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
- Filing insurance claims and Payment Reports
- Viewing your Payment Report
- Accessing the full EOB
- Reviewing payment details
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 > Enrollments. Click + Enroll next to the respective payer, under the Payment Reports Enrollments column:
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:
- Attach to their respective claims
- Update the claim status to
- Automatically add the insurance payment for the listed appointments
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:
- Filing primary claims in SimplePractice
- Creating and printing a CMS 1500 (HCFA) claim form
- Adding an insurance payments
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
Through the claim
- Navigate to Insurance > Claims
- Click the claim in question
- Choose Claim Details to view the associated Payment Report
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. With this information integrated within your SimplePractice account, you'll no longer need to reference two different systems in order to locate the full details outlined in the EOB.
This also means that all EOBs that 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 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.
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 the Insurance Payer to view 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