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
- 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
If you’d like to receive electronic Payment Reports in SimplePractice, submit a Payment Report enrollment.
To start:
- Navigate to Settings > Insurance
- Click Search available payers
- Enter the name or payer ID
- Click + Add
- Locate the payer in your My Insurance Payers page
- Click Enroll
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'll then be sent to your SimplePractice account via a Payment Report. Payment Reports will:
- Attach to their respective claims
- Update the claim status to
- Automatically add the insurance payment for the listed appointments
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
- Open 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:
- Total Billed amount
- Provider name
- Provider NPI
- Service dates and CPT codes
- Payer claim #
- Clearinghouse reference #
Note: When reaching out to a payer for insight into a claim, always provide them with the payer claim number, 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:
- Billed amount
- 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 no payment has been added
-
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
If you see a Write-off too high or Duplicate payments status, click on the Received link to locate and edit the payment.
Insurance payment report (ERA)
If one or more Payment Reports are received, they’ll 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. The type of Payment Report received will update the claim’s status to one of the following:
- Paid
- Deductible
- Denied
If a claim is Denied, the reason will be listed under the Remarks section. 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’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
- Click View
- Click 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 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.
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
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 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 > Insurance
- On the My Insurance Payers page, search for the insurance payer
- Click on the document icon in the Payment report enrollment column
- 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 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. For more information, see Sharing a secure URL with your help request.
Understanding each type of Payment Report
There are three types of 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, the Contractual obligation represents the write-off amount, and the Client responsibility shows what the client owes.
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 the Deductible amount listed under the Client responsibility. This amount is now the client's responsibility and will be applied to their deductible. You'll see the system automatically reflecting 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 when a claim is processed toward a client’s deductible are not 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 How to bill clients that 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 What do I do if my claim is denied?
