Skip to main content

ERAs in SimplePractice (Payment Reports)

ERAs in SimplePractice (Payment Reports)

 

Payment Reports are a great way to save time by automating your insurance bookkeeping. Payment Reports are just like EOBs (Explanation of Benefits) and are our version of ERAs (Electronic Remittance Advice).

They provide a detailed breakdown of the insurance payer’s finalized claim status after the claim has been processed and will indicate which appointments were paid, if the claim was denied, or if the claim was applied to the client's deductible.

In this guide, we’ll cover:


Enrolling to receive Payment Reports

If you’d like to receive electronic Payment Reports in SimplePractice, you’ll want to submit an enrollment.

To start:

  • Navigate to Settings > Insurance
  • Click Search available payers

searchavailablepayers.simplepractice.insurance.png

  • Enter the name or payer ID
  • Click + Add

%2Badd.simplepractice.insurance.png

enroll.simplepractice.insurance.png

 

For detailed instructions on what an enrollment is and how to submit your Payment Reports enrollment, see: How do I submit an enrollment to file claims or receive Payment Reports?

Once your Payment Report enrollment is accepted, the payer will send ERAs to our clearinghouse after they've processed the claim. They will then be sent to your SimplePractice account via a Payment Report. Payment Reports will:


Filing insurance claims and Payment Reports

Whether you file claims through SimplePractice or manually outside of your account, Payment Reports will be delivered to your account once a claim has been processed, as long as you’re enrolled to receive them from that payer. 

Note: If a claim is filed outside of SimplePractice and you’re enrolled to receive electronic Payment Reports from that payer, you’ll want to manually add the insurance payment(s) to the claim.

For information on filing electronic claims, generating auto-filled CMS1500 claim forms, and adding insurance payments, see:


Viewing your Payment Report

There are two ways you can access your Payment Reports:

Through the Payment Reports report

  • Navigate to Reports > Payment Reports
  • Enter the date range for the Payment Report you’d like to view
  • Click the Date Received next to the Payment Report in question

ERA.simplepractice.paymentreports.png

Through the claim

  • Navigate to Insurance > Claims
  • Open the claim in question
  • Click Claim Details to view the associated Payment Report

claimdetails.simplepractice.insurance.png

Important: Electronic Payment Reports will override a client's copay for any appointments included. If the copay amount is different on the report than on their client Billing page, the Client Owes field will automatically update. This may result in a fee adjustment invoice, which can result in the client being charged if they have Autopay enabled.


Accessing the full EOB

If you're enrolled to receive Payment Reports, you’re also able to access the full EOB (Explanation of Benefits) within SimplePractice.

This can save you time when investigating insurance payments with unallocated amounts and when preparing secondary claims. 

This also means that all EOBs you receive through SimplePractice will be shown in the same format, whereas EOBs accessed outside of SimplePractice may vary in formatting. 

To access the full EOB:

  • 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 an question mark icon next to it

autocreated.simplepractice.payments.png

  • Click Download EOB

downloadEOB.simplepractice.payments.png

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:

eob.simplepractice.paymentreports.png

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 a reason for why the payer processed the claim the way that they did. 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: The full EOB will only be generated if the payer issued an insurance payment for the claims that they processed. This means that if all claims were denied, no EOB would be created.


Reviewing payment details

When your Payment Report is delivered to SimplePractice, your claim's status will automatically update, and we’ll notify you via email.

We take the Payment Report information and automatically record insurance payments for each appointment associated with the claim.

There are a few ways to review the payment details from a Payment Report:

  • From the Payments tab 
    • Navigate to Insurance > Payments to see the insurance payment amount and the associated Check/Wire transfer number
    • Click View to see the payment details

Note: If needed, you can also edit the insurance payment on this page.

  • From a Claim
    • Open the Claim in question
    • Select Claim Details 
    • Click the Insurance Payment highlighted in blue to review the payment details

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 > Insurance
  • On the My Insurance Payers page, search for the insurance payer 
  • Review the Payment report enrollment column
    • The status should be Ready to receive ERAs

paymentreportenrollment.simplepractice.enrollments.jpg

If a Payment Report enrollment doesn’t have this status, you won’t receive Payment Reports from the payer in SimplePractice. For more information, see Enrollment FAQs

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 do not match the NPI and Tax ID on your Payment Report enrollment, the payer will not send Payment Reports to your SimplePractice account. 

To review the NPI and Tax ID on a Payment Report enrollment:

  • Navigate to Settings > Insurance
  • On the My Insurance Payers page, search for the insurance payer
  • Click on the document icon in the Payment report enrollment column

reviewenrollmentdetails.simplepractice.enrollment.jpg

  • Select 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 to update your enrollment information in SimplePractice

Note: If the Billing Provider NPI and Tax ID on a submitted claim do not 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, please 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. For more information, see Sharing a secure URL with your help request.

Still have questions?

Get more help