This article includes answers to the most frequently asked questions regarding enrolling for e-claim filing with insurance payers. If you need some guidance submitting your enrollments, check out this guide.
- What is 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 are the requirements to enroll for claim filing or payment reports?
- 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 I still can't file these claim's through SimplePractice?
- When can I start filing claims?
- How to update your enrollment information in SimplePractice
What is Enrollment?
Enrollment is the process of informing your client's insurance company that you plan to submit electronic claims via SimplePractice and/or that you wish to receive electronic EOB's (or payment reports).
When you start managing your insurance through SimplePractice, you will need to notify some payers that you plan to use our software. You can manage the process of any required enrollments directly through SimplePractice in almost all cases, with just a few clicks of the mouse.
Enrollments are specific to a billing NPI. That's why you need to make sure that when you submit an enrollment you use the NPI and Tax ID that you will be including as the billing NPI on your claims to that payer. The Billing NPI is the one that goes in box 33 of your claim form.
Note: Enrollment is NOT the same as getting 'paneled' or 'credentialed' with an insurance payer. If you are enrolling with a payer through SimplePractice, you will likely need to already be paneled with an insurance payer in order for them to approve your enrollment. SimplePractice does not assist with credentialing.
How can I find out if my insurance payers require enrollment for claims and/or payment reports?
Many payers do not require that you enroll for claim filing. Some payers DO require that you enroll for payment reports.
If enrollment for either claim filing or for payment reports is required, you must upgrade to a paid account with SimplePractice and have at least 1 client that is listed as using that insurance payer.
How to check if your client's insurance companies requires enrollment
- Go to My account > Settings > Insurance.
- Begin typing 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?
- Not Required: Enrollment is not required for this payer. Go ahead and start submitting claims right away!
- No Clients on File: You have a paid SimplePractice account, but have not yet entered this payer into any of your client profiles. Enrollment requires a paid account and at least one client using the payer in order to enroll.
- Payment Reports Not Supported: Payment reports are not available for this payer. You will receive paper EOB's.
- +Enroll: Click the +enroll button in order to submit the simple application to your payer. We handle the rest!
What if I was already enrolled with my payer prior to SimplePractice?
Even if you've enrolled directly with an insurance company or through another clearinghouse, you still need to enroll through SimplePractice in order to set up the connection. Having been accepted to submit claims electronically with a payer in the past does not correlate to a faster acceptance through SimplePractice.
What are the requirements to enroll for claim filing or payment reports?
If enrollment is required for a payer, you must:
- Have at least one client on file with that payer entered into their profile
- To check: Go to Client > Edit Client info > Billing & Insurance Tab
- Provide your credit card information by going to My Account > Settings > Subscription Information
- This will not result in a charge on your card
What is "Ptan" on the enrollment page?
PTAN stands for Provider Transaction Access Number. Sometimes the PTAN is also called the provider number, Medicare PIN, or Medicare ID number. The PTAN is not an NPI, Tax ID, or Medicare UPIN.
The PTAN field is only required for Medicare enrollment. If you are trying to submit an enrollment to Medicare you will have to enter your PTAN in the enrollment form or your enrollment will be rejected. If you are a Medicare provider but cannot locate your PTAN reach out to Medicare and request that they provide it for you.
Note: If you're not submitting an enrollment to Medicare 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, check out this guide to see how long (in weeks) 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.
Note: We recommend that until your enrollments are approved, you submit claims by mail to avoid any delays in reimbursement for your sessions.
How can I check on the status of an enrollment?
- You can check the Enrollments page (Go to My Account > Settings > Insurance > Enrollments) to check on the status of your enrollments.
- You will also receive email updates from SimplePractice when the insurance company updates your enrollment status.
Note: If your enrollment was accepted, but you can't file claims see: What should I do if I receive an enrollment approval from the payer, but I still can't file these claim's through SimplePractice?
If your enrollment is rejected, you can learn more about re-enrolling here: What to do if your enrollment is rejected.
What should I do if I receive an enrollment approval from the payer, but I still can't file these claim's through SimplePractice?
Sometimes payers will notify our providers that an enrollment for claims filing and/or electronic payment reports has been approved, but not notify our clearinghouse. Our clearinghouse has to receive clear confirmation that your enrollment has been accepted so that you can file claims to this payer through SimplePractice. If you receive an approval notification, please contact our support team, so that we can expedite the process for you and provide clear confirmation.
When contacting our team, 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?
1. 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.
2. 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 My Account > Settings > Insurance > Enrollments.
How to update your enrollment information in SimplePractice
Whenever 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, too.
If the following information has changed or has been updated with the insurance payer you’ll want to check that your enrollment information is correct:
- Provider/facility name
- Tax ID
To update your enrollment information, here are the steps to follow:
- 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 contact our Customer Success team.
- 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.
- Next, go to My Account > Settings > Insurance > Enrollments.
- Click rejected. This will take you to the enrollment screen. Here you can update your information as needed.
- Our clearinghouse will work with the payer to process the resubmitted enrollment with your updated information.