About the class
The Advanced Insurance Claim Filing with SimplePractice class discusses common claim filing mistakes and how to avoid them, Payment Reports, and ways to correctly resubmit rejected and denied claims. Watch the introduction video above, and then get started with Part 1. Checking claim status, below.
- Getting started with insurance billing
- Insurance Q&A live class
- Submitting enrollments to file claims and receive Payment Reports
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Part 1. Checking claim status
After you create a claim in SimplePractice, its status will automatically update based on:
- The claim's history in your account
- Status updates received from the payer
- The payment status of the appointments billed on the claim
- Electronic Payment Reports (ERAs)
Part 2. How to access and read Payment Reports
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.
Part 3. Claim rejections
When a claim is submitted electronically, an insurance payer can reject it if any errors are detected or if there's any incorrect or invalid information that doesn't match what they have on file. This means the claim needs to be submitted with the correct information before it can be processed.
Part 4. Claim denials
A denied status indicates that the insurance payer processed the claim, but denied payment. These are different from rejected claims or scrub errors because the denied claim was successfully processed by the payer, but due to an issue on the claim, they didn’t provide reimbursement.
Part 5. Submitting a corrected claim
There are times when you may need to resubmit a claim that has already been processed. These are considered corrected claims, and they may be needed if the claim is denied, if there was a mistake on the first submission, or if the claim wasn’t properly adjudicated upon the first submission.