Before submitting a claim, it’s important to verify a 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 an insurance status 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.
Insurance status checks
Requesting an insurance status check
Once you’ve entered all required insurance information, you can request an insurance status check for a client. To do this:
- Navigate to your client's profile
- In the Insurance summary, click Request insurance status check
Note: Insurance status checks not supported in the Insurance summary indicates we don’t have a connection with the payer and are unable to request status checks. We recommend contacting the payer directly to verify the client’s benefits.
After requesting an insurance status check, you’ll be taken to the Insurance status details page, where you can view and print the information, or request a new status check.
Insurance status 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 an insurance status 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.
Locating insurance status checks
You can access all insurance status checks you’ve requested by navigating to the reports in your account:
- Navigate to Analytics > Reports > Insurance status checks
You can also locate an individual client’s insurance status checks from their profile:
- Navigate to the client’s profile
- Click View insurance status check
In the Insurance status details page, you can view their past status checks using the date dropdown menu.
Receiving insurance status check errors
There are times when an insurance status check can’t be created. You’ll receive an error message when a check fails.
Note: You won’t be charged for failed status checks.
Common error messages and the reasons for each are outlined below.
| Error message | Reason |
| Insurance status check couldn't 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 insurance status checks for this client. |
Automatic insurance status checks
Understanding automatic insurance status checks
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 insurance status check or claim in the past 90 days
Note: There are no additional charges for automatic insurance 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.
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.
Client profile
On a client’s profile, an insurance plan’s status will display in their Insurance summary.
Calendar appointment
When viewing an appointment in your calendar, an insurance plan’s status will display next to the Billing Type.
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.
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.
Disabling automatic insurance status checks
Automatic status checks are sent by payers. When these statuses aren’t accurate, SimplePractice isn’t able to manually update them. If you’re finding that payers you work with don’t consistently return accurate statuses, you can disable the automatic status checks.
To do this:
- Navigate to Settings > Client billing and insurance > Insurance billing
- Uncheck the box under Automatic status checks
- Click Save changes
If you find these checks helpful, you can leave them enabled at no additional cost to your subscription. This is a practice-wide setting and can’t be enabled on a per-payer basis.