Understanding Payment Reports (ERAs)

Payment Reports (also known as ERAs) are electronic versions of EOBs and provide a detailed breakdown of how a claim was processed. When enrolled to receive Payment Reports in SimplePractice, claim statuses will update automatically, and insurance payments will be recorded in your account.

• Locating Payment Reports
• Reviewing the Claim Details page
• Accessing the full EOB
• Understanding each type of Payment Report

Locating Payment Reports

Payment Reports attach to claims once they’ve been processed and record insurance payments for the associated appointment(s). Payment Reports will update claims to one of the following statuses:

• Paid
• Paid Pending
• Rejected
• Denied
• Deductible

There are two ways you can access your Payment Reports:

Through your Insurance reports

1. Navigate to Analytics > Reports > Payment Reports

2. Enter the date range for the Payment Report you’d like to view
   • Group practices can also filter this page by clinician
3. Click the Date Received next to the Payment Report in question

Through the claim

1. Navigate to Insurance > Claims
2. Select View next to the claim in question
3. 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:

1. Navigate to Insurance > Payments
2. 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

3. Click View
4. 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. 

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
• Claims applied towards client's deductible
• Denied claims

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.

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.