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Verifying a client’s insurance benefits

Verifying a client’s insurance benefits

Before submitting a claim, it’s important to verify the client’s insurance benefits to confirm that their coverage is active and that their member information is correct. This helps you avoid claim rejections and denials.

You can verify a client’s insurance benefits by requesting a coverage check from the client’s payer. If you’re on the Plus plan, our clearinghouse will run automatic insurance status checks to verify a client’s coverage.

In this guide, we’ll cover:

Note: When verifying benefits through SimplePractice, the information that’s returned is dependent on the payer. If you aren’t able to verify a client’s benefits through SimplePractice, we recommend contacting the payer directly.


Entering information to verify benefits

To verify a client’s insurance benefits, certain information is required in your settings and in the client’s profile. 

Your individual (Type 1) NPI number should be entered at Settings > Profile > Clinical info:

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A client’s demographic and insurance information is also required. To enter this information:

  • Navigate to the client’s profile 
  • Click Edit 
  • On the Client Info tab, enter the client’s: 
    • Address 
    • Date of Birth
    • Sex
      • As this can differ from the client's Gender Identity, select the client's Sex that's on file with the payer. Insurance payers require this for claim filing. 

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To enter a client’s insurance information: 

  • Click the Billing and Insurance tab
  • Under Billing Type, choose Insurance

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  • Scroll to Insurance info
  • Click + Insurance info

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  • If your client isn’t the subscriber, select the Primary policy holder and enter the subscriber’s information in the available fields 
    • If the subscriber’s information matches the client’s, click Same as client 
  • After entering any additional plan details, click Save 

Note: For more information on entering a client’s insurance information, see Setting up insurance billing for your clients.


Coverage checks


Requesting a coverage check

Note: Coverage checks are currently available on the Essential and Plus plans and cost $0.05 per successful check. Beginning your first subscription billing date on or after March 3, 2025, coverage checks will also be available on the Starter plan. As of this billing date, the cost per successful check will be $0.25 for Starter, $0.15 for Essential, and included for free for Plus. Automatic insurance status checks will be available soon for customers on the Plus plan for no additional charge.

Once you’ve entered all required information, you can request a coverage check for a client. To do this:

  • Navigate to your client's profile
  • In the Insurance summary, click Request coverage check

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Note: Coverage checks not supported in the Insurance summary indicates we don’t have a connection with the payer and are unable to request coverage checks. We recommend contacting the payer directly to verify the client’s benefits. 

After requesting a coverage check, you’ll be taken to the Insurance coverage details page, where you can view and print the check, or request a new one. 

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Coverage checks include the following sections:

  • Subscriber
  • Patient
  • Payer
  • Mental Health
  • Mental Health Provider - Inpatient
  • Mental Health Provider - Outpatient
  • Mental Health Facility - Inpatient
  • Mental Health Facility - Outpatient
  • Psychiatric
  • Psychotherapy
  • Psychiatric - Inpatient
  • Psychiatric - Outpatient
  • Day Care (Psychiatric)
  • Psychiatric Treatment Partial Hospitalization
  • Alcoholism Treatment
  • Drug Addiction
  • Social Work
  • Substance Abuse
  • Physician Visit - Well
  • Physician Visit - Sick
  • Prescription Drug
  • Adjustment to dentures/repairs to complete dentures
  • Bariatric services
  • Diagnostic Lab
  • Diagnostic X-Ray
  • Hospitalization
  • Urgent Care
  • Hospital - Ambulatory Surgical
  • Hospital - Emergency Accident
  • Hospital - Emergency Medical
  • Hospital - Inpatient
  • Hospital - Outpatient
  • Professional (Physician) Visit - Home
  • Professional (Physician) Visit - Nursing Home
  • Professional (Physician) Visit - Outpatient
  • Psychiatric - Room and Board

Note: The information that’s included in a coverage check is dependent on the payer. Because some payers only provide information for a client’s medical coverage, mental health benefits won’t always be included. If coverage information needed to bill your client isn’t included, you can verify their benefits by contacting the payer.

You can adjust the client’s Copay/Coinsurance or Deductible directly from this page in the Client Info section.

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Locating coverage checks

You can access all coverage checks you’ve requested by navigating to Analytics > Reports > Coverage checks

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You can also locate an individual client’s coverage checks by navigating to their profile and clicking View coverage check

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In the Insurance coverage details page, you can view their past coverage checks using the date dropdown menu.  

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Receiving coverage check errors

There are times when a coverage check can’t be created. You’ll receive an error message when a coverage check fails. 

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Note: You won’t be charged for failed coverage checks. 

Common error messages and the reasons for each are outlined below. 

Error message 

Reason
Coverage check could not be created Required information is missing. Click Add now to enter the information.
Unable to respond at current time The client's subscriber information may be inaccurate or the payer may not yet offer coverage checks for this client.

Automatic insurance status checks


Understanding automatic insurance status checks

Note: This feature is being rolled out in groups and will be available to all customers on the Plus plan at a later date.  

If you’re on the Plus plan, we’ll run automatic insurance status checks on a regular basis. Automatic insurance checks are only run for primary insurance plans, and will occur:

  • When you add a new insurance payer to a client’s profile 
  • When you update an existing insurance payer or Member ID 
  • On a weekly basis for clients that haven’t had a successful coverage check or claim in the past 90 days

Note: There are no additional charges for automatic insurance status checks or coverage checks generated by status checks. 

After an insurance status check is run, the plan will update to one of the following statuses. 

Status Description
Active We can verify that the insurance plan exists and that the benefits are available with the provided information.
Review info We can’t verify that the insurance plan exists based on the provided information. It’s possible that a claim may still be successful.
Inactive We can verify the insurance plan exists, but the benefits have likely expired. A claim will likely be rejected or denied by the payer.

Note: For an overview of next steps, see Resolving insurance plan statuses

Automatic insurance status checks use coverage checks to verify benefits. To review the coverage check associated with a status check, see Locating coverage checks


Viewing insurance plan statuses

As automatic insurance status checks are run, there are four locations an insurance plan’s status will display in your account. 

Insurance information

In a client’s Insurance info settings, an insurance plan’s status will display next to the payer’s name. 

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Client profile

On a client’s profile, an insurance plan’s status will display in their Insurance summary. 

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Calendar appointment 

When viewing an appointment in your calendar, an insurance plan’s status will display next to the Billing Type

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Banner

When an insurance plan updates to the Review info or Inactive statuses, a banner will display on the client’s profile and in their Billing and Insurance and Insurance info settings. Click to dismiss the banner.


Resolving insurance plan statuses

Addressing insurance plans that are displaying Review info or Inactive statuses will reduce the likelihood that a claim will be rejected or denied. 

Review info

The Review info status indicates that we weren’t able to verify the insurance plan with the existing information. While the information may still be correct, we recommend that you verify that the client’s information matches what’s listed on their insurance card. 

If you’re not able to verify the information based on the insurance card, we recommend that you reach out directly to the payer to verify benefits. After verifying and updating the client’s information, you can submit a claim. 

Note: If all the information is correct but you’re still receiving claim rejections, the payer may require a different payer ID. For more information, see Selecting the correct payer ID. If you receive additional rejections and aren’t sure why, you can submit a help request so we can investigate.

After the claim is processed successfully, the payer’s status will update to Active.

Inactive

The Inactive status indicates that the plan has likely expired. We recommend that you verify the client’s current insurance plan, request their new insurance card, and reach out to the payer if necessary. 

Once you’ve received their updated information, you can add it as a new Primary insurance plan using the steps in Entering information to verify benefits. You can also update the Inactive payer to the Other insurance type to retain the information for your records. 

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