Submitting enrollments is an important part of electronic insurance billing in SimplePractice. There are two types of enrollments in SimplePractice: one for filing claims electronically (Claim Filing Enrollment), and one for receiving electronic payment reports (Payment Report Enrollment). Some enrollments are required, while others are recommended to help streamline your insurance billing.
In this guide, we’ll cover:
- What is an enrollment?
- Determining if an insurance payer requires an enrollment
- Submitting an enrollment to file claims and/or receive payment reports
- Manually adding a payer
- Removing a payer
- Sorting your insurance payers
What is an enrollment?
A Claim Filing enrollment is the process of letting an insurance payer know that you plan to submit claims electronically through SimplePractice. A Payment Report enrollment is a request to receive electronic payment reports which are just like EOBs (Explanation of Benefits) and are our version of ERAs (Electronic Remittance Advice).
Enrolling is not the same as becoming credentialed, and most payers will require that you be credentialed with them before submitting an enrollment. Enrollments submitted to payers that you aren’t credentialed with will typically be rejected, as the payer doesn’t have your billing information on file.
Once you’re credentialed with a payer, an enrollment can be submitted using your billing information.
To learn more about enrollments, see: Enrollment FAQs.
Determining if an insurance payer requires an enrollment
Most payers don’t require that you submit a Claim Filing Enrollment to submit claims electronically. Payers that do require an enrollment to submit claims include Medicare, Medicaid, and some BCBS payers.
A payment report enrollment isn’t typically required, but it is recommended as it helps to automate your bookkeeping. For more information on the benefits of submitting a payment report enrollment, see: ERAs in SimplePractice (Payment Reports).
To determine a payer’s enrollment requirements:
- Navigate to Settings > Insurance
- Click Search available payers
- Search the payer ID or the payer’s full name as it appears on the client's member ID card
Note: For more information on choosing a correct payer, see: Adding insurance payers and selecting the correct payer ID.
- Click + Add
The payer will now be added to your My Insurance Payers page. The payer's enrollment requirements will be displayed in the Claim filing enrollment and Payment report enrollment columns.
An Enroll option in either column means an enrollment is available. Click Enroll to begin the process of submitting the enrollment. See Submitting an enrollment to file claims and/or receive payment reports for instructions.
Important: An Enroll option in the Claim filing enrollment column means the payer requires you to have an accepted enrollment before being able to submit claims electronically.
A green checkmark and Ready to file claims status indicates that no claim filing enrollment is required and you can start submitting claims right away.
Important: Even though a payer says Ready to file claims in the Claim Filing Enrollment column, you’ll still need to be credentialed with them or be approved to file claims as an out-of-network provider.
If there’s a green checkmark and Ready to file claims status in the Claim filing enrollment column, but a Not Supported status in the Payment report enrollment column, you’re able to submit claims to this payer electronically, but electronic payment reports aren’t supported.
For payers that don't support payment reports, we recommend manually adding insurance payments to keep your records up-to-date.
Submitting an enrollment to file claims and/or receive payment reports
When submitting an enrollment, you’ll want to make sure you have your billing information in order. If you’re not sure which information to include, we recommend contacting the payer to confirm what they have on file. Billing information needed to submit an enrollment includes the following:
- The billing NPI that’s on file with the payer and that’s approved to file electronic claims
- If you’re billing as an organization, this will be your group NPI
- The Tax ID or Social Security Number associated with your billing NPI
- For group practices, this may be a unique number tied to your group NPI
- The full name (personal or organization) and address associated with your billing NPI
Important: If there’s any mismatch between the information the enrollment is submitted under and what the payer has on file, the enrollment can be rejected. To avoid longer processing times, we highly recommended confirming that the payer has your up-to-date billing information before submitting an enrollment.
