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) sent from the payer or accessed from their online portal to allocate an insurance payment to the appointment(s) that it covers. This is a great way to keep track of which claims have been paid.
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
- 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?
- Why is my insurance payment only allocating to one service code when there's multiple on the same date of service?
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 Setting up insurance billing for your clients.
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.
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.
If 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?
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.
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.
Important: If you don't calculate the write-off amount when adding an insurance payment, the associated insurance claim will not update to Paid.
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
To delete or edit an insurance payment to make updates or corrections:
- Navigate to the Insurance page
- Click the Payments tab
- Select the insurance payer from the All insurance payers dropdown box
- Use the date range to filter by the payment date
- Click View next to the insurance payer's name to navigate to the Insurance Payment page
- To delete the insurance payment, click More > Delete Payment
- To edit the insurance payment, click Edit
- After you've made the necessary corrections, click Save Payment
Adding negative insurance payments
Occasionally, payers will retract or “clawback” an insurance payment. If you’re enrolled to receive payment reports, these clawbacks will be automatically recorded. If you need to manually record a retraction from an insurance payer, you can do so by adding a negative insurance payment. To do this:
- Navigate to the client's Overview page
- Click Add Insurance Payment
- Enter the clawback amount as a negative insurance payment in the Amount and Insurance Paid fields
Note: The original payment will be listed as Other Payment.
- Click Save Payment
To see what this clawback looks like:
- Locate the claim in question
- Click Claim Details under the client's name
- The appointment that had it’s payment withdrawn will have a negative amount balancing out what was initially paid, and the Insurance Paid will show $0
If the payer asked that you resubmit the claim, once you received a finalized payment, add that as you would a normal insurance payment. This will be listed in the Claim’s Details 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 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, 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 How do I submit an enrollment to file claims or 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 for:
- 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 Edit 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 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:
- This status shows as a green check mark next to the date of service. Seeing that green check mark means that you've entered the payments correctly, and there are no discrepancies with the payments related to the appointment.
- 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.
- Payment missing
- This 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
- 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?
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.
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 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.
- 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 Billing > 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. See the image below for an example of what each looks like
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 on the date of service listed on the Payment Report.
If you’d like a payment to apply to more than one appointment 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
- Select the Insurance Payment
- Click Edit Payment 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 spiral 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 spiral 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 Payment Report will show a green check mark next to each date of service.
Note: When services are provided back-to-back by the same clinician, we recommend using our unit billing feature. Our unit billing 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, please see Using Unit Billing and multiple service codes.
Additional insurance resources: