How to Submit a Claim in SimplePractice: A Step-by-Step Guide

SimplePractice is a cloud-based practice management and EHR platform widely used by behavioral health providers — therapists, counselors, psychologists, and social workers. Its integrated billing module lets providers generate, submit, and track insurance claims without leaving the platform. When configured correctly and used with the right workflow, SimplePractice can significantly reduce manual billing errors and accelerate reimbursements. This guide walks through every step of submitting an insurance claim in SimplePractice, from initial client setup through denial management, with the practical detail needed to minimize rejections and keep your revenue cycle healthy.

What is SimplePractice billing?

SimplePractice is a practice management platform purpose-built for mental health, speech therapy, occupational therapy, and other allied health disciplines. Its billing module integrates with clinical documentation so that CPT codes and diagnosis codes flow from the session note into the claim without re-entry. Core billing capabilities include:

• Insurance profile management — store multiple payer IDs, subscriber information, and authorizations per client.
• Automated eligibility verification — run real-time eligibility checks through the clearinghouse to confirm active coverage and copay/deductible status.
• Electronic claim generation and submission — generate 837P claims and submit through Waystar to enrolled payers.
• ERA (electronic remittance advice) auto-posting — 835 ERAs from enrolled payers post automatically to client accounts.
• Claim status tracking — monitor accepted, pending, and denied claims from the Billing dashboard.
• Superbills — generate itemized superbills for clients who self-pay and submit to their own insurer for out-of-network reimbursement.

SimplePractice does not process claims directly — it submits through Waystar, its clearinghouse partner. Payer enrollment through Waystar is required before claims will be accepted electronically. This setup step is often where new users encounter delays; plan for 5–10 business days for initial enrollment with most commercial insurers.

Before you submit: setup checklist

Claim rejections are almost always preventable at the setup stage. Before submitting your first claim for a client, confirm all of the following:

• Practice and provider settings — your NPI (individual and group, if applicable), Tax ID, and rendering provider credentials must be complete under Settings > Practice > Insurance. The NPI in SimplePractice must match exactly what the payer has on file from credentialing.
• Payer enrollment complete — the payer must be enrolled through Waystar for electronic submission. In SimplePractice, navigate to Settings > Insurance > Payer List and verify enrollment status. Submitting to a non-enrolled payer generates a rejection, not a denial — claims disappear rather than adjudicating.
• Client insurance profile — member ID, group number, subscriber name and date of birth, and relationship to subscriber must be entered accurately. One transposed digit in the member ID is enough to reject the claim.
• Active coverage confirmed — run an eligibility check from the client's Insurance tab. Review the returned benefit summary for deductible/copay amounts, mental health vs. medical benefits parity, and any authorization requirements.
• Authorization on file (if required) — some payers require prior authorization for mental health services above a threshold session count. Store the authorization number in the client's insurance profile; SimplePractice will include it in Box 23 of the 837P.

Step 1 — Create or verify the client profile

Every claim originates from the client profile. To create or update a client record in SimplePractice:

1. Navigate to Clients > Add New Client (or open the existing client).
2. Enter demographics: legal name (as it appears on the insurance card), date of birth, address, and contact information.
3. Under the Insurance tab, add the insurance plan: search for the payer by name, enter the member ID exactly as printed on the insurance card, and enter group number if applicable.
4. Specify the subscriber relationship — if the insured is a parent or spouse, enter subscriber demographics separately.
5. Save the profile and run an eligibility check to confirm coverage is active and review benefit details.

Common profile errors that cause rejections: using a nickname instead of legal name, transposing digits in the member ID, selecting the wrong payer (e.g., BCBS of Georgia vs. BCBS of Texas), or not updating insurance information when a client changes plans mid-year.

Step 2 — Verify insurance eligibility

Run eligibility verification before every new episode of care and at the start of each calendar year (when deductibles reset and plan changes take effect). In SimplePractice:

1. Open the client record and navigate to the Insurance tab.
2. Click Verify Eligibility. SimplePractice queries the payer through Waystar and returns a benefit summary, typically within 30–60 seconds.
3. Review the returned information for: active/inactive status, plan type (HMO/PPO), individual and family deductible amounts and year-to-date accumulation, copay and coinsurance for mental health services, out-of-pocket maximum, and any session limits or authorization requirements.

Eligibility responses are not guarantees of payment — they reflect coverage status at the time of the query. A patient's plan can change after the query if they switch jobs, age off a parent's plan, or enter/exit a qualifying event period. For high-dollar or long authorization episodes, re-verify at 30-day intervals.

Verimedix's eligibility verification services can automate batch verification across your full active patient roster, catching coverage lapses before they become denials.

