The average claim processing time varies by payer. If you haven’t received an update on a claim after 30 days, it’s possible there was a processing issue causing it to remain in the Accepted or Received status. In this guide, we’ll cover:
- Understanding the Accepted/Received status
- Following up on a claim with insurance payers
- Issues that can lead to a claim being stuck in the Accepted/Received status
Understanding the Accepted/Received status
A claim will go through several status updates in your SimplePractice account. An Accepted or Received status indicates that the claim made it past any initial scrubs or rejections and has entered the payer’s adjudication system, where it will be processed accordingly.
Note: For a full list of claim statuses, see Checking a claim status: The different phases of an insurance claim.
If you’re enrolled to receive Payment Reports (ERAs), the claim will automatically update to Paid, Denied, or Deductible, depending on how the payer processed it. If you’re not enrolled for Payment Reports, Accepted or Received will be the last status shared with SimplePractice, and you’ll receive an Explanation of Benefits once the payer has finished processing the claim.
If 30 days have passed without an automatic update or without receiving an Explanation of Benefits, we recommend reaching out to the payer directly to request a status update.
Following up on a claim with insurance payers
When reaching out to a payer, providing accurate information and documenting details from the call can lead to faster resolution.
During the call, request to speak with a live representative and reference the claim by its claim number, not its clearinghouse reference number.
Note: Insurance payers won’t be able to locate the claim using the clearinghouse reference number.
If the claim doesn’t yet have a payer claim number, provide:
- The client’s member ID (listed in box 1a)
- The date(s) of service listed on the claim (listed in box 24a)
When speaking with the representative, take note of:
- The representative’s name
- The call reference number
- The number called
Documenting this information and submitting a help request can be helpful if further investigation is needed with our clearinghouse.
Issues that can lead to a claim being stuck in the Accepted/Received status
When speaking with a payer representative, they may confirm that the claim is still processing, in which case no action is needed.
If the representative can’t locate the claim using the information you provided, one of the following may have occurred:
- The claim was submitted to the incorrect Payer ID
- If so, the payer wouldn’t have received the electronic submission. If you’re not sure which Payer ID should be used, submit a help request and we’ll provide the correct Payer ID.
- After identifying the correct Payer ID, see Resolving claims submitted to the wrong payer for steps to resubmit the claim.
- The client information on the claim wasn’t found in the payer’s member database
- This typically results in an immediate rejection, but it can also occur after the claim was accepted/received.
- Verify with the payer that the client’s plan was active for the date(s) of service and that their information is correct. Ask whether any demographic details need updating.
If you’ve confirmed that the client’s plan was active and all insurance and demographic information is correct, and the payer still can’t locate the claim, document the following:
- The representative’s name
- The call reference number
- The number called
- What was discussed
Then, submit a help request and include all call details. We’ll work with our clearinghouse to determine why the claim wasn’t processed and what the next steps should be.
Important: Unless you provide proof that you contacted the payer first, the information they share with our clearinghouse will be limited. This is why it’s important to provide call details before we can investigate further.