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Enrollment FAQs

Enrollment FAQs

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

Submitting an enrollment

Submitting multiple enrollments per payer 

Enrollment approval 

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 typically 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 > Client billing and insurance > Payers
  • Click Search available payers

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  • Type the payer ID or payer name into the search box
  • Locate the payer
  • Click + Add

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  • Locate the payer in your Payers list
  • Check the Claim filing enrollment and Payment report enrollment columns to see the payer's requirements
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Prior to submitting an enrollment, each payer will have a designation in the Claim filing enrollment and Payment report enrollment columns.

Status Meaning
Ready to file claims A claim filing enrollment isn’t required for this payer. You can start submitting electronic claims through SimplePractice immediately.

Not supported

In the Claim filing enrollment column, this indicates the payer was manually added and that claims can’t be submitted electronically through SimplePractice. 

In the Payment report enrollment column, this indicates that Payment Reports aren't available for this payer. You can still submit claims electronically, but you’ll receive remittance information outside of SimplePractice and can manually add those payments.

Ready to enroll 

In the Claim filing enrollment column, this status indicates the payer requires an enrollment to submit claims electronically. 

In the Payment report enrollment column, this status indicates the payer offers Payment Reports. 


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 Upgrade Your Plan in the top navigation bar.

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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 Completing additional steps


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?

If you have unique billing provider information on file with certain payers, you can use multiple Tax IDs/NPIs when submitting enrollments. However, each enrollment can only have a single Tax ID/NPI combination. 

Group practices with members that have unique billing information on file with specific payers can submit multiple enrollments to those payers. For more information, see Submitting multiple enrollments per payer

Important: Only one enrollment can be submitted per NPI to a payer in SimplePractice. For more information, see How many enrollments can I submit per NPI to a payer?

For any enrollment that differs from your practice’s default billing information, we recommend that you add billing profiles so this information automatically populates claims. For an overview of billing profiles, see Managing billing profiles for insurance

Note: Billing profiles are only available on the Plus plan.


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. 

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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 Info 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 > Client billing and insurance > Payers

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  • Locate the payer  
    • Enrollments in the Info required status will have a notification next to them in the Claim filing enrollment or Payment report enrollment columns 
  • Click Manage 

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  • Click Manage Enrollment

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  • Download the PDF in Step 1

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  • 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, 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 Info 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.


Why did my enrollment’s status move from Accepted to Info required?

Payers occasionally update their enrollment process. When this happens, the payer notifies our clearinghouse that customers need to re-enroll using the new process and must complete additional documentation. 

If a previously accepted enrollment is now asking that you complete additional steps to receive Payment Reports, you’ll need to re-enroll using the payer’s new process. 

To do this:

  • Navigate to Settings > Client billing and insurance > Payers 
  • Click Manage next to the payer in question

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  • Select Manage Enrollment under the Info required status

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  • Download the PDF in Step 1

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  • Follow the instructions detailed in the document and complete the remaining steps

Payers who’ve updated their enrollment process generally take less time to re-accept them. During that time, we recommend manually adding insurance payments that you’ve received, but haven’t received Payment Reports for. 

If 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're 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. 

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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 many enrollments can I submit per NPI to a payer?

Only one claim filing enrollment and one Payment Report enrollment can be submitted per NPI to a single payer in SimplePractice. If you have multiple SimplePractice accounts, you’ll only be able to submit these enrollments using a single NPI through one account. 

If you have an existing enrollment that you’d like to link to a different SimplePractice account, submit a help request through your new account with the following information:

  • The payer name and payer ID for the enrollment  
  • The NPI number submitted on the enrollment

How can I have a unique enrollment’s information populate on claims?

If you have an enrollment that was submitted with billing information that differs from your practice’s default billing information, you can add a corresponding billing profile with matching billing information. This information will then automatically populate claims so you don’t have to make manual edits to boxes 25 and 33.  

For more information, see Managing billing profiles for insurance

Note: Billing profiles are only available on the Plus plan. 


Will Payment Reports allocate to the correct claims with multiple enrollments per payer?

If you have multiple accepted Payment Report enrollments with a payer, claims submitted with billing information matching those enrollments will receive Payment Reports in SimplePractice. 

To make sure that claims populate the correct billing information, we recommend adding a corresponding billing profile for enrollments that don’t match the practice’s default billing information. Billing profiles can be associated with a clinician and/or payer.  

For more information, see Managing billing profiles for insurance


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 > Client billing and insurance > Payers and click Manage next to the payer. Below, we’ll cover each of the statuses. 

Submitted

If an enrollment shows as Submitted, it's still being processed by the payer and will need more time to be approved.

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Info required 

The Info required status indicates that the payer requires additional steps before they’ll accept the enrollment. 

You can click Manage Enrollment to complete those additional steps. For more information, see Why is my enrollment requiring additional steps?

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Rejected

If an enrollment was rejected, click Manage Enrollment to view the reason and resubmit the enrollment. For more information, see Resolving rejected enrollments.

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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:

Operating system

Keyboard shortcut

OS X (using a Mac computer)

Command + Shift + 4
Windows

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.

EDISS Connect 

  • 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

Payspan 

  • 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 

WPS 

  • 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

Availity

  • 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 > Client billing and insurance > Payers, 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 Accepted on the payer’s enrollment page 

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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: 

  • NPI
  • Provider/facility name
  • Tax ID
  • Address

You can review an enrollment’s information if it’s in the Accepted, Submitted, or Rejected status. To view this information: 

  • Navigate to Settings > Client billing and insurance > Payers
  • Click Manage next to the payer 

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  • Select Manage Enrollment under the enrollment

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  • Click Review Enrollment Details

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You can resubmit a Rejected or Submitted enrollment. To do this: 

  • Click Resubmit Enrollment

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  • Select Yes, I want to resubmit 

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  • On the next pages, confirm the enrollment type(s), the information that you want to update, and your signature 
  • In the final step, review the information on the enrollment and click Submit Enrollment 

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Note: While resubmitted enrollments typically process quickly, it can take as much time as a new enrollment, depending on the payer. For more information, see Average payer enrollment approval times

If you need to update the NPI on an Accepted enrollment, submit an additional enrollment to the payer following the steps in Submitting multiple enrollments per payer. This allows the enrollment to be processed as quickly as possible and gives you the option of submitting claims with the current NPI through the existing enrollment. 

If the NPI on an Accepted enrollment isn’t changing but you need to update other information on the enrollment, the enrollment will need to be temporarily rejected and resubmitted. This is because only one enrollment can be submitted per NPI to a single payer. 

To have the enrollment rejected, submit a help request so that we can ask our clearinghouse to reject the enrollment, allowing you to resubmit it with the correct information. You'll receive an email confirmation when the enrollment has been rejected. 

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. 

You can delete a payer from your Payers list. However, this will only remove the payer from the list and won’t cancel it on the payer’s end. For more information, see Removing a payer.

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