When insurance payments are posted to your account, either automatically through Payment Reports or after being added manually, they’re allocated to their respective appointments. If a payment isn’t fully allocated, it’s considered Unallocated. For accurate reporting, we recommend that standard insurance payments be fully allocated.

Note: Unallocated amounts are expected when insurance adjustments take place. For more information, see Managing insurance adjustments. 

In this guide, we’ll cover: 

• Understanding unallocated insurance payments 
• Locating unallocated insurance payments
• Addressing unallocated insurance payments 
• Reviewing unallocated Payment Reports 
• Scenarios that result in unallocated amounts
• FAQs

Understanding unallocated insurance payments

The Amount field of an insurance payment under Payment Details should reflect the total payment amount, which is the transfer of funds between the insurance payer and you. 

The Amount column under Payments Allocated should reflect what the insurance payer paid for each appointment included in the payment. 

If the total payment amount is more than the sum of the amounts paid for each appointment, the difference will reflect as a positive Unallocated amount. 

If the total payment amount is less than the sum of the amounts paid for each appointment, the difference will reflect as a negative Unallocated amount. This usually indicates an insurance adjustment took place. 

Note: For an overview of insurance adjustments, see Managing insurance adjustments. 

Locating unallocated insurance payments

If you need to locate an unallocated insurance payment, you can use your insurance Payments page. To do this:  

• Navigate to Insurance > Payments
• Filter to Unallocated payments

• Filter by date and/or insurance payer
• Look for any payments with an Unallocated amount 

• Click View next to the payment in question 

There are several scenarios that can lead to unallocated insurance payments. For some common examples, see Scenarios that result in unallocated amounts.

Addressing unallocated insurance payments

After locating an insurance payment with an unallocated amount, you can review the Explanation of Benefits (EOB) to determine the cause of the unallocated amount. The EOB lists all the information in the electronic Payment Report (ERA) sent by the payer, including an overview of the complete payment and individual remittance information for each claim on the payment. 

Note: If an insurance payment wasn’t automatically created because of a missing claim or appointment, the EOB can’t be accessed. For an overview of steps to take in this situation, see Reviewing unallocated Payment Reports. 

To download and review the EOB: 

• Navigate to Insurance > Payments
• Filter to Unallocated payments
• Filter by date and/or insurance payer to locate insurance payment
• Click View 
• Select Download EOB

• Compare the information on the EOB with the insurance payment to determine the discrepancy 
  • For example, if different dates are listed on the EOB, this usually indicates an appointment was deleted or moved

Note: If asterisks appear instead of a client name on the EOB, this is because a corresponding claim wasn’t found in SimplePractice. For more information, see Why isn’t my client’s name showing on the Payment Report/EOB? 

Once you’ve determined the discrepancy, you can make the necessary changes in your account. For an overview of common scenarios and what actions to take, see Scenarios that result in unallocated amounts.

You can then edit the insurance payment to allocate the remainder of the payment. For example, you may need to add an appointment to the payment or update the amount that insurance paid for an appointment that’s already attached.  

Reviewing unallocated Payment Reports

When an insurance payment’s information is received from the payer through an electronic Payment Report (ERA), there must be a claim and appointment with matching information in your account for an insurance payment to be automatically created. 

If an insurance payment isn’t able to attach to any appointments, an insurance payment won’t be created automatically, and the EOB can’t be accessed. In this situation, you can view the payment information in your Payment Reports. 

Note: For more information on Payment Reports, see ERAs in SimplePractice (Payment Reports). 

To do this: 

• Navigate to Analytics > Reports > Payment Reports
• Adjust the date range to locate a specific Payment Report 

• If you have a check/wire number, search the page (using Command + F on a Mac or Ctrl+ F on a PC)for the number 
  • This will highlight all the Payment Reports associated with the check/wire number
  • A check/wire number can be obtained outside of SimplePractice or from your Insurance > Payments page if an insurance payment was automatically generated 

An individual Payment Report is generated for each claim. Click the Date Received to open a Payment Report. 

Note: If a client’s name contains asterisks, this indicates that the Payment Report couldn’t attach to a claim in SimplePractice. For more information, see Why isn’t my client’s name showing on the Payment Report/EOB?

If a Payment Report was able to attach to a claim, it’ll show both the Payment Overview and Insurance payment report (ERA) sections. The Payment Overview section shows the date(s) of service attached to the claim and corresponding insurance payments. For more information, see Reviewing the Claim Details page. 

If a Payment Report wasn’t able to attach to a claim, only the Insurance payment report (ERA) section will show. 

If an insurance payment was automatically generated by a Payment Report on your Insurance > Payments page, you can compare the Payment Report and insurance payment to determine what’s causing an unallocated amount. Then, you can correct the insurance payment by following the steps in Editing or deleting an insurance payment. 

If an insurance payment wasn’t automatically generated by a Payment Report, you can manually add the payment by following the steps in Adding insurance payments. 

For examples of common unallocated payment scenarios, see Scenarios that result in unallocated amounts.

Note: If a claim was deleted or submitted outside of SimplePractice, a placeholder claim can be created to mark the appointment as resolved. For an overview of these steps, see Removing appointments from the Unbilled appointments list. 

Scenarios that result in unallocated amounts

Some unallocated insurance payments are the result of manual changes made to appointments or claims. Other times, unallocated amounts are the result of insurance payers making adjustments on their end.

In this section, we’ll cover some common scenarios:

• Deleted appointments
• Appointments moved
• Appointments marked No show, Canceled, or Late canceled
• Claims deleted or submitted outside of SimplePractice
• Insurance adjustments
• Interest payments

Deleted appointments

In this scenario, an appointment was deleted from the calendar after the appointment was billed to insurance. This results in the insurance payment being unable to allocate to a date of service. 

