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Payers with unique claim filing rules

Payers can go by different names and use different payer IDs depending on the clearinghouse they're working with. If you are uncertain of which payer you should be filing with in SimplePractice, you can reach out to our Customer Success team and we will be able to work with our clearinghouse to identify the correct payer ID for you.

This guide will detail some unique payers with specific rules for how to best file claims electronically in SimplePractice:


Blue Cross Blue Shield

Blue Cross Blue Shield Plans are known for being extremely complicated when it comes to figuring where to file a claim. However, when you're working with clients who are insured with BCBS, the rule is: always file your claims with the local BCBS payer.

This is true even if a client's BCBS ID card is out-of-state. For example, if a new client has a BCBS California ID card, but you are in Hawaii, you must file the claim in Hawaii. Once you file the claim to BCBS of Hawaii, the local Plan will electronically forward the claim to the correct branch to ensure that you get paid. The same is true if you're trying to file claims to the Federal Employee Program (FEP). File your FEP claims to your local BCBS payer.

Note: There are two exceptions to this rule. If your client has an FEP plan through the states Michigan or Connecticut, use the payer IDs MIFEP and C2BLS respectively.

Some Blue Cross/Blue Shield insurance plans require mental health claims to be submitted to a separate payer. For instance, Capital Blue Cross (Payer ID 23045) frequently requires mental health claims to be submitted to Magellan Behavior Health (Payer ID 01260)

Call your client's BCBS insurer to confirm where they would like electronic mental health claims sent.

Some states like Michigan will have multiple BCBS payer IDs within SimplePractice. If you are located in Michigan, please follow these guidelines to ensure you are filing to the correct payer ID based on the client's benefits:

  • MIBLS - PPO plans
  • MIBCN - HMO plans
  • MIFEP - FEP plans

Note: Each payer ID for Michigan BCBS requires a claim filing enrollment prior to filing claims. If you receive an approval for one payer ID, you can reach out to our team and we can work with our clearinghouse to get acceptances for the rest of the payer IDs.

If you're filing claims for Excellus BCBS in New York, you'll need to pay attention to your location because the payer ID you'll need to use will vary depending on your zip code. There are 3 possible payer IDs based on the county where your practice is located. Be sure to check that you're using the correct ID for your county

  1. Payer ID - BCBSRA:Excellus BCBS Rochester area. Use this payer if your practice is in the following counties:
    • Monroe
    • Ontario
    • Wayne
    • Seneca
    • Livingston
    • Yates
  2. Payer ID - BCBSCNY: Excellus BCBS CNY. Use this payer if your practice is in the following counties:
    • Oswego
    • Onondaga
    • Cayuga
    • Cortland
    • Chenango
    • Broome
    • Tioga
    • Tompkins
    • Schuyler
    • Chemung
    • Steuben
  3. Payer ID - BCBSUW: Excellus BCBS Utica/Watertown. Use this payer if your practice in the following counties:
    • Clinton
    • Essex
    • Franklyn
    • St. Lawrence
    • Jefferson
    • Lewis
    • Oneida
    • Madison
    • Herkimer
    • Hamilton
    • Fulton
    • Montgomery
    • Otsego
    • Delaware

If you're not sure what county you're in, you can check by clicking here.

Highmark in Pennsylvania

If you're in Pennsylvania and your local Blue Cross Blue Shield payer is Highmark, you can file claims with either of the Highmark payers listed in SimplePractice: 

54771 - Highmark | Highmark PA

PABLS - Blue Cross Blue Shield of Pennsylvania Central Highmark


Medicare or Medicaid

1) You must be credentialed

You must be credentialed with Medicare or Medicaid before they will accept claims from you. (This is a separate process from enrolling through SimplePractice.) Credentialing is a process you manage directly with the payer. If you are not credentialed directly with Medicare or Medicaid, they will not accept your claims or enrollments through SimplePractice.

2) File with your correct NPI

If Medicare has 2 NPI numbers on file for you ( a billing NPI and a provider NPI), be sure to use your billing NPI when filing CMS claim forms. Read this article for details: Populate your billing NPI to CMS claim forms.

National Government Services (NGS)

If you have Medicare clients on a National Government Services insurance plan, you will file those claims with the in-state Medicare payer.

For example, if you have a client on an NGS plan and you practice in New York, you'll file this client's claims with Medicare of New York (payer ID: NYMCR).


Magellan Behavioral Health

Magellan is the only payer we work with who cares about the physical address on the claim forms when the claims are submitted electronically. They have a few different P.O. Boxes they use and they want you to send your claims to a specific address based on the client's plan and location.

We recommend that you contact the payer directly to get the correct P.O. Box you should use for your clients. Once you have that information, you can update Magellan's address in your account to ensure all of your claims include the correct information.

  • Go to My Account > Settings > Insurance Payers.
  • When you search for payer ID 01260, you will see two entries for Magellan. Both of these entries represent the same payer. They have two different names because some member ID cards show Magellan Behavioral Health, while others show Magellan Health Services. 
  • Select either listing for Magellan; both will route your claims to the same payer.

How to update Magellan's address

  • Go to My Account > Settings > Insurance Payers.
  • Search for payer ID 01260.
  • Click the current address for one of the entries. This will allow you to update it with the correct address, as shown below.Updating Magellan's address on the Insurance Providers page in SimplePractice
  • Click Save

Tip: You can update the address for both of the Magellan entries to make sure that you're always sending the claim to the correct address, regardless of the entry you select.


FHC & Affiliates

The payer "FHC &Affiliates" is in SimplePractice but the payer ID our clearinghouse uses is under the payer ID: 00813

This payer requires you to file an enrollment in order for you to be able to file claims to them electronically via SimplePractice. In order for you to file your enrollment with payer 00813, they require you to enter your Value Options ID. If you don't have your VOID handy, reach out to the payer so they can assign one to you. They will not accept your enrollment unless you include that number in your application. If you need help submitting your enrollment, click here.


Hudson Health

If you have a client with a Hudson Health insurance plan, you will most likely need to submit your claims for mental health services to Beacon Health Strategies with payer ID: 43324. In many cases Hudson Health contracts with Beacon Health Strategies to pay mental health claims. 

Call the payer to confirm this and read the client's ID card. Call Hudson Health to confirm which payer you should submit to for online mental health claims: https://www.hudsonhealthplan.org/contact/provider-relations


United HealthCare

ValueOptions is the payer for mental health claims for many UnitedHealthCare plans.

If your client has UnitedHealthCare printed on his/her insurance card it's best to call the number on the card to confirm whether mental health claims should be sent to UHC or ValueOptions.

Sometimes, mental health claims submitted to ValueOptions will require an alternate member ID from the one printed on the client's ID card. Be sure to ask the insurance company what member ID should be used for submitting mental health claims to ValueOptions


Value Options

Value Options sometimes pays out mental health claims for other insurance plans (United Health Care). If your claims are to be submitted to Value Options, it's important to know that Value Options uses a slightly different Payer ID with SimplePractice than they use with other online claim filing systems.

If you have previously filed online claims with Value Options under the Payer ID VALOP, you will now be submitting claims to Value Options under the Payer ID 43307, or 00813, or one of the other Value Options payers in SimplePractice. Search for "Value Options" to see the options and find the right payer for you. 

 

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