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.
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 our guide on 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 All Clients filter.
- 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 spiral icons in the Write-Off column to have the system automatically populate this field.
- Click Save Payment to add the insurance payment.
Note: You can filter your insurance payments by All Clinicians or All Clients.
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?
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 spiral icons to have the system auto-calculate this for you, 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
If you need to delete or edit an insurance payment to make updates or corrections, here are the steps to follow:
- Navigate to Billing > Insurance.
- Click the Payments tab.
- From here, you can select the insurance payer from the All Insurance Payers dropdown box and use the date range to filter by the payment date.
- Click the blue link on the insurance payer's nam, to navigate to the Insurance Payment page.
- To delete the insurance payment, click the three dots and select Delete Payment.
- To edit the insurance payment, click Edit Payment. After you've made the necessary corrections, click Save Payment.
Adding negative insurance payments
If you need to record a retraction from an insurance payer, SimplePractice allows you to add insurance payments with negative amounts.
This enhancement allows you to keep a more accurate accounting record for all insurance payments. Now, when a payer requests a refund from you for a previous overpayment, you can keep a complete record of both the initial payment and the refunded payment. This lets you preserve all details of the initial payment that you received, including its associated payment reference number and date received:
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.
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 our guide on 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 our guide on 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, let's say 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, so 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.
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 I enter $350 in the Amount field, the Unallocated field will also show $350 (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 appointment. As shown in the example below, when I allocate $150 to the first appointment, the amount in the Unallocated field decreases to $200. And, after I allocate the last $200, 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 of $100. Since the goal is to get the Unallocated field to $0, you should only allocate the amount available.
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.
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.
- 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 that if we do, you wouldn't have a way to record the check number. 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.
- Secondary payments: When entering a secondary insurance payment, you'll need to create a brand 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 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.
- From your SimplePractice calendar, go 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. 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.
Why is my insurance payment only allocating to one service code, when there's multiple on the same date of service?
Currently, 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 Billing > 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 our guide on Understanding Unit Billing and using Multiple CPT Codes in SimplePractice.
Additional insurance resources: