Coverage Reports allow your clients to see the details of their insurance coverage. When online claim filing is enabled for your account, you can create a Coverage Report.

If some insurance payers haven’t included mental health coverage details on the Coverage Report, you can verify a client's benefits and eligibility by calling the payer, using their online provider portal, or using another clearinghouse.

In this guide, we’ll cover:

• Requesting a Coverage Report
• Locating insurance reports
• Coverage report error messages

Note: Coverage Reports are only available on the Essential and Plus plans and cost $0.05 each. 

Requesting a Coverage Report

To request a Coverage Report, the client's Billing Type must be set to Insurance. To adjust the client’s Billing Type:

• Navigate to the client’s Billing page
• Click Edit
• Select the Billing and Insurance tab 
• Under Billing Type, choose Insurance

• Click Save Client

Note: To learn more about updating a client’s file, see Editing a client's information.

Once the Billing Type is set for your client, make sure you’ve entered the following information before you request a Coverage Report:

• On your Clinical info page:
  
  • NPI Number

• On your client’s Overview page > Edit > Client Info tab
  • Date of Birth

• • Assigned Sex
  • Gender Identity
• On your client’s Overview page > Edit > Billing and Insurance tab
  • Under Insurance info, click + Insurance info and enter the:
    
    • Insurance Payer and Member ID

• If your client isn’t the primary insured, select the correct relation to the subscriber for Primary policy holder and enter:
  • The information of the primary insured, including:
    • First and last name
    • Sex
    • DOB
    • Phone number
    • Address information

Once you’ve verified that all the above information is correctly entered, you’re ready to request a Coverage Report. To do so:

• Navigate to your client's Billing page
• In the Insurance section, click Request Coverage Report

Note: If you don't see the Request Coverage link, it indicates that the client's insurance payer hasn’t been set up for automated Coverage Reports. If you run into this, you can submit a help request so we can see if we can establish a Coverage Report connection with this payer.

You’ll be taken to the client’s Insurance Coverage Report page, where you can print the report and request a new one.

Coverage Reports will reflect the following sections:

• Patient/Subscriber
• Payer
• Plan Coverage and General Benefits
• Mental Health
• Chiropractic
• Medical Care
• Prescription Drug
• Retail/Independent Pharmacy
• Dental Care
• Emergency Services
• Hospitalization
• Optometry
• Urgent Care
• Hospital - Inpatient
• Hospital - Outpatient
• Plan Coverage and General Benefits
• Mental Health
• Chiropractic
• Medical Care
• Prescription Drug
• Dental Care
• Emergency Services
• Hospitalization
• Optometry
• Urgent Care
• Hospital - Inpatient
• Hospital - Outpatient

You’re also able to adjust the client’s Copay/Coinsurance and Deductible from this page:

Locating insurance reports

A record of all your Coverage Reports is available for you to access by navigating to Analytics > Reports > Coverage Reports.

Coverage report error messages

We’ve included the most common Coverage Report error messages and the possible reason for each error below.

Invalid/Missing Provider Identification

• This means that the insurance payer requires that you file your first claim with them before they’ll deliver coverage information

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

• The client's subscriber information may be inaccurate
  • For more information, see Requesting a Coverage Report above
• The payer may not yet offer electronic Coverage Reports for this client
• Our clearinghouse may not yet have an established Coverage Reports connection with the payer
  • In this case, you can submit a help request so our team can see if we can establish a Coverage Report connection with this payer