The video below will walk you through locating the appointment’s adjudication information on the EOB, recreating the appointment, and adding it to the payment. 

Appointments moved

In this scenario, an appointment was moved to a different date on the calendar after it was billed to insurance. This results in the insurance payment not allocating to the appointment. 

The video below will walk you through locating the appointment’s adjudication information on the EOB, moving the appointment back to the original date, and adding it to the payment. 

Appointments marked No show, Canceled, or Late canceled

In this scenario, an appointment was marked as No show, Canceled, or Late canceled after the appointment was billed to insurance. Due to this, the insurance payment didn’t allocate to the appointment. 

Note: For an overview of appointment statuses, see How to change an appointment status. 

The video below will walk you through locating the appointment’s adjudication information on the EOB, updating the appointment’s status on the calendar, and adding it to the payment. 

Claims deleted or submitted outside of SimplePractice

In this scenario, a claim was submitted and then deleted, or was submitted outside of SimplePractice. In both instances, the insurance payment isn't able to allocate to a specific claim. 

The video below will walk you through locating the appointment’s adjudication information on the EOB, recreating the claim, and adding it to the payment. 

Insurance adjustments

In this scenario, an insurance payer audits a claim that they’ve previously processed. To update their initial payment, they’ll first send an adjustment payment to zero out the payment. Then, they’ll typically send an updated payment. 

Unallocated amounts are expected on adjustment payments. For an overview of insurance adjustments and how they should reflect, see Managing insurance adjustments. 

The video below will walk you through the stages of an insurance adjustment, how insurance adjustments reflect in SimplePractice, and next steps to take in this situation. 

Interest payments

In this scenario, the insurance payer included interest on the insurance payment due to a delay in processing the claim. Since payers don’t send information on which appointment(s) interest applies to, the interest shows as Unallocated. 

The video below will walk you through locating the interest amount on the EOB, contacting the payer to determine what appointment the interest is for, and allocating the interest to the appointment. 

FAQs

• Do unallocated insurance payments affect my income reports?
• Do unallocated insurance payments affect payroll? 
• Why do I have a negative unallocated insurance payment?
• Why isn’t my client’s name showing on the Payment Report/EOB? 
• What should I do if an insurance payment wasn’t automatically created? 
• How do I remove all unallocated insurance payments? 

Do unallocated insurance payments affect my income reports?

The number in the Amount field of an insurance payment under Payment Details directly corresponds with your income reports. It’s important to make sure the Amount reflects the transfer of funds between you and the payer outside of SimplePractice.

If the Amount field is reflecting correctly but hasn’t been allocated to all necessary appointments, your income will still reflect correctly. 

The Amount field may reflect incorrectly and need to be adjusted on certain insurance adjustment payments. For more information, see Unallocated amounts on clawback payments. 

Do unallocated insurance payments affect payroll?

An insurance payment has to be allocated to an appointment to count towards payroll. If an unallocated amount is originating from the insurance payment not being allocated to an appointment, the payment will have to be allocated for your payroll to reflect correctly. For more information, see Navigating the Income allocation report. 

If an insurance payment is allocated to all applicable appointments but the Amount is different than the total amount allocated, there was likely an insurance adjustment. As long as the payment has been allocated to the necessary appointments, your payroll will reflect correctly. 

Note: For more information on insurance adjustments, see Managing insurance adjustments. 

Why do I have a negative unallocated insurance payment?

A negative unallocated amount on an insurance payment indicates that the amounts allocated to the appointments total more than the Amount field under Payment Details. This happens when an insurance payer withholds funds from a payment due to an adjustment or previous overpayment. 

For more information, see Negative unallocated amounts. 

Why isn’t my client’s name showing on the Payment Report/EOB?

When a Payment Report (ERA) can’t automatically attach to a claim in SimplePractice, the majority of the client’s name will be replaced with asterisks on your Payment Reports page, the Payment Report, and the EOB (Explanation of Benefits). This indicates the claim was deleted or submitted outside of SimplePractice. 

You can compare the dates of service and appointment information to the appointments in your account to determine which client the payment is for. Then, you can edit the corresponding insurance payment to add the appointment, or add a new insurance payment if an insurance payment wasn’t automatically created. 

Note: For more information on handling unallocated Payment Reports, see Reviewing unallocated Payment Reports. 

If you’re not able to determine which client the Payment Report or EOB is for, you can reach out directly to the payer for more information. You can use the Payment reference ID and Payer Claim number (if available) from the Payment Report or EOB as reference with the payer.  

For more information on handling this situation in SimplePractice, see Claims deleted or submitted outside of SimplePractice.

Note: If a claim was deleted or submitted outside of SimplePractice, a placeholder claim can be created to mark the appointment as resolved. For an overview of these steps, see Removing appointments from the Unbilled appointments list. 

What should I do if an insurance payment wasn’t automatically created?

If you received a Payment Report but an insurance payment wasn’t automatically created because of a missing claim or appointment, you can manually add an insurance payment using the Payment Report information. For an overview of these steps, see Reviewing unallocated Payment Reports. 

How do I remove all unallocated insurance payments?

If an insurance payment is reflecting an unallocated amount because of incorrect payment details, you can follow the steps in Addressing unallocated insurance payments to remove the unallocated amount. 

Unallocated amounts are expected on adjustment insurance payments and accurately reflect the insurance adjustment process. However, the Amount field of an insurance payment may have to be adjusted on certain adjustment insurance payments to make sure your income reflects correctly. For more information, see Reviewing unallocated amounts on adjustment insurance payments. 

Important: We don’t recommend altering adjustment insurance payments to reflect a $0 unallocated amount, as your income won’t reflect correctly in SimplePractice.