an electronic Payment Report will have a question mark icon. Payments that were manually added won’t have this. 

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:

• Navigate to Insurance > Payments
• Use the All Insurance Payers filter to choose the client's insurance payer
• Sort the date range by the date the payment was received
• Click View next to the insurance payment

• Click Edit in the upper right hand corner
• 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
• Click the wheel icon next to the appointment under the Write-Off column

• Click All Appointments

• Select the All Clients filter and choose the client in question
• 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
• Click the wheel icon next to the appointment under the Write-Off column
• Click Save Payment

Once you’ve successfully changed the Insurance Paid and Write-Off amount 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, so you may find that this helps to streamline your billing processes. For more information on Unit Billing, see Using Unit Billing and multiple service codes.