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Setting up insurance billing for your clients

Entering your clients' billing and insurance information will allow you to readily create claims directly from your SimplePractice account. The system will pull the stored information from the client's file to help automate this process for you. 

Making sure that your clients' information is entered properly from the start will minimize claim rejections and help you avoid lengthy calls with insurance payers later on. Use this guide to set yourself up for success when entering your clients' insurance information.

After you've added a client, you can manage all of their information by clicking Edit under their name while viewing their profile. 

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We'll walk through the following client information settings:


Demographic Info

Payers will require that a client's demographic information is listed on claims and that it matches exactly what the payers have on file.

To meet these requirements, make sure every insurance client has all of the following information stored in their profile under Edit > Client Info and be sure to verify that the information is accurate:

  • First and Last name
    • List the client's name exactly as shown on their insurance member ID card
  • Phone number
  • Address
  • Date of birth
  • Sex 
    • This can differ from the client's gender identity - please select the client's sex that's on file with their insurance policy

Billing Type

All of your clients that you bill through insurance must have their Billing Type set to Insurance. To do so, go to the client’s Overview page > Edit > Billing and Insurance, and select Insurance as the Billing Type

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As always, make sure to Save any changes.


Insurance Info

To enter a client's insurance plan information, go to the client’s Overview page > Edit > Billing and Insurance. Scroll down to Insurance Information and click +Insurance info. All of the fields with a red asterisk are required.

Here are the pieces of the insurance information you’ll need to enter:

  • Who is the Primary Insured?
    • If the client is under someone else’s plan, make sure to select the correct relationship and enter the Primary Insured's information
  • Insurance Payer 
  • Member ID 
    • List the full member ID number including any prefixes or suffixes
    • Don't include any spaces or dashes in this field

After the primary insurance information is entered, you can scroll down and click + Insurance Info to record any additional insurance plans. Be sure to Save any changes.

Tip: Insurance plans and requirements can often change suddenly. We always recommend verifying benefits and eligibility before your first appointment with a client, and again at the start of a new year. This can help to avoid claim denials and unexpected client balances due to a lapse of coverage.


Copay/Coinsurance

If your client is responsible for a copay or a coinsurance, you can list the dollar amount that they will owe for each appointment in the Copay / Coinsurance field of their Insurance Information settings. 

Note: If your client has a coinsurance, meaning that they are financially responsible for a set percentage of the contracted rate, you will need to manually calculate the dollar amount due in order to use this feature. For example, if your client has a 20% coinsurance, and you have a contracted rate of $80, you will need to enter $16 in this field (.2 x 80 = $16).

Listing this information will trigger the system to auto-populate the client owes amount for the client's upcoming appointments. After an invoice is created for an appointment, the client owes amount will be reflected in their Client Balance. This allows you to collect the client's portion of the bill before the claim is processed.

If you find that a claim is processed and the payer outlines a different copay amount in the remittance information, you can make the necessary corrections using Appointment level billing changes. This can often be the case if the client has an annual deductible.

Tip: If you're enrolled for payment reports and a claim was processed with a different copay amount due, the information we receive from the payer will automatically correct the client owes amount, to streamline your workflow.


Deductible

If your client has an annual deductible, you can record the total amount of the deductible in this field to give you a sense of how many appointments they will be responsible for out-of-pocket. However, it's important to note that the system won't be able to track the remaining deductible amount because clients may be billing their insurance for services held by other providers.

Tip: See How to bill clients who haven't met their deductible to learn more.


Insurance card on file

We highly recommended uploading copies of the front and back sides of your clients’ insurance member ID cards. In the case of a claim rejection, the client's member ID card will be the starting point for determining what needs to be corrected. The front side will contain important information about the client's specific insurance plan, while the back side will list important claim filing information that's specific to the payer. 

To upload a member ID card:

  • Scroll to the bottom of the client's Insurance information settings until you see a box that says Front of Insurance Card with a blue document icon
  • Click Browse to upload a copy of the ID card, or drag a file from your computer directly into this box
  • Repeat these steps to upload the Back of Insurance Card

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Note: You can upload either JPEG or PDF files. If you upload PDF files ,you won’t have a “preview” option but you’ll still be able to view the file by clicking it.

Tip: Download the SimplePractice Mobile app to upload member IDs cards directly from your mobile device.


Authorization Tracking

Certain insurance plans will require prior authorization in order for a client to be eligible for coverage. To add a prior authorization number to your client's Insurance Information, click +Authorization number and list the starting date in the Valid from field. Storing this information will trigger the system to auto-populate the prior authorization number into box 23 of the client's claims.

Note: See How do I use Authorization Tracking? for more information about this feature.


Insurance Claim/CMS Fields

Check Show additional claim fields to enable the additional fields that are available to auto-populate onto your claims:

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NoteBy default, Accept Assignment? will be set to Yes. This indicates that the insurance payment should go to the provider. When performing courtesy billing, you can change this to No to have the payment to go to the client instead.


Client’s Default Service

To set a Default Service for the client, click the dropdown and select the Client’s Default Service. The default service code will auto-populate when you create a new appointment for this client. It will also auto-populate into box 24d of the claim form. You can change this setting at any time.

Tip: To learn more about setting a default service code and rate, see How to set a custom service code rate for a client 


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