When submitting claims electronically, the most important piece of information is the payer ID. Adding the correct payer ID to your clients’ insurance information reduces the likelihood of encountering rejections or denials.
In this guide, we’ll cover:
- Selecting the correct payer ID
- Searching for additional payers
- Manually adding a payer
- Verifying a payer before submitting a claim
Selecting the correct payer ID
A five-digit payer ID is required when adding a client’s insurance information. Payer IDs are unique and are used to submit claims electronically through our clearinghouse.
Note: Insurance payers often use different payer IDs depending on the clearinghouse they’re working with. Because of this, payer IDs are unique in SimplePractice.
To select the correct payer ID, first upload the client’s insurance ID for reference. To do this:
- Navigate to the client’s Overview page
- Click Edit > Billing and Insurance
- Scroll down to their Insurance information
- Click + Insurance Info
- Click browse to upload the file
- Click Save Client
Note: Uploading the front and back of a client’s insurance ID to their file is highly recommended, as many claim errors that lead to scrubs, rejections, or denials are because insurance information wasn't correctly entered. With a card uploaded, you’re able to review the information if you encounter any claim issues.
We also recommend adjusting your Demographics form, so it includes a field for clients to enter their insurance information and ID. To do this:
- Navigate to Settings > Client Portal > Shared Documents and Files
- Check the Insurance box
Once the client’s insurance ID is uploaded, review the front and back to see if there are any special online filing instructions. If there aren’t any special instructions, search the payer’s name using the Insurance Payer dropdown under the client’s Insurance Information.
After selecting the payer, add the Member ID, any other relevant details, such as Copay/Coinsurance, and click Save Client.
Searching for additional payers
Searching for a payer in a client’s Insurance Information will only show the name and payer ID. You can perform an expanded search by navigating to Settings > Insurance and clicking Search available payers.
This is helpful for payers that have different payer IDs associated with them, or unique claim filing rules. If a payer has multiple unique IDs, look for the one with the closest description to that on the client’s insurance ID or with a matching address.
If a payer has the same ID listed multiple times, see What do I do if there are multiple payers with the same ID?
After locating the correct payer ID, return to the client’s file and add it to their Insurance Information.
Tip: Click + Add to add a payer to your insurance payers list, so you can submit an enrollment. For more information, see How do I submit an enrollment to file claims or receive Payment Reports?
Manually adding a payer
Our list of insurance payers includes over 2,000 plan names. If a payer you’re searching for isn’t on this list, you have the option to manually add it.
Important: Manually added payers aren’t available for electronic claim submission. This option is only recommended if you’re preparing and downloading claims for submission outside of SimplePractice. If you need to submit a claim through SimplePractice but can’t locate the correct payer, see Verifying a payer before submitting a claim.
To manually add a payer:
- Navigate to Settings > Insurance
- Click Add payer manually
- Enter the Payer name and Coverage type
- If you’re unsure which coverage type to select, choose Other
- Click + Address to add the payer’s address
- This will be needed if you’re preparing and downloading claims for submission outside of SimplePractice
- Click Save
Once added, the payer can be added to a client’s Insurance Information.
Verifying a payer before submitting a claim
Selecting the correct payer ID can be difficult, as insurance payers can go by multiple names, or have different plans to choose from. If you’re unsure which payer to pick, we can work with our clearinghouse to verify this for you. In order for us to do this, submit an email help request and include the client's secure URL.
Important: Our team can only verify which payer ID to use if the client has an insurance card uploaded to their file.
Below, you’ll find answers to some frequently asked questions about payer IDs:
- What do I do if there are multiple payers with the same ID?
- The payer I need is missing an address (or lists the incorrect address). How can I fix this?
- How do I choose the correct BCBS or Medicare payer?
What do I do if there are multiple payers with the same ID?
You may find that there are multiple listings of a payer, each with the same payer ID. This is because clients’ insurance IDs can have any of those different names on them. However, if the payer ID is the same across each of listings, then they’re all associated with the same payer and any one can be used for electronic claim filing. This is because the payer ID is the most important piece of information our clearinghouse uses to route claims.
For example, if you search payer ID 68069, which is used for payers such as Centene, Bridgeway, and AmBetter, you’ll see that many names are associated with the payer ID.
You can choose the name that best matches the client’s insurance card; however, as long as the payer ID is 68069, the claim will be routed to the correct payer.
There are some payers with unique claim filing rules. For more information, see Payers with unique claim filing rules.
The payer I need is missing an address (or lists the incorrect address). How can I fix this?
Apart from a few rare cases, a payer’s address isn’t required for electronic claim filing. This is because the payer ID is what our clearinghouse uses to route claims.
If you notice that a payer’s address is incorrect, and you’re only filing claims to that payer electronically, you can leave it as is. However, if you’re preparing and submitting claims outside of SimplePractice, or would like to update the address for your own records, you can add or edit the address. To do this:
- Navigate to Settings > Insurance
- Search for the insurance payer by name or payer ID
- Once you’ve located the payer, click Edit
- If there’s an address and it needs to be edited, click the existing address to make edits
- If there isn’t an address, click + Address and enter the relevant details
- Click Save
How do I choose the correct BCBS or Medicare payer?
BCBS and Medicare are unique payers, in that each state has its own payer ID. BCBS IDs are typically the state’s initials, followed by BLS, and for Medicare, the ID will be the state’s initials followed by MCR. For example, Illinois’ payer ID for each is ILBLS and ILMCR respectively. For Texas, the payer IDs are TXBLS and TXMCR.
For both payers, you’ll need to submit claims using the state ID where you’re credentialed. The state you’re in will be the payer ID used for all BCBS/Medicare claims, even if a client’s ID is out-of-state.
For example, if you’re credentialed in Illinois, and you’re seeing a patient that has a California BCBS plan, you’ll submit the claim to BCBS of Illinois using the ILBLS payer ID. The payer will then electronically forward the claim to the correct branch. This process takes place internally, and once the claim is submitted to your local BCBS/Medicare branch and is accepted for processing, no further action is needed on your part.
This rule also applies to enrollments. Meaning, you’ll only need to submit one BCBS or Medicare enrollment, using your state’s payer ID.
Note: A few states have specific guidelines when it comes to choosing a BCBS plan. See Payers with unique claim filing rules for exceptions.