An ERA (Electronic Remittance Advice) is the electronic version of an EOB (Explanation of Benefits). Insurance payers send an ERA or EOB after a claim has been finalized. These documents contain the same information, with each providing a detailed breakdown of how the claim was processed, including which appointments were paid, if the claim was denied, or if the claim was applied to the client’s deductible.
In SimplePractice, ERAs reflect as Payment Reports and will save you time by automating your insurance bookkeeping. With Payment Reports, claim statuses automatically update, and insurance payments are added electronically.
In this guide, we’ll cover:
- Enrolling to receive Payment Reports
- Locating Payment Reports
- Reviewing the Claim Details page
- Accessing the full EOB
- Investigating missing Payment Reports
- Understanding each type of Payment Report
Enrolling to receive Payment Reports
To receive Payment Reports from a payer in SimplePractice, you can submit a Payment Report enrollment. To do this:
- Navigate to Settings > Client billing and insurance > Payers
- Click Search available payers
- Enter the name or payer ID
- Click + Add
- Locate the payer in your Payers list
- Click Manage next to the payer
- Select Enroll
Once the payer accepts the enrollment, they’ll send ERAs to SimplePractice after processing claims. These will show as Payment Reports in your account and will:
- Attach to corresponding claims
- Update the claims with the following statuses:
- Automatically add insurance payments for the appointments listed on the payments
Note: For a comprehensive overview of submitting enrollments, see Submitting enrollments to file claims and receive Payment Reports.
Locating Payment Reports
There are two ways you can access your Payment Reports:
Through your Insurance reports
- Navigate to Analytics > Reports > Payment Reports
-
Enter the date range for the Payment Report you’d like to view
- Group practices can also filter this page by clinician
- Click the Date Received next to the Payment Report in question
Through the claim
- Navigate to Insurance > Claims
- Select View next to the claim in question
- Click Claim Details to view the associated Payment Report
Reviewing the Claim Details page
The Status tab of a claim’s details page features three sections that provide insight into the claim’s billing information.
Claim overview box
The claim overview box outlines the:
- Payer Claim #
- Clearinghouse Reference #
- Provider name
- Provider NPI
- Total billed amount
- Service dates and CPT codes
Note: When reaching out to a payer for insight into a claim, always provide them with the Payer Claim #, not the Clearinghouse Reference #. For more information, see Using claim reference numbers.
Payment overview
The Payment overview lists the billing information for each date of service on the claim, including the:
- Service code
- Client responsibility
- Insurance paid amount
- Write-off amount
- Status
The Status column will update based on any payments that have been added.
Note: If you’re not enrolled to receive Payment Reports, the Payment overview will update based on manually added payments.
Statuses you’ll see in the Payment overview include:
-
Pending
- This indicates that the billed amount hasn’t been fully accounted for
-
Write-off too high
- This indicates the entered write-off amount exceeds the expected write-off
-
Duplicate payments
- This indicates that the amount paid exceeds the billed amount for the service
-
Settled
- This indicates the billed amount has been fully accounted for. For a date of service to be settled, the Client Responsibility, Insurance paid, and Write-Off values must be equal to the Billed amount
- For a date of service to be settled, the sum of the Client Responsibility, Insurance paid, and Write-off values must be equal to the Billed amount
If you see a Write-off too high or Duplicate payments status, click the Received link to locate and edit the payment.
Insurance payment report (ERA)
Payment Reports that are received will be listed chronologically in the Insurance payment report (ERA) section.
This section lists the claim’s adjudication information and is received directly from the payer. See Understanding each type of Payment Report for examples of each type of Payment Report.
Accessing the full EOB
If you're enrolled to receive Payment Reports, you can access the full EOB for an insurance payment in SimplePractice. EOBs can save you time when investigating unallocated insurance payments and when preparing secondary claims.
Note: All EOBs you receive through SimplePractice will be shown in the same format. EOBs accessed outside of SimplePractice may vary in formatting.
To access the full EOB for an insurance payment:
- Navigate to Insurance > Payments
-
Choose an insurance payment that was generated from a Payment Report
- An insurance payment generated by a Payment Report will have a question mark icon next to it
- Click View
- Select Download EOB
When viewing the downloaded EOB, you'll see an overview of the complete payment at the top of the page, followed by the individual remittance information for each claim that the payment includes:
Each claim included in a full EOB will be followed by a Remarks section, which lists all additional information we received from the payer. This can include reasons for how the payer processed the claim. If you have any questions regarding the payer's remarks or processing of the claim, you can contact the payer directly for more information.
