When adding insurance information for your client, the most important piece of information to verify is the payer ID to make sure you've selected the appropriate insurance payer. This guide walks through everything to keep in mind when searching for a payer, and the steps you can take if the payer you need seems to be missing.
Tip: Before adding insurance payers to your clients' profiles, we recommend reviewing Setting up insurance billing for your clients to make sure all of their insurance information is entered correctly from the start.
This guide covers:
- What is a payer ID?
- How do I find the correct insurance company for my client?
- Why are there multiple listings with the same payer ID? Which one is the correct one?
- Can I add a payer if the payer I need is missing?
- The payer I need is missing an address (or lists the incorrect address). How can I fix this?
- How do I remove an insurance company I added to the Insurance Providers list?
- Selecting the correct Blue Cross Blue Shield payer
- Selecting the correct Medicare payer
- Can you verify which payer ID to use before I start submitting claims?
What is a payer ID?
A payer ID is a unique ID that’s assigned to each insurance company. This ID is used to submit claims electronically through our system. The payer ID is typically a 5 character code, but it could be longer.
Note: Payers sometimes use different payer IDs depending on the clearinghouse they're working with. Because of this, it's possible the payer ID you've previously used won't match the ID listed in our system.
How do I find the correct insurance company for my client?
To get started, scan or photograph your client's insurance ID card for reference. You can then upload it to the client's file for safe keeping.
If you don't have a client's insurance ID, you can request that they upload it through the Client Portal. See Choosing optional fields for the Demographics form for instructions on how to include an insurance field in your intake forms.
Read the front and back of the client's ID card to see if there are any special online filing instructions indicating which payer claims should be sent to. If there are no special instructions, you'll file claims with the insurance company printed on the front of the ID card.
To locate the appropriate payer ID:
- Start by looking at your client's insurance member ID card to see if there's a payer ID listed on it. This is often listed on the backside of a client's member ID under Claim Filing information. It can also be listed on the front side of the card.
- For example, the back of this member ID card includes the Electronic Payer ID #74227
- You can then search our system for this payer by heading to Settings > Insurance and typing that payer ID into the Search available payers field.
- You can also try searching the entire name of the payer. In this example, you would search for "UnitedHealthCare Student Resources." If that doesn't give you the results you're looking for, you can try "Student Resources."
Tip: It's very important that you keep a copy of the front and back of the client's member ID card in their profile. That way, you can double-check the information if you ever have any issues submitting claims for the client. Here's how you can upload the card to your client's profile for safe keeping.
Why are there multiple listings with the same payer ID? Which one is the correct one?
There are multiple listings of names with the same payer ID because clients' member ID cards can have any of those different names on them. However, they're all associated with the same payer.
For instance, if you're looking for UnitedHealthCare with payer ID 87726, you’ll see that there are quite a few names associated with that payer ID. Select the name that best matches the client's member ID card, and it’ll be correct as long as the payer ID is the same. All names under a common payer ID link to the same payer.
Can I add a payer if the payer I need is missing?
If none of the options seem to match the one you're looking for, you have the option to add an insurance company yourself. Just remember that insurance payers you manually add won't be available for online claim filing or for receiving Payment Reports in your account.
Note: The updated insurance page is part of a phased rollout and won't be available for all practices until a later time. If you don't have access to this feature but would like it enabled in your account, reach out to our team so it can be enabled.
Important: You should only manually add a payer if you plan on downloading and submitting those claims outside of SimplePractice, or if you want to record an insurance payment from a payer that’s not in our list.
Before adding a new payer to your list of insurance payers, we recommend that you double check the existing list to make sure you're not overlooking the payer you need. Our list contains over 2,000 plan names, including most of the major payers.
Tip: If you still don't see the insurance payer you're looking for in the drop-down list, try alternate spellings of the payer's name.
