This article includes answers to the most frequently asked questions regarding enrolling for electronic filing with insurance payers. If you need some guidance submitting your enrollments, see How do I submit an enrollment to file claims or receive payment reports?
- What is an enrollment?
- How can I find out if my insurance providers require enrollment for claims and/or payment reports?
- What if I was already enrolled with my payer prior to SimplePractice?
- What is "PTAN" on the enrollment page?
- How long until my enrollments are accepted by the insurance provider?
- Why is my enrollment requiring additional steps?
- What should I do if I receive an enrollment approval from the payer, but I still can't file these claim's through SimplePractice?
- When can I start filing claims?
- Can I enroll with a payer if I'm out-of-network?
- How to update your enrollment information in SimplePractice
What is an enrollment?
An enrollment is the process of informing an insurance payer that you plan to submit electronic claims via SimplePractice and/or receive electronic payment reports (ERAs).
When you start managing insurance through SimplePractice, you’ll need to notify some payers that you plan to use our software by submitting enrollments. You can manage this process directly through SimplePractice in just a few steps.
It’s important to make sure you use the NPI and Tax ID that you’ll be including as the Billing NPI on your claims to that payer when submitting an enrollment. The Billing NPI is the NPI listed in box 33 of your claim form. If you’re billing under an organization NPI, also known as a type 2 NPI, use this when submitting your enrollment.
Note: Enrolling is NOT the same as getting 'paneled' or 'credentialed' with an insurance payer. If you're enrolling with a payer through SimplePractice, you'll likely need to already be paneled with an insurance payer in order for them to approve your enrollment. SimplePractice doesn't assist with the paneling or credentialing process.
How can I find out if my insurance payers require enrollment for claims and/or payment reports?
Many payers don’t require that you enroll for claim filing. Enrolling for payment reports is never required in order to submit claims electronically, but it’s recommended if you’d like to automate your bookkeeping. However, if you’d like to receive payment reports, you’ll always need to enroll with the payer first.
You must have a paid account with SimplePractice and have at least one client assigned to that payer in order to submit an enrollment.
To check if your client’s insurance payers require an enrollment, follow these steps:
- Navigate to Settings > Insurance
- Type the name of your payer into the search box
- Locate the payer
- Check the Claim Filing Enrollment and Payment Report Enrollment columns to see the payer's requirements:
What do the column statuses mean?
Prior to submitting an enrollment, each payer will have a designation in the claim filing and payment report enrollment columns. Here's what each of those statuses means:
|You can file claims now||
An enrollment isn’t required for this payer. You can start submitting electronic claims right away.
Assign this payer to a client to enroll
You have a paid SimplePractice account and the payer supports payment reports and/or electronic claim filing, but you haven’t assigned this payer to at least one of your clients.
|Payment reports aren't available for this payer. You can still submit claims electronically, but you’ll receive a paper Explanation of Benefits (EOB) and can manually add those payments to keep your bookkeeping up-to-date.|
This payer offers payment reports and is already assigned to one of your clients. Click +Enroll in order to submit the enrollment.
Tip: If you’re already paneled with a payer and want to begin the enrollment process right away, but don’t yet have a client to assign to that payer, you can still submit the enrollment. To do this, you can use the Jamie Appleseed test client and assign them to the payer in question. If you’ve deleted Jamie Appleseed, you can create a test client. Assigning Jamie Appleseed or a test client to a payer will simply let you begin the enrollment process and will have no bearing on the enrollment’s processing. See Setting up insurance billing for your client for instructions on how to assign a payer to a client.
What if I was already enrolled with my payer prior to SimplePractice?
If you've enrolled directly with an insurance company or through another clearinghouse, you still need to enroll through SimplePractice to set up the connection. Having been accepted to submit claims electronically with a payer in the past doesn’t correlate to a faster acceptance through SimplePractice.
Payers can only send payment reports to a single clearinghouse. If you currently receive payment reports through another clearinghouse, you’ll need to submit an enrollment through SimplePractice in order to receive payment reports in your account.
What is "PTAN" on the enrollment page?
PTAN stands for Provider Transaction Access Number. PTAN can also refer to the provider number, Medicare PIN, or Medicare ID number. The PTAN isn’t an NPI, Tax ID, or Medicare UPIN.
The PTAN field is only required for Medicare enrollments. If you’re trying to submit an enrollment to Medicare, you’ll have to enter your PTAN in the enrollment form or your enrollment will be rejected. If you’re a Medicare provider but can’t locate your PTAN, reach out to Medicare directly and request that they provide it for you.
Medicare assigns both an individual and organization PTAN, similar to how you have individual and organization NPIs. If you’re submitting a Medicare enrollment, make sure to use the PTAN specific to your NPI type. For example, if you’re submitting Medicare claims under your organization NPI, make sure to submit the enrollment using your group NPI and group PTAN.
