In this guide, you’ll find answers to commonly asked questions about enrolling to file electronic claims and receive electronic Payment Reports (ERAs) through SimplePractice. For more information on submitting enrollments, see Submitting enrollments to file claims and receive Payment Reports.
Below, we’ll answer:
General enrollment information
- What is an enrollment?
- How can I find out which enrollments are available for an insurance payer?
- Can I submit enrollments during my trial?
- What if I was already enrolled with my payer prior to SimplePractice?
- Can I enroll with a payer if I'm out-of-network?
- How do I enroll for EFT?
Submitting an enrollment
- Can I use multiple Tax IDs/NPIs for my enrollments?
- Why can’t I submit an enrollment with my NPI?
- Why is my enrollment requiring additional steps?
- What is a Trading Partner/Submitter ID?
- What is "PTAN" on the enrollment page?
- How long until my enrollments are accepted by the insurance provider?
- What should I do if I receive an enrollment approval from the payer, but my enrollment still shows as Submitted?
- When can I start filing claims?
- When will I start receiving Payment Reports?
Making changes to an existing enrollment
What is an enrollment?
An enrollment is the process of informing an insurance payer that you plan to submit electronic claims and/or receive electronic Payment Reports (ERAs) through SimplePractice. Many payers don’t require claim filing enrollments, but all payers that we have Payment Report connections with require electronic Payment Report enrollments.
Note: You must have a paid account with SimplePractice to submit an enrollment. For more information, see Can I submit enrollments during my trial?
When submitting an enrollment, it’s important to use the billing NPI and Tax ID/Social Security Number that you have on file with the payer. For group practices, this will be the group’s billing information.
Important: Enrolling is a separate process from getting paneled or credentialed with an insurance payer. You’ll typically need to already be paneled or credentialed with an insurance payer for them to approve your enrollment. SimplePractice doesn't assist with the paneling or credentialing process. For more information, see The credentialing process.
How can I find out which enrollments are available for an insurance payer?
To check the enrollments available for an insurance payer:
- Navigate to Settings > Insurance
- Click Search available payers
- Type the payer ID or payer name into the search box
- Locate the payer
- For more information on selecting the correct payer, see Selecting the correct payer ID
- Click + Add
- Locate the payer under My Insurance Payers
- Check the Claim filing enrollment and Payment report enrollment columns to see the payer's requirements
Prior to submitting an enrollment, each payer will have a designation in the Claim filing enrollment and Payment report enrollment columns.
|Ready to file claims||A claim filing enrollment isn’t required for this payer. You can start submitting electronic claims through SimplePractice immediately.|
|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 in SimplePractice.|
In the Claim filing enrollment column, this status indicates the payer requires an enrollment to submit claims electronically. Once the enrollment is accepted, the status will update to Ready to file claims.
In the Payment report enrollment column, this status indicates the payer offers Payment Reports. Once the enrollment is accepted, the status will update to Ready to receive ERAs.
Can I submit enrollments during my trial?
A paid account is required to submit enrollments. To submit enrollments during your free 30-day trial, you can upgrade to a paid account by clicking Activate plan in the top navigation bar.
After you select your plan and add a credit card, you’ll be upgraded to a paid account and can submit enrollments.
Important: The remainder of your trial will still be free as your subscription will only begin once your trial ends.
For more details on our available plans, see Which subscription plan is right for me?
What if I was already enrolled with my payer prior to SimplePractice?
If you've previously enrolled directly with an insurance payer or through another clearinghouse for electronic claims or Payment Reports (ERAs), you’ll still need to enroll through SimplePractice to set up a connection. Having previous enrollments accepted doesn’t expedite enrollment processing through SimplePractice.
Important: Payers can only send Payment Reports to a single clearinghouse. If you submit a Payment Report enrollment through SimplePractice, any existing connection with another clearinghouse will be disconnected once the enrollment is accepted.
If you have an existing enrollment outside of SimplePractice, you may need to submit a Change of Vendor letter when enrolling through SimplePractice. For more information, see Provider is linked to another clearinghouse.
Can I enroll with a payer if I'm out-of-network?
Most insurance payers allow you to submit an enrollment if you’re out-of-network. 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 with the payer and you’re approved to submit electronic claims, submit the enrollment following the standard steps. For more details, see Submitting an enrollment to file claims and/or receive Payment Reports.
