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 use them to learn more about how a claim was processed.
- Viewing a payment report
- Understanding a payment report
- Scenario 1: Claim is paid
- Scenario 2: Claim is applied toward client’s deductible
- Scenario 3: Claim is denied
Note: For more information on payment reports and how to enroll, please see our guide to Payment reports (ERAs).
Viewing a payment report
When viewing a claim, click Claim Details, then scroll down to the Insurance Payment Report section to view the associated payment report.
Understanding a payment report
When viewing a payment report, you’ll come across some commonly-used insurance terms.
The Insurance Paid 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.
Scenario 1: Claim is paid
In this scenario, the claim has been successfully processed by the payer and paid. When a payment report comes in, our system takes the information from the payment report and automatically records an insurance payment 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.
Scenario 2: Claim is applied toward client’s deductible
In this scenario, the client hasn’t met their deductible and a payment report came in to update 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.
Note: SimplePractice doesn’t automatically record $0 insurance payments when a claim is processed toward a client’s deductible. To learn more about managing deductibles, see: How to bill clients that haven't met their deductible.
Scenario 3: Claim is denied
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. 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?