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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. Coverage reports allow your clients to see the details of their insurance coverage for $0.05 per report.

Currently, most payers don't include mental health coverage details in these reports. Since this is the case, we don't recommend using this report to verify member eligibility and benefits.

In this guide, we’ll cover:

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


Requesting a coverage report

To use this feature, 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

billingtype.simplepractice.insurance.png

  • Click Save Client

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

  • In your Clinical Profile:
    • NPI Number
  • For your client, click Edit on their client Overview page and enter their:
    • Date of birth
    • Gender
    • Insurance payer name/ID
    • Member ID
  • If your client is not the Primary Insured:
    • Primary Insured/Subscriber Name
    • DOB
    • Gender

Once you’ve verified that all the above information is properly completed, navigate to your client's Billing page. In the Insurance Info section, click Request Coverage Report, and you'll be taken to the Insurance Coverage Report page where you can view and download the report:

requestreport.simplepractice.insurance.png

Coverage Reports will reflect the following sections:

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

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

copay.simplepractice.coveragereports.png

Note: If you don't see the Request Coverage link, it indicates that 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 whether we can create a connection with the insurance payer. Submit a Help Request and tell us which insurance payer you'd like to set up for coverage reports.


Finding insurance reports

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

coveragereports.simplepractice.reports.png


Coverage report error messages

Invalid/Missing Provider Identification

  • If you receive this error message when generating a Coverage Report, this means that the payer requires that you file your first online 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
  • 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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