If you need to add a new payer, follow these steps:
- Go to Settings > Insurance
- Click Add payer manually
- Enter the Payer name, Coverage type, and Address for the payer
- The Coverage you select will determine which coverage option is selected in the CMS 1500 form if you print or download a claim form with that payer on it.
- If you're unsure what option to select, choose the "other" option
- Click Save
Once you've entered this information, the payer will show up in the insurance payer list and payer lists throughout your account. This will allow you to add insurance payments from this payer, just as you would with adding any other insurance payment.
This will also allow you to create claims and download them so you can submit them by mail or by fax to the payer.
Note: If you're going to be creating claims to download and file them via fax or mail, you'll also need to add the payer's address in your account so the claims include this information. See the next section to find out how to add/edit a payer's address.
The payer I need is missing an address (or lists the incorrect address). How can I fix this?
For online claim filing, the insurance company address isn't used (except in rare cases). This is because the five digit payer ID is used to route claims electronically. If you'll be filing claims online, you don't need to verify the address of the insurance company you select from the drop-down menu. If you’d like to update the address, follow these steps:
- Go to Settings > Insurance
- Search for your insurance payer by the payer's name or the payer ID
- Once you've found the payer, click Edit
- If there is an address but it needs to be edited, click on the existing address to make the necessary changes
- If there isn't an address, click + Address to add one
- Click Save
How do I remove an insurance company I added to the Insurance Providers list?
If you’ve added an insurance company to your list of insurance payers and need to remove it:
- Navigate to Settings > Insurance
- Click Edit
- Click Delete Payer in the flyout
Note: A payer can only be deleted from your list if there are no clients assigned to it. For instructions on how to remove all clients assigned to a specific payer, see: Removing a payer.
Selecting the correct Blue Cross Blue Shield payer
When selecting a Blue Cross Blue Shield payer, you’ll always need to use your state’s BCBS payer.
The payer ID for your local Blue Cross Blue Shield payer will be your state’s abbreviation followed by BLS. For example, if you’re credentialed in Texas, the payer ID for your local BCBS payer is TXBLS. If you’re credentialed in Illinois, the payer ID for your local BCBS payer is ILBLS.
This rule is true even if a client’s BCBS ID card is out-of-state. For example, if you’re credentialed in Illinois and your client has a California BCBS ID, you’ll submit their claims to your local payer (ILBLS), who 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 branch and is accepted for processing, no further action is needed on your part.
This rule also applies to enrollments. If you’re enrolling to receive payment reports, you’ll only need to submit an enrollment to your state’s BCBS payer.
A few states have specific guidelines when it comes to choosing a BCBS plan. See Payers with unique claim filing rules for exceptions to this rule.
Selecting the correct Medicare payer
When selecting a Medicare payer for your clients, you’ll also need to use your state’s payer.
The payer ID for your local Medicare payer will be your state’s abbreviation followed by MCR. For example, if you’re credentialed in Texas, the payer ID for your local Medicare payer is TXMCR. If you’re credentialed in Illinois, the payer ID for your local Medicare payer is ILMCR.
This rule is true even if a client’s Medicare ID card is out-of-state. For example, if you’re credentialed in Illinois, and your client has a California Medicare ID, you’ll submit their claims to your local payer (ILMCR), who will then electronically forward the claim to the correct branch. This process takes place internally, and once the claim is submitted to your local Medicare branch and is accepted for processing, no further action is needed on your part.
This rule also applies to enrollments. Medicare will always require a claim filing enrollment be accepted before you can start submitting claims. You’ll only need to submit an enrollment to your local Medicare payer to be able to submit claims. See How do I submit an enrollment to file claims or receive payment reports? for more information.
Can you verify which payer ID to use before I start submitting claims?
If you have a client’s member ID uploaded to their file and are unsure which payer ID to select, we can work with our clearinghouse to verify this for you. In order for us to do this, submit an email support request and include the client’s secure URL so that our team can locate the necessary information to complete this request.