Adding insurance payments

When you receive insurance payments for claims that you’ve filed, you can manually add insurance payments to keep your accounting records up to date. 

To add a manual insurance payment, you'll use the payment information outlined on the Explanation of Benefits (EOB) sent from the payer, or accessed from their online portal, to allocate an insurance payment to the appointments that it covers. This is a great way to keep track of which claims have been paid.

Tip: Enrolling for electronic payment reports from the payers that you bill can help streamline this process for you by automatically adding insurance payments to mark your claims as Paid. 

Adding insurance payments

• 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

• Why are there appointments missing when I try to add an insurance payment?
• Why won’t my claim update to Paid?
• Why does my manually added insurance payment have an unallocated amount?
• 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?

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Adding an insurance payment

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 our guide: Setting up insurance billing for your clients.

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

From the Add payment screen:

• Select the insurance payer you'd like to add a payment for from the Payer drop-down menu.
  • If 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 the 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 Client drop-down menu.
  • Note: Only the 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.
• Click the blue refresh icons in the Write-off column to have the system automatically populate this field.
  
• Click Save 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. If the payment has been added properly, the claim's status will update to Paid. If you're not seeing this status, jump ahead to: Why won’t my claim update to Paid?

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Entering write-offs

By definition, a write-off is a reduction of the recognized value of something. When billing insurance companies for reimbursement, it is likely that your contracted rate will be lower than your advertised session fee. So, the amount that you "write-off" would be the difference between your total appointment fee and the amount that you are actually paid. When adding a manual insurance payment, use the blue refresh icons to have the system auto-calculate this for you and easily track the write-off amount for each appointment.

Important: If you do not calculate the write-off amount when adding an insurance payment, the associated insurance claim will not update to "Paid"

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Editing or deleting an insurance payment

If you need to delete or edit an insurance payment to make updates or corrections, here are the steps to follow:

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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, SimplePractice makes it easy for you to make adjustments to this amount directly when adding an insurance payment.

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

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

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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 for:

• The date range must be set correctly:
  • Check to make sure that the date range includes the Date of Service (DOS) for the appointment(s) you're looking for.

• The appointment's Billing Type must be set to “Insurance:”
  • Navigate to the client's Billing page of their profile and click Edit on the appointment in question to make sure that it's set to "Insurance Pay:"

• You haven’t assigned the appropriate insurance company to your clients.
  • 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 Insurance Information.To make sure your client is set up properly, see our guide: Setting up insurance billing for your clients.

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Why won’t my claim update to Paid?

The Payment Overview section of a claim is the best place to way 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: "Good," "Write-off too high", "Payment missing," or "Duplicate Payments recorded."

What do these statuses mean?

• Good status means that you have entered the payments correctly and there are no discrepancies with the payments related to this appointment.
• Write-off too high status means that the insurance write-off amount exceeds the expected write off. For example, let's say your session fee is $100, your client has a $20 co-pay, and the insurance is responsible for $60. The expected write-off for that appointment would be $20 and any amount over that would trigger this status.
• Payment missing status means that the payments entered from both the client and insurance company are not enough to cover the full fee of that appointment. This can often be the case if the write-off is missing for an appointment.
• Duplicate payments recorded status means that the amount paid for this appointment, by either the client or the insurance company, exceeds the fee for the appointment.

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

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 will notice that the adjacent Unallocated field will initially match. In the example below, when I enter $200 in the Amount field, the Unallocated field will also show $200 (until I allocate it to an appointment).

The goal is get the unallocated amount to $0.

 

As you start allocating payments to appointments, the unallocated amount goes down by the amount you allocated to each appointments. As shown in the example below, when I allocate $100 to the first appointment, the amount in the Unallocated field decreases to $100. And, after I allocate the last $100, the Unallocated field now shows $0. 

Why do I have a negative unallocated amount?

A negative unallocated amount happens when you have allocated more money to the sessions than the full amount of the payment you received. In the example below, you'll see that I have a payment of $200, but I allocate $300 which results in a negative unallocated amount. Since the goal is to get the Unallocated field to $0, you should only allocate the amount available.

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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 Existing payment on XX/XX/XXXX from ..., this means that a payment was already entered for that appointment. 

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

1. You or a Team Member in your account already entered the payment manually.
2. You're receiving Payment Reports from the insurance payer and the payment was entered automatically by our system.

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Can I add multiple insurance payments for the same appointment?

There are a couple of cases in which you'd want to enter a second payment for the same appointment.

1. Insurance Corrections: If the insurance payer made a mistake when they originally processed the claim and now they have sent you some more money for the same session, you will have to enter a new payment to account for that new payment. The reason we're not adding that money to the original payment is because if we do, then you wouldn't have a way to record the check number. This way, by adding a new payment you can enter a new check number that is just for the amount the payer sent you this second time. 
2. Secondary payments: When entering a secondary insurance payment, you will need to create a brand new payment for a specific session. This guide will give you details on how to enter the secondary insurance payments. 

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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. 

1. If you open the actual insurance payment you will be able to see that next to the Check or Wire number, there's an "i". That indicates that the payment was added automatically. If you don't see that symbol, it means that the payment was added manually. 
2. From your SimplePractice calendar, go to Billing > Insurance > Payments. From there, you will be able to see all of the insurance payments that have been added for any specific date-range you select. Again, if you see an "i" next to the Check or Wire number that means that that specific payment was added automatically by our system. If you don't see that, you can be certain that the payment was added manually. 

Additional insurance resources:

• Payment reports (ERAs)
• Checking a claim status: The different phases of an insurance claim