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Payers with unique claim filing rules

Payers with unique claim filing rules

Certain insurance payers will vary in their requirements for submitting electronic claims. In this guide, we'll cover which payers in SimplePractice have unique rules, and we'll outline the steps you'll need to take to select the appropriate payer ID and successfully file electronic claims to these payers.

Note: Payers can go by different names and use different payer IDs depending on the clearinghouse they're working with. If you're still uncertain of which payer ID you should select after reviewing this guide, you can reach out to our team and we'll be able to help verify the correct payer ID for you.

Payers with unique claim filing requirements in SimplePractice:


Blue Cross Blue Shield

Blue Cross Blue Shield Plans are known for being 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're 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 make sure 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.

Important: 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.


Blue Cross Blue Shield of Arizona

Our clearinghouse uses payer ID 53589 for BCBS of Arizona. This payer requires the group ID on claim submissions and a claim note in box 19 if you are submitting a resubmission. To learn more about corrected claims, look at this guide: When to submit a corrected claim in SimplePractice and how


Blue Cross Blue Shield of Michigan

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
  • MIMPB - Medicare PlusBlue
  • MIBCC - Blue Cross Complete

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. This will also apply for payment report enrollments for MIBLS and MIFEP but not MIBCN as that is a different pay source.


Blue Cross Blue Shield of Washington

Our clearinghouse has two different payer IDs for BCBS in Washington state:

  • Premera Blue Cross - WABLC
  • Regence Blue Shield - RGBLS

You can find out what your local BCBS plan is and which payer ID you should be filing to based on where you are located in Washington. This Claim Submission Map from BCBS will help identify where you should be filing. Out-of-state BCBS cards will be submitted to the local BLS.

If you are inquiring about payer ID 00430 for claim submissions to Premera, all claims should be submitted to WABLC. You can still enroll in payment reports for payer ID 00430 as some ERAs will come through this payer ID as it is dependent on the client's plan.


Capitol Blue Cross

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.


CareFirst BCBS

Some claims, depending on the client's plan, submitted to Blue Cross Blue Shield of Maryland (payer ID - MDBLS) and CareFirst BCBS - DC National Capitol Area (payer ID - SB580), will have their remits returned under CareFirst Administrators (payer ID - 75190).


Excellus BCBS in New York

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 (the same as BCBSX): 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: 

35145 - Highmark | Highmark PA

PABLS - Blue Cross Blue Shield of Pennsylvania Central Highmark


MCDIL

If you are filing claims to Blue Cross Community Solutions or BCBS Family IL which both have payer ID MCDIL, our clearinghouse has let us know that payment reports for claims being submitted to MCDIL will come through payer ID ILBLS.


Colorado Medicaid

Colorado Medicaid has carved-out their mental health benefits to 5 different regional areas as of July 1, 2018. If you are already aware of which region you are located in and know which payer you need to submit claims to, you can find the appropriate Payer ID for that payer on the list below. 

If you're not sure which region you are in, you may check here for help with determining the correct region and payer to submit claims to:

  • Rocky Mountain - Payer ID: RMHMO 

  • Northeast Health Partners - owned and operated by Beacon Health Options. We support this payer with payer ID 00813 

  • Colorado Access - Payer ID: COACC 

  • Health Colorado - Payer ID: COMCD 

  • Colorado Community Health Alliance - Payer ID: COMCD


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. See How do I submit an enrollment to file claims or receive payment reports? if you need help submitting your enrollment. 


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 ID you should use for submitting electronic mental health or behavioral health claims: Hudson Health Plan.


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. See this guide 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.
  • 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.
  • 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.Magellan.simplepractice.insuranceproviders.gif
  • 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.


Meritain Health

For Meritain Health plans, claims should be submitted to payer ID 64157, and for Meritain Health Minneapolis plans, the claims should be submitted to payer ID 41124. Providers can submit claims based on the plan for each client. Also, please note that the payment report enrollment is common for both payer IDs so providers can enroll with either payer ID.


MVP Health Plan

If you are filing claims to MVP Health Plan of New York, payer ID 14165, please know that all claims should have the relationship to the insured marked as Self or Client. This is because the two digit suffix on a partner's or dependent's member ID acts as a unique member ID and this payer does not accept any claims which do not have the primary insured marked as Self.

Additionally, if you are enrolling in payment reports and you do not have an existing EFT enrollment with MVP, you can complete the enrollment through MVP's website directly, per the instructions on the enrollment form if you are not planning to enroll for EFTs.

If you already have an existing EFT enrollment with MVP or would like to enroll for EFTs, you will need to complete both enrollments through PaySpan.


Quartz/Unity Health Insurance

If you are filing claims to Quartz Health Solutions or Unity Health Insurance, payer ID 66705, please know that all claims should have the relationship to the insured marked as Self or Client. This is because the two digit suffix on a partner's or dependent's member ID acts as a unique member ID and this payer does not accept any claims which do not have the primary insured marked as Self.


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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