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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 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. This guide will walk you through the following:

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

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

insurancetype.simplepractice.billingtype.png

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 your client's Billing Overview. In the Insurance Info section, click View Coverage, and you'll be taken to the Insurance Coverage Report page where you can view the report and download the report.


requestcoveragereport.simplepractice.billingoverview.png

Note: If you don't see the View Coverage link, 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.


Finding insurance reports

A record of all your coverage reports is available for you to access at any point, and you can access these at Reports > Coverage Reports.

insurancereports.simplepractice.reports.png


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

  • 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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