Billing insurance should be simple, and enrolling with the insurers that you bill can help streamline the process by allowing everything to live in one fully integrated billing system. For many payers, you can start submitting electronic claims through SimplePractice right away. However, some payers will require that you submit a claim filing enrollment, which will need to be processed and accepted before they'll accept electronic claims submitted from your SimplePractice account.
This guide will walk you through the following:
- What is an enrollment?
- Determining if an insurance payer requires an enrollment
- Entering payer information into your client's profile
- Selecting the correct NPI for an enrollment
- Submitting an enrollment
What is an enrollment?
An enrollment is the process of letting your client's insurance company know that you plan to submit electronic claims via SimplePractice and/or that you wish to receive electronic payment reports. While not all payers require an enrollment to be able to submit claims and receive electronic payment reports through SimplePractice, some payers do. With SimplePractice, you're able to manage your enrollments, submit claims electronically, and automate your insurance payment information all in one place.
You can read more about enrollments in our Enrollment FAQs.
Determining which payers require enrollment
You can quickly and easily locate the insurance payers you work with and assess whether they will require you to enroll to submit claims electronically. Payer IDs and payer names can be specific to the clearinghouse they work with. If you're having difficulty finding a specific insurance payer, please reach out to our Insurance Team, and we'll be able to verify the payer ID for you. You can send us the secure SimplePractice client URL with their insurance card uploaded, and we will be able to either verify the payer ID or create a case with our clearinghouse to do so. If you need help uploading the insurance card, you can review Setting up insurance billing for your clients.
Note: Payment reports, if available from a payer, will always require enrollment.
- Go to My Account > Settings > Insurance Payers.
- In the text field, begin typing your payer's name or payer ID to locate your payer.
- Keep in mind that many insurance payers may be listed under a single payer ID, so don't worry if there is a large grouping of names with your payer. The payer ID for almost all payers (expect Magellan) is the only significant piece of information our clearinghouse uses to ensure the claim you submit in SimplePractice is sent to the correct payer. For more information on how to file claims to Magellan, please see Payers with unique claim filing rules.
Note: The Insurance Payers list only shows the first 50 payers on the list. You'll most likely need to use the search option to find the correct payer.
Check the Claim Filing Enrollment and Payment Report Enrollment columns to determine if enrollment will be required.
Here are the designations you may see:
- You can file claims now: Enrollment is not required for this payer. If you are already credentialed/paneled as an in-network provider or set up to bill as an out-of-network provider, you can start filing claims electronically in SimplePractice immediately.
- Paid Account Required: This means that enrollment IS required, but you are not yet on a paid account with SimplePractice. Upgrade in order to initiate the enrollment process.
- Assign this payer to a client to enroll: You are on a paid 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.
- Not Supported: Payment reports are not available for this payer and you will receive paper EOB's for the claims submitted in SimplePractice.
- +Enroll: Click on the +Enroll button in order to complete the simple application form to your payer. If the enrollment doesn't require additional documents, our clearinghouse handles the rest.
Entering payer information into your client's profile
Now that you've assessed your payers' enrollment requirements, you can enter your client insurance information into their profiles if you haven't already done so.
- Go to Client Profile > Edit > Billing & Insurance tab. Enter the payer either by payer ID (from step 1) or by typing in the keywords for the payer.
Note: You can add a payer to a test client's profile if you want to submit an enrollment in advance.
Selecting the correct NPI for an enrollment
It's important to make sure that the NPI you're including on your enrollment is the same NPI that the insurance payers have on file for you. Even if you have both an Individual and an Organization NPI, the information that the payer has on file for you will be dependent on the NPI that was submitted when you became credentialed.
Important: If you're unsure of what information the payer has on file for you, we highly recommend calling the payer directly to confirm your credentials that they have listed and avoid any delays with your enrollment. Any mismatch of information on your enrollment submission can lead to significant delays in enrollment processing time and will ultimately result in the enrollment being rejected. The payer is the only party that can verify your credentialed information. Even if your enrollment is submitted with up-to-date provider information, it's possible that the payer has outdated information on file which would also cause a rejection. By calling the payer directly, you can verify what should be listed on the enrollment and make sure that they have the correct information listed.
To avoid any delays in your enrollment processing time, we recommend first confirming the following billing information with the payer before submitting:
- The Billing NPI that's on file with the payer and that it's approved to file electronic claims
- The Tax ID or Social Security Number associated with your Billing NPI
- The full name (personal or organization) and address associated with your Billing NPI
Important: For out-of-network providers, your billing information must be on file with the payer before submitting an enrollment. Please contact the payer to confirm that you're registered as a non-participating provider and are approved to file electronic claims.
Submitting an enrollment
Now that you've entered client information, you need to go back to your settings and enroll for the payers that require enrollment. Here's how to submit an enrollment:
- Enrollment type: Payment Report vs. Claim Filing
- First, select whether you'd like to enroll in Payment Reports or to file claims. You can read about the differences between these enrollments here: Enrollment FAQs.
- Note: Only the enrollments that are available for submission will appear on this page.
- Billing Information: Select your Billing NPI
- This information should match the NPI that you list in box 33b of the CMS 1500 claim form when submitting claims. Providers will always have a Type 1 Individual NPI used to identify them. However, the Type 2 NPI would be considered the Billing NPI to list on the enrollment as long as that's the information the payer has on file if the payer bills through an organization with a Type 2 Organization NPI.
- Select your Type 1 Individual NPI or Type 2 Organization NPI based on your credentials, and enter the appropriate information that matches what the payer has on file.
- Type 1 Individual NPI includes the following:
- Full Name
- Facility Name
- Individual NPI Number
- SSN or Tax ID
- City, State, ZIP
- Type 2 Organization NPI includes the following:
- Organization Name
- Facility Name
- Organization NPI Number
- Tax ID
- City, State, ZIP
- Next, submit your electronic signature, and click Continue to Review & Submit:
- Review and Submit
- Verify all of the information that you've inputted. It's important to note that any discrepancies between what you've listed here and what the payer has on file can cause delays in processing times and lead to rejections. After carefully reviewing this information, click Submit Enrollment.
Once your enrollment request is submitted
You can view all your enrollments and enrollment request statuses on the Enrollments tab.
Typically, it takes between 2-8 weeks for insurance payers to process your enrollment request. Medicare, Medicaid, and some other payers can take up to 8+ weeks.
Note: We've created a searchable table for the average enrollment approval times for the most common enrollments we see, and you can reference it here: Average payer enrollment approval times.
We will email you when your enrollment has been completed or if there are any other steps needed from you in order to complete this process. Some enrollments will require additional documents to continue processing of the enrollment. You can review this guide this will detail that process: 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, this will help speed up the process. Sometimes the payers will update the clinicians but not the clearinghouse.
You'll also see the status change from Submitted to Accepted in the Enrollment section of the practice settings. When this happens, you're ready to file claims through SimplePractice!
Note: The PTAN field, as shown below, is only required for Medicare enrollment.
For additional information on insurance enrollments, check out the following articles: