Getting started with electronic insurance filing in SimplePractice

Follow

Getting started with the insurance process in SimplePractice doesn't have to feel overwhelming! This article will break down the basic insurance process in SimplePractice, so you'll be equipped with the tools to start filing claims and managing insurance right away, even during the 30-day free trial.

1. Set Up Your Client's Profile for Insurance Billing

  1. Set Billing Type
  2. Enter Client's insurance information

For your clients with insurance, first, you'll want to set their billing type to Insurance

Note: We recommend you set your client's billing type before you enter any sessions in the calendar so that you do not need to change the billing type later. 

  1. Click on the client's name from anywhere in the app.
  2. Click Edit client info > Billing & Insurance > Billing Type.

SP-HelpCenter-Screenshots-6.png

This will allow SimplePractice to automatically track the balance for the client as well as for the client's insurance company. You can read more about it here: Setting up billing for an insurance client.

If you haven't yet created any clients or you haven't filled out their insurance info, you can see what's required here: What information do I need from a client to file a claim?

Once you've entered the billing type, it's time to enter the client's insurance information into their profile. Here's how:

  1. Scroll down and start typing the name of the insurance payer on your client's insurance card.
  2. If you are having trouble seeing the list of payers, you can also search for the correct payer (and payer ID) by going to My Account > Settings > Insurance Providers.  SP-HelpCenter-Screenshots-7.png
  3. Select type (primary, secondary, other) as well as client's relationship to insured.  
  4. If you select Spouse or Child, enter the information for the primary insured, not your client.
  5. Enter the member ID, as this will be required information on the claim form.  
  6. Click Save.

 2. Enroll

After you have entered your clients' insurance information into his or her profile, you can enroll for any payers that require enrollment. Here's how:

  1. Go to My Account > Settings > Insurance Providers > Enrollments.
  2. Check if your clients' insurance company requires enrollment. If the payer requires a claim filing enrollment, you won't be able to file claims until your enrollment has been accepted. If the payer doesn't require a claim filing enrollment, but they do require a Payment Reports (also known as EOBs or ERAs) enrollment, you can start filing claims to them right away.

Tip: Keep in mind that enrollments can take anywhere between 1-8 weeks to be accepted by the payers. We recommend that you continue to file claims outside of SimplePractice to this payer until your enrollment is accepted so that you don't experience an interruption to your cash flow.

 In case you need help submitting your enrollment, take a look at this article: Click here to learn how to submit enrollments

SP-HelpCenter-Screenshots-8.png

What do the enrollment statuses mean?

  • Not Required - This is great news! It means you are not required to enroll for claim filing and can start submitting claims right away through SimplePractice, even in your free trial. Go ahead and start filing for these payers!
  • +Enroll - This means that you will need to enroll with this payer for electronic claim filing (or payment reports). Simply click the +Enroll button and fill out a quick application to start the process. Our clearinghouse will take it from there and you'll be notified as soon as the enrollment is accepted.
  • Document Required - You have begun the enrollment process, but this payer requires that you complete additional information for the enrollment to process. Please follow the directions provided when you click the link. 
  • PR's Not Supported - This payer does not provide the option to receive electronic payment reports. You can continue to manually add any insurance payments that you receive.
  • No Clients on File - You must have at least one client using the payer in order to enroll. Please add the insurance company to that client's profile and then return to this page to enroll.
  • Paid Account Required - In addition to at least one client using that insurance payer, you must be on a paid account with SimplePractice in order to enroll. If you are still in trial, you can submit any claims electronically where enrollment is not required. 

Note: Remember that even if you are waiting for an enrollment to be accepted, you can still generate claims using SimplePractice so you can print and mail (via snail mail) to avoid any delay in payment. 

3. Start Filing Claims

Once your enrollments are approved (and for payers that do not require enrollment), filing is as simple as it gets! Here's how:

  1. After creating a CMS 1500 form, click Submit at the top of the claim, as shown below. SP-HelpCenter-Screenshots-9.png
  2. This will send the claim information to the insurance company and begin the process of tracking the claims' progress until it is paid.

Note: Additional information is provided in the article How to file a claim.

4. Track Claims

With SimplePractice, you can track a claim's progress in the app. Here's how:

  1. Go to Billing > Insurance > Claims. 
  2. Review your pending claims to see the status of all your claims. 

Note: We also send you an email update each time a claim status updates. Read more about tracking claims in the article: The different phases of an insurance claim.

SP-HelpCenter-Screenshots-11.png

5. Review Automated Accounting / Add Insurance Payments

If you are not yet receiving payment reports, you can manually add insurance payments in SimplePractice, using the EOB that you have received in the mail.  

Click here to read about adding insurance payments. 

Once your payment reports have accepted, they will completely automate the bookkeeping for claims with this payer. We take information from the payment reports and automatically record the insurance payment in your account and apply the correct reimbursement amounts to each session.

SP-HelpCenter-Screenshots-12.png

Tip: To receive payment reports: Go to My Account > Settings > Insurance Providers > Enrollments.

That's it! Dealing with insurance companies just got a little bit easier. Let us know how we can help you as you get started!

FAQs

Q. Please clarify what you mean by client relationship to insured. My client is insured through her husband, but where do I indicate this? 

A. Client relationship to insured refers to the client's relationship to the insured person stated from the client's point of view. Therefore, if the client and the insured are the same, it would be Self. If the client is the insured's child, it would be Child. Or, as in your situation, if the client and the insured are married, it would be Spouse

Since your client's husband is the person insured, here's how you would indicate this information:

  1. Click on the client's name from anywhere in the app.
  2. Click Edit client info > Billing & Insurance.
  3. Set Billing Type to Insurance (if it isn't already).
  4. In the Insurance Info section, you will see: *Who is the Primary Insured? Select Client’s Spouse.
  5. Then enter her husband's name and insurance information below.

 

 

Have more questions? Submit a request

Comments