How do I enroll for EFT?
SimplePractice and our clearinghouse are not involved in any aspect of the transfer of funds between payer and provider. If you’d like to set up or update an Electronic Funds Transfer (EFT) with a payer, contact the payer directly. For more information, see Getting paid by an insurance payer.
Note: If you’ve received a Payment Report but haven’t received the funds for the payment, reach out to the payer directly for assistance. For more details, see Experiencing a delayed insurance payment or Payment Report.
Can I use multiple Tax IDs/NPIs for my enrollments?
We recommend that you don’t submit your enrollments with multiple Tax IDs/NPIs because you can only enter one Tax ID/Social Security Number and NPI in your account to automatically populate on claims. If enrollments are submitted with conflicting information, your settings will have to be adjusted before submitting claims to each payer. For more details, see Entering your provider information.
If you have contrasting billing information on file with different insurance payers, we recommend contacting the payers directly so that your information is aligned with each one. This will save you time by allowing you to submit all enrollments and claims with the same information.
Group practices should submit enrollments with their group NPI and Tax ID/SSN. Team members have to be linked with the group on the payer’s end, allowing them to file claims under the group’s billing information with their individual NPI listed as the rendering provider. For more details, see Billing services and automations.
Note: SimplePractice isn’t able to assist with updating the information that you have on file with a payer. If you want to update the information on an accepted enrollment, see How do I update my enrollment information?
Why can’t I submit an enrollment with my NPI?
After submitting an enrollment, you may receive an error message indicating that “an enrollment is already submitted for the NPI XXXXXXXXX for the payer ID.” This error message appears when you've previously submitted an enrollment with the payer through a different SimplePractice account.
Note: This may occur if a clinician starts their own solo account after being part of a group SimplePractice account, or vice versa.
To resolve this, submit a help request with the following information:
- The payer name and payer ID for the enrollment with this error message
- The NPI number submitted on the enrollment
Why is my enrollment requiring additional steps?
Some payers may require you to complete additional steps before processing an enrollment. In addition to seeing a Document required status in your payers list, you’ll also receive a banner notification.
To complete the document:
- Select View Insurance Payers in the banner or navigate to Settings > Insurance
Click the Document required icon
- Download the PDF in Step 1
- Follow the 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 in 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 continue processing
If the document didn’t upload correctly or you would like assistance with these steps, please submit a help request.
What is a Trading Partner/Submitter ID?
A Trading Partner ID (or Submitter ID) is an identification number assigned to a clearinghouse by an insurance payer.
A payer may request this ID if you are trying to set up a claim filing or Payment Report enrollment directly with them. Instead of connecting with the payer, you should submit your enrollments in your SimplePractice account so they can be successfully set up through our clearinghouse.
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 submitting 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 group PTAN. 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 group 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, enter N/A in the field.
How long until my enrollments are accepted by the insurance provider?
To review the expected processing time for an enrollment, see Average payer enrollment approval times. As approval is dependent on the payer, SimplePractice has no control over this part of the process. We’ll email you once your enrollment has been accepted.
Note: Some payers don’t accept claims filed through SimplePractice from before a claim filing enrollment’s acceptance date. While waiting for your enrollment to process, we recommend filing your claims outside of SimplePractice to avoid disruption in reimbursement.
To check the status of your enrollment, navigate to Settings > Insurance. Below, we’ll cover each of the statuses.
If an enrollment shows as Submitted, it's still being processed by the payer and will need more time to be approved.
The Document required status indicates that the payer requires additional steps before they’ll approve the enrollment.
You can click the Document required icon to complete those additional steps. For more information, see Why is my enrollment requiring additional steps?
If an enrollment was rejected, click the Rejected icon to view the reason and resubmit the enrollment. For more information, see Resolving rejected enrollments.
What should I do if I receive an enrollment approval from the payer, but my enrollment still shows as Submitted?
Sometimes payers will notify providers that an enrollment has been approved, but won’t notify our clearinghouse. This can lead to an enrollment not updating from the Submitted status in SimplePractice.