Note: If you're submitting an enrollment to a non-Medicare payer and you're still seeing a PTAN field, simply write "N/A" in that field and submit your enrollment.
How long until my enrollments are accepted by the insurance payer?
Once you submit an enrollment, please see Average payer enrollment approval times to see how long you can expect to wait for your enrollment to be processed. Keep in mind that SimplePractice has no control over this part of the process, but we’ll email you once your enrollment has been accepted.
Note: While waiting for an enrollment to be accepted, we recommend that you submit claims by mail to avoid delays in reimbursement until your enrollments are approved.
To check the status of your enrollment, navigate to Settings > Insurance > Enrollments:
If an enrollment shows as submitted, it's still in process and will need more time to be approved.
An enrollment may also have a Document Required status. If you see this status, the payer requires additional steps be completed before they’ll approve the enrollment. Click Document Required to complete those additional steps. See Why is my enrollment requiring additional steps? for more information.
If an enrollment was rejected, click the Rejected status to view the reason and to resubmit the enrollment. See What to do if your enrollment is rejected to learn more about resubmitting the enrollment.
Why is my enrollment requiring additional steps?
Some payers may require additional steps be completed before processing an enrollment. In addition to seeing a Document Required status in your payers list, you’ll also receive a banner notification asking you to review the information:
Click View Insurance Payers or navigate to Settings > Insurance > Enrollments and click Document Required to view the document:
To complete the enrollment:
- Click Document Required
- Download the PDF in Step 1:
- Follow the step-by-step instructions detailed in the document
Note: These instructions are required by a third-party clearinghouse and are subject to change. If you have any questions about the directions, please reach out to the number or website listed on the document.
- Once you’ve completed all steps, print out and physically sign a copy of the instructions to confirm that you’ve completed all of the directions
- Some payers may require that you upload a document packet that you’ll receive after completing the steps
- Click Choose PDF to upload the completed document
- Once the document is uploaded, the enrollment will move from Document Required to submitted and will process accordingly
If you feel the document wasn’t uploaded correctly, or are having difficulty completing the steps outlined, reach out to our team and we’ll be happy to review the submitted document.
What should I do if I receive enrollment approval from the payer, but my enrollment still shows as Submitted?
Sometimes payers will notify providers that an enrollment for claim filing and/or electronic payment reports has been approved, but won’t notify our clearinghouse. Our clearinghouse has to receive confirmation that your enrollment has been accepted, and a payer not notifying our clearinghouse can lead to an enrollment remaining stuck in the Submitted status. If you receive an approval notification and your enrollment hasn’t updated past Submitted, please submit a help request so that we can help expedite the process for you.
When submitting a help request, please provide one of the following pieces of information to serve as clear confirmation of your enrollment approval:
- Copy of the approval email or letter received from the insurance payer.
- If the approval was verbal, please include the representative’s name that you spoke with, as well as the phone number and reference number for the call.
When can I start filing claims?
- The payer you're working with doesn't require a Claim Filing Enrollment. If you're working with a payer that says "You can file claims now" under the Claim Filing Enrollment column, you can file claims to them right away.
- The Claim Filing Enrollment you submitted has been Accepted. You will know that this has been accepted because you'll receive an email from us letting you know. You can also check the status by going to Settings > Insurance > Enrollments.
Can I enroll with a payer if I'm out-of-network?
Most insurance payers will allow you to submit an enrollment if you’re not in their network. This is beneficial if you’re submitting claims as an out-of-network provider.
To submit an enrollment as an out-of-network provider, your billing information must be registered with the insurance payer as a non-participating provider. If you’ve confirmed that your information is on file and you’re approved to submit electronic claims, submit the enrollment in the same way you would any other enrollment.
How to update your enrollment information in SimplePractice
When there are changes to your practice information, you’ll want to update the insurance payers and make sure your enrollments within SimplePractice have the correct information associated with them.
If the following information has changed or has been updated with the insurance payer, you’ll want to check that the following information is correct in your enrollment:
- Provider/facility name
- Tax ID
If you think an enrollment may need to be updated, navigate to Settings > Insurance > Enrollments and click on the Accepted status to view the billing information that enrollment is currently accepted under. To update your enrollment information, follow these steps:
- Contact the insurance payer to verify the information that they have on file for you.
- If the enrollment in SimplePractice needs to be updated, please submit a help request.
- One of our team members will reach out to our clearinghouse and request that they temporarily reject your current enrollment. This will allow you to update your information.
- You'll receive an email notification informing you that the enrollment has been rejected.
- Go to Settings > Insurance > Enrollments and click Rejected. This will take you to the enrollment screen where you can update your information as needed.
- Submit the enrollment under the updated information.
- We’ll email you once the enrollment is accepted again, or if additional steps are needed.