CoPayments not deducting when submitting claims

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Trecia Davis

• February 08, 2020 00:17

Under my client's billing information, I added that they have a copayment.  When I clicked "create claim" it populated everything needed to submit to the insurance company, but it does not deduct the copayment.  Do I need to manually put the copayment amount?  Why doesn't it deduct it?  

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  Brian

  • February 13, 2020 03:00

  Hi Trecia,

  I'd be happy to help with your question. The insurance companies assume that the copay is being paid up-front, so they are only concerned with the total session fee being billed for the date of service.

  Please let me know if you have any additional questions, and I’ll be glad to assist you.

  Best,

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  Katie Johnson

  • June 24, 2020 20:03

  So if we don't confirm the copayment amount and list that in their insurance information, then we miss out on collecting the copayments?

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  Ruth

  • June 29, 2020 17:28
  • Edited

  Hi Katie - You'll want to enter your client's copay in their Billing and Insurance tab. Here is how to enter a copay for your client: Copay/Coinsurance. 

  If you're enrolled in Payment Reports (electronic EOBs or ERAS) through SimplePractice, then your clients' copayment amount will update when the insurance payer indicates payment has been made for billed services. This will generate Fee Adjustment Invoices, charging your clients their correct copayment amounts. Here is more information on Payment reports (ERAs).

  To clarify, when a claim is created, the billed amount on the claim won't deduct the copayment amount. The insurance payer will know how much to pay and deduct the copayment amount themselves. 

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