A Payment Report is our version of an Electronic Remittance Advice (ERA). If you’re enrolled to receive Payment Reports within SimplePractice, you'll receive one of these reports from the payer when a claim is finalized.
In this guide, we’ll cover how you can access payments reports and the three types of reports you can receive:
Note: For more information on payment reports and how to enroll, please see ERAs in SimplePractice (Payment Reports).
Viewing a Payment Report
When viewing a claim, click Claim Details to see its payment information.
Scroll down to the Insurance Payment Report section to view the associated Payment Report.
When viewing a Payment Report, you’ll come across some commonly-used insurance terms.
The Paid field refers to the amount the insurance payer will pay for the service(s) provided, while the Client Responsibility refers to the amount owed by the client (for example, their copay, coinsurance, or deductible amount). The remaining amount is the Contractual Obligation, also known as the write-off.
Note: Check out our Glossary of insurance terms to learn more.
To view all Payment Reports received for your practice, navigate to Reports > Payment Reports.
The date range in this report will default to the past 30 days, but it can be adjusted. If you’re part of a group practice, you can search for payment reports by clinician.
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.
Tip: 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.
In this scenario, the payer has denied payment for the submitted claim. You can view the denial reason by hovering your cursor over the ? icon.
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?