Note: A full EOB will only be generated if the payer issued an insurance payment for the claim. If a claim is denied, no EOB will be created as an insurance payment wasn’t issued. However, you can still view Payment Reports for denied claims.
Investigating missing Payment Reports
Even if you’ve received the funds for an insurance payment from a payer, an electronic Payment Report for the payment might not be delivered. This can happen if:
- Our clearinghouse received the Payment Report from the insurance payer but wasn’t able to send it to your SimplePractice account successfully
- Our clearinghouse never received the Payment Report from the payer
If you’re missing a Payment Report, first check that you have an accepted Payment Report enrollment with the payer. To do this:
- Navigate to Settings > Client billing and insurance > Payers
- Search for the insurance payer
- Click Manage next to the payer
-
Review the Payment Reports column
- The status should be Accepted
If a Payment Report enrollment doesn’t have the Accepted status, you won’t receive Payment Reports from the payer in SimplePractice. For more information on next steps for each status, see Viewing enrollment statuses.
A Payment Report enrollment must be submitted with the Billing Provider NPI and Tax ID that you have on file with the insurance payer. If the Billing Provider NPI and Tax ID on claims submitted to the payer don't match the NPI and Tax ID on your Payment Report enrollment, the payer won't send Payment Reports to your SimplePractice account.
To review the NPI and Tax ID on a Payment Report enrollment:
- Navigate to Settings > Client billing and insurance > Payers
- Search for the insurance payer
- Click Manage next to the payer
- Select Manage Enrollment
- Click Review Enrollment Details
If you need to update the NPI and Tax ID on your Payment Report enrollment to match what’s on file with the payer, see How do I update my enrollment information?
Note: If the Billing Provider NPI and Tax ID on a submitted claim doesn't match the Payment Report enrollment with the payer, the insurance payment for the claim will have to be manually added. For more details, see Adding insurance payments.
If your Payment Report enrollment is accepted and has the correct NPI and Tax ID, we can create a case with our clearinghouse to investigate the missing Payment Report with the payer. For us to open this investigation, submit a help request with the following information:
- The wire/check number for a payment you received from this payer that you didn't receive an ERA for through SimplePractice
- The dollar amount of the payment
- The payment date
If you have an EOB for the payment, please also share this with our team by uploading the EOB to a client’s profile. Then, send us the secure client URL following the steps in Sharing a secure client URL.
Note: If you need to update the Billing Provider NPI or Tax ID being submitted on claims, see Entering your billing information.
Understanding each type of Payment Report
There are three types of Payment Reports you can receive. In this section, we'll cover how to read each type:
Paid claims
In this scenario, the claim has been successfully processed by the payer and has been paid. When a Payment Report comes in, the payment information will automatically be recorded for the date(s) of service included on the claim. This will update the status of the claim to Paid.
Insurance payers will often issue reimbursement for multiple claims at the same time. Automated insurance payments can include information for several clients, but each claim will have its own Payment Report.
In this example, the Paid field lists what the insurance payer paid for the appointment.
Note: For the claim to update to Paid, the sum of the Client Responsibility, Insurance Paid, and Write-Off amounts must equal the total appointment fee.
Claims applied towards client's deductible
In this scenario, the client hasn’t met their deductible, and a Payment Report has come in and updated the claim status to Deductible. When viewing the Payment Report, you'll see Deductible Amount in the Remarks section:
This amount is now the client's responsibility and will be applied to their deductible. You'll see the system automatically reflect this amount in the Client balance of the client's Overview page.
While SimplePractice automatically records insurance payments from a Payment Report, $0 insurance payments for deductible claims aren't automatically recorded. This means that the client will still have an insurance balance, and you’ll need to manually record the $0 insurance payment and write-off. To learn more about managing deductibles, see Billing clients who haven’t met their deductible.
Denied claims
In this scenario, the payer has denied payment for the submitted claim. You can view the denial reason listed in the Remarks section.
The information shared with our clearinghouse can be limited. If you have questions about a denied claim, we recommend contacting the payer directly to provide further insight. When speaking with a representative, you can reference the claim by the member ID and date(s) of service. For more information on claim denials, see Handling claim denials.