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Adding insurance payers and selecting the correct payer ID

Adding insurance payers and selecting the correct payer ID

When adding insurance information for your client, the most important piece of information to verify will be 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 an insurer, 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 our guide, 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?

A payer ID is a unique ID that is assigned to each insurance company. This ID is used for submitting claims electronically through our system. The payer ID is typically a 5 character code, but it could be longer.

Note: Payers can sometimes use different payer IDs depending on the clearinghouse they're working with. It is possible that the payer ID you see in our system is different from the payer ID you were using for the same payer through another 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

Read the front and back of the client's ID card to see if there are any special online filing instructions indicating what company 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 is a payer ID listed on it. This is often listed on the backside of a client's member ID under Claim Filing information (but 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 - this is the first thing to search for.
      The front and back of an insurance member ID card
  • You can then search our system for this payer by typing that payer ID into the Insurance Company field in the client's Billing and Insurance settings page as well as by searching in the Insurance list.You can search for a payer ID in SimplePractice
  • You could 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.

Why are there multiple listings with the same payer ID? Which one is the correct one?

The reason there are multiple listings of names with the same payer ID is because clients' member ID cards could have any of those different names on them, but they're all associated with the same payer.

For instance, if you're looking for UnitedHealthCare with payer ID 87726, you will 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 as long as the payer ID is the same, it will be correct. All of those names 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 any insurance payer you add won't be available for online claim filing or for receiving Payment Reports in your account.

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. For example, UnitedHealthCare won't be found under "UHC" or United Health Care. 

If you need to add a new payer:

  • Go to Settings > Insurance.
  • Click Add Insurance Payer.
  • Enter the Name and coverage type 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 add 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 & file them via fax or mail, you will 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). So, 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 would like to update this, you can.

Adding or editing an insurance payer address

If the insurance payer doesn't have an address associated with it, here's how you can add one.

  • Go to Settings > Insurance
  • Search for your insurance payer's by the payer's name or the payer ID
  • Once you've found the payer, click +Address to add, or click the existing address to edit
  • Use the address fields to make any changes
  • Be sure to click Save

Adding a payer's address:

Editing an insurance payer address:

How do I remove an insurance company I added to the Insurance Providers list?

If you added an insurance company to your list of Insurance Providers and now need to remove it, we can help you. Right now we don't have a way for you to do this directly in your account, but our support team can do that for you.

In order for us to able to do this, we need you to send us a screenshot of the Insurance Provider's page and let us know which payer(s) you'd like us to remove. Keep in mind that we can only remove insurance companies that you added, you will be able to identify them because they'll be in blue writing in your Insurance Providers list. Once you have the screenshot, reach out to our support team by clicking here.

In case you need help with taking screenshots, we've included instructions below to show you how to take a screenshot of part of your screen for both Mac and Windows computers.

If you have a Mac:

  • Take a screenshot of part of your screen.
  • Press Command-Shift-4. The pointer changes to a crosshair pointer.
  • Move the crosshair pointer to where you want to start the screenshot.
  • Drag to select an area. While dragging, you can hold the Shift key, Option key, or Space bar to change the way the selection moves.
  • When you've selected the area you want, release your mouse or trackpad button.
  • To cancel, press the Escape (esc) key before you release the button.
  • Find the screenshot as a .png file on your desktop.

If you have a Windows computer, take a look at the article below:

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