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Coverage Reports in SimplePractice

Coverage Reports in SimplePractice

 

When online claim filing is enabled for your account, you can easily create a Coverage Report for your clients to see the details of their insurance coverage for $0.05 each report.

Currently, most payers are not including mental health coverage details in these reports and because of this, we do not recommend to use this report to verify member eligibility and benefits.

Important: Verification of benefits and eligibility should be completed by calling the payer, using an online provider portal or another clearinghouse.

In order to use this feature, the client's Billing Type must be set to "Insurance" Read more about the client's billing type here.

Setting Billing Type to Insurance in SimplePractice

Once the billing type is set for your client, make sure you have the following information filled out before you run a coverage report:

  • In your Practice Settings:
    • NPI Number
  • For your Client, click Edit and enter:
    • Date of birth
    • Gender
    • Insurance Payer Name/ID
    • Member ID
  • If Client is not the Primary Insured:
    • Primary Insured/Subscriber Name
    • DOB
    • Gender

Once you have verified that all the above information is properly filled out, go to the Billing page for the Client. In the Insurance Info section, click View Coverage and you will be taken to the Insurance Coverage Report page where you can view the report and download the report.

View Coverage link located in the Insurance Info section of SimplePractice

Note: If you don't see the View Coverage link, that means the client's insurance payer isn't yet set up for automated coverage reports. If you run into this, let us know and we'll see what we can do about getting the insurance payer set up. Contact us and tell us which insurance payer you'd like to set up for coverage reports.

View past Coverage Reports

A record of all your coverage reports is available for you to access at any point. Simply go to Reports > Coverage Reports.

All coverage reports are available through the Coverage Reports link via the Insights section in SimplePractice

Coverage Report error messages

 "Invalid/Missing Provider Identification"

If you receive this error message when running a coverage report, this means the payer requires you to file your first online claim with them before they will deliver coverage report information. 

"Payer ID is not supported by SimplePractice" or "Unable to respond at current time"

Coverage report requests can fail for several reasons:

  • The client's subscriber information may be inaccurate.

  • The payer may not yet offer electronic coverage reports for this client.

  • Our clearinghouse may not have an established connection with the payer to request/receive coverage reports

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