Once you have your information ready, here’s how you can submit an enrollment:
- Locate the payer in your My Insurance Payers page
- Click Enroll
- Confirm you’ve read the on-screen information and click Begin Enrollment
- If the payer requires a claim filing enrollment, you’ll be able to submit both enrollments (claim filing and payment report) from the Enrollment Type page
- Choose Type 1 Individual NPI if billing as an individual provider, and Type 2 Organization NPI if billing as part of an organization
- If you're submitting an enrollment under your Type 1 Individual NPI, the following billing information will be required
- If submitting an enrollment under your Type 2 Organization NPI, the following billing information will be required
- Once the information is entered, click Continue to Signature
- Enter your electronic signature and click Continue to Review & Submit
- Review and confirm the information entered, and click Submit Enrollment
Typically, it takes between 2-8 weeks for insurance payers to process your enrollment request. You can view all of your enrollments and enrollment requests in your My Insurance Payers page.
Note: We've created a searchable table for the average enrollment approval times. You can find this table here: Average payer enrollment approval times.
We'll email you when your enrollment has been completed or if there are any other steps needed from you to complete this process. Some enrollments will require additional documents to continue processing the enrollment. You can lean more about this here: Why is my enrollment requiring additional steps?
Important: If you receive a notice from the payer stating that they've accepted your enrollment, please share it with our team to help speed up the process. Sometimes payers will update clinicians but not our clearinghouse.
You'll see the status change to Ready to file claims and Ready to receive ERAs once accepted.
Note: The PTAN field is only required for Medicare enrollments. If submitting an enrollment under your Type 2 Organization information, you may have a separate group PTAN. If you’re unsure what your PTAN is, contact Medicare directly.
Manually adding a payer
If a payer you need to bill isn’t in our system, you can manually add them. Manually adding a payer to your list won’t make that payer eligible for electronic claim filing. By manually adding a payer, you’re able to prepare and download your claims so they can be submitted outside of SimplePractice. To submit a claim electronically, our clearinghouse must have an active connection with them, and if a payer isn’t in our system, it means there isn’t an active connection.
Important: Electronic payment reports won't be available for manually added payers.
To manually add a payer, follow these steps:
- Click Add payer manually
- Enter the Payer name and Coverage Type
- If this is an EAP, choose Other for the Coverage Type
- Enter the address
- Click Save
Manually added payers will be marked as Manual in your My Insurance Payers page and won't support either enrollment type.
For more information, see: Adding an employee assistance program (EAP).
Removing a payer
The My Insurance Payers page will list all insurance payers that you’ve added, as well as any that are currently assigned to at least one client.
If you aren’t billing a payer anymore, if a payer was added in error, or if you’d like to manage this list, you can remove a payer at any time. Here’s how:
- Locate the payer in your My Insurance Payers page
- Click Edit
- Click Delete Payer
A payer can’t be deleted if it’s assigned to at least one client. If you try to delete a payer that’s still assigned to at least one client, you’ll be blocked from doing so, and will be asked to remove the payer from those clients’ insurance information.
To determine which clients are still assigned to that payer, follow these steps:
- Navigate to the Clients & Contacts page
- Enter the payer ID in question in the Insurance Payer filter
- You’ll see all clients who are actively assigned to that payer
- Click Manage > Edit Client Info
- Navigate to that client's Billing and Insurance tab
- Update the insurance payer in their file
- If you’re no longer seeing this client, don’t have their updated insurance information, or if they‘re now self-pay, you can click the trash icon to remove their insurance information
- Repeat these steps until all clients are unassigned from the payer in question
- Return to your My Insurance Payers page
- Click Edit
- Click Delete Payer
Sorting your insurance payers
You have the ability to sort your Insurance Payers list as you add payers and submit enrollments.
The Most recent filter sorts the payers based on the order they were added.
The Priority filter sorts the payers based on the following order:
- Document Required
- Ready to receive claims / ERAs
- Payers that don’t require enrollments
- Manually added payers
Tip: The Priority filter lists enrollments that require action first. This makes it easy to determine which enrollments haven't been completed.