If you’re notified of an enrollment approval but your enrollment hasn’t updated past Submitted, please submit a help request with one of the following pieces of information as confirmation of your approval:
- The reference number for a call with the insurance payer, the name of the representative that you spoke with, and the phone number
- A copy of the approval email or letter received from the insurance payer
- A complete screenshot from the insurance payer’s portal stating that our clearinghouse, Eligible, is your vendor or clearinghouse
Below, we’ll outline steps for obtaining screenshots from common payer portals. To take a screenshot, see the following table for keyboard shortcuts based on your computer’s operating system:
OS X (using a Mac computer)
|Command + Shift + 4|
Windows key + Print Screen key
Note: If you have any questions about selecting our clearinghouse in a payer portal, contact the portal provider or payer directly for assistance.
- Log in to EDISS Connect
- Click the Manage Transactions tab
- Click the NPI to view the status of your 835 Transaction (Payment Report/ERA enrollment) and/or 837p Transaction (claim filing enrollment)
- Make sure the enrollment shows Completed
- Take a complete screenshot of this page
- Log in to your Payspan account
- Click Your Payments
- Under Manage Panel, select Accounts
- Click Account Name > Delivery Settings
- Make sure Eligible, Inc. is selected for your enrollment
- 835 Recipient indicates a Payment Report enrollment
- Take a complete screenshot of this page
- Log in to the WPS website
- Make sure your enrollment shows as completed
- 837p Transaction indicates a claim filing enrollment
- Take a complete screenshot of this page
- Log in to the Availity website
- Click Payer Spaces
- Choose the payer in question
- From the Application tab, select the ERA/EFT Enrollment app
- Search by Tax ID and Request ID
- The Request ID is located on the Confirmation page
- On this page, you'll see any open requests that have been submitted with your Tax ID
- Make sure your enrollment has the Completed status
- Take a complete screenshot of this page
- Make sure your NPI and/or Tax ID are visible in the screenshot
When can I start filing claims?
You can start filing claims if either one of these is true:
- The payer doesn't require a Claim filing enrollment
- If a payer has Ready to file claims under the Claim filing enrollment column in Settings > Insurance, you can file claims to them right away
- The Claim filing enrollment you submitted has been accepted
- You’ll receive an email when your enrollment is accepted, and the status will update to Ready to file claims in Settings > Insurance
Note: Some payers don’t accept claims filed through SimplePractice from before a claim filing enrollment’s acceptance date. While waiting for your claim filing enrollment to process, we recommend filing your claims outside of SimplePractice to avoid disruption in reimbursement.
When will I start receiving Payment Reports?
You should receive any Payment Reports generated by the payer after the date your Payment Report enrollment is accepted. Any Payment Reports generated before this date won’t be received in SimplePractice. To reflect previous payments in your account, you can add them manually. For more information, see Adding insurance payments.
Note: If your Payment Report enrollment is accepted but you aren’t receiving Payment Reports, see Investigating missing Payment Reports.
How do I update my enrollment information?
When there are changes to your practice information, this should be communicated to your insurance payers, and your enrollments should be updated.
If the following information has changed or has been updated with an insurance payer, check that the information on your enrollment with the payer matches:
- Provider/facility name
- Tax ID
To view this information:
- Navigate to Settings > Insurance
- Click on the document icon to view the information currently listed on an enrollment
To update an enrollment:
- Contact the insurance payer to verify the information that they have on file for you
Submit a help request so that our team can contact our clearinghouse and request that they temporarily reject your current enrollment, allowing you to update your information
- You'll receive an email confirmation when enrollment has been rejected
- Navigate to Settings > Insurance and click the Rejected icon
- This will take you to the enrollment screen where you can update your information as needed
- Update the information on the enrollment and resubmit
- We’ll email you once the enrollment is accepted again, or if additional steps are needed
Note: If you’re switching from a solo practice to a group practice, your insurance information will have to be updated. For more details, see How to switch from a solo practice to a group practice for insurance billing?
How do I cancel my enrollment?
An enrollment can only be canceled directly with the insurance payer. We aren’t able to cancel an enrollment on your behalf.
If you’d like to stop filing claims and/or receiving Payment Reports through SimplePractice, you can reach out to the payer directly to request that your enrollment(s) be canceled. Once your enrollment is canceled by the payer, the connection with SimplePractice is terminated, regardless of the enrollment’s status in SimplePractice.