Step 3 — Document the session and assign CPT and diagnosis codes

After completing a session, create a progress note in SimplePractice. The billing-critical elements of the note include:

• CPT code selection — behavioral health providers most commonly use:
  • 90837 — Psychotherapy, 53+ minutes (the most common individual therapy code)
  • 90834 — Psychotherapy, 38–52 minutes
  • 90832 — Psychotherapy, 16–37 minutes
  • 90847 — Family psychotherapy with the patient present
  • 90853 — Group psychotherapy
  • 90791 — Psychiatric diagnostic evaluation (intake/assessment)
  • 90792 — Psychiatric diagnostic evaluation with medical services
  • 99213/99214 — E&M codes for medication management (psychiatrists)
• ICD-10-CM diagnosis codes — select the most specific applicable code. Common behavioral health diagnoses include F32.1 (major depressive disorder, single episode, moderate), F41.1 (generalized anxiety disorder), F43.10 (PTSD, unspecified), and F90.0 (ADHD, predominantly inattentive). Codes must be documented in the clinical record and must match what the treating provider has assessed — upcoding or selecting codes not supported by documentation is a compliance violation.
• Rendering provider — confirm the rendering provider on the claim is the provider who actually delivered the service. In group practices, this is a common error: the supervising provider's NPI is billed when the associate who rendered the service should be the rendering provider.

Step 4 — Create the insurance claim

Once the session note is finalized, generate the insurance claim in SimplePractice:

1. Navigate to Billing > Insurance Claims > New Claim, or generate the claim directly from the appointment record.
2. SimplePractice pre-populates most claim fields from the client profile, provider settings, and session note. Review each populated field for accuracy.
3. Confirm the Place of Service code:
   • POS 11 — Office (in-person sessions at your practice location)
   • POS 02 — Telehealth Provided Other Than in Patient's Home (provider office to non-home location)
   • POS 10 — Telehealth Provided in Patient's Home (provider rendering service to patient in their home)
4. Verify that the authorization number (if required) is populated in the authorization field.
5. Confirm the billing provider NPI (group NPI, if applicable) and rendering provider NPI are both correctly populated.
6. Review the diagnosis code pointer — each CPT line on the claim must point to at least one diagnosis code in the claim header. SimplePractice handles this automatically, but verify it is mapping correctly when multiple diagnosis codes are present.

Step 5 — Submit the claim electronically

After reviewing the claim for completeness and accuracy:

1. Click Submit Claim. SimplePractice sends the 837P transaction to Waystar for clearinghouse validation and onward transmission to the payer.
2. Waystar performs front-end edits (NPI validation, payer ID check, required field review) and returns an acknowledgment — typically within minutes for real-time-enabled payers, or within 24–48 hours for batch payers.
3. Once accepted by the clearinghouse, the claim enters the payer's adjudication queue. Most commercial payers adjudicate electronic claims within 14–30 days; Medicare typically processes within 14 days.

Electronic claims submitted through SimplePractice are equivalent to CMS-1500 paper claims. They meet all standard professional billing format requirements (837P version 5010 transaction set). Paper claim submission is also available in SimplePractice but significantly slows processing — electronic submission is strongly recommended for all enrolled payers.

Step 6 — Track claim status

After submission, monitor claim status from the Billing dashboard in SimplePractice:

• Submitted — claim sent to clearinghouse; awaiting acknowledgment.
• Accepted — clearinghouse has validated the claim and forwarded to the payer.
• Rejected — clearinghouse found a validation error; the claim did not reach the payer. Correction and resubmission required.
• Pending — received by payer; awaiting adjudication.
• Paid — adjudicated; ERA received and posted.
• Denied — adjudicated; payer declined payment. See Step 7.

Set a follow-up schedule for unpaid claims: flag any claim that has been in Accepted/Pending status for more than 30 days for active follow-up with the payer. Timely filing windows — typically 90–180 days for commercial payers and 12 months for Medicare — are non-negotiable; claims that age past the filing deadline become unrecoverable write-offs.

Step 7 — Review and resolve denied claims

Denied claims appear in the Billing dashboard with a denial reason code and, if ERA is enrolled, a CARC/RARC explanation. Common denial reasons in behavioral health billing include:

In SimplePractice, denied claims can be corrected by editing the relevant fields and resubmitting. For complex appeals involving medical necessity (CO-50) or coordination of benefits disputes, you may need to submit a formal appeal letter with supporting clinical documentation directly to the payer outside the SimplePractice workflow.

Claim submission workflow summary

How Verimedix helps SimplePractice users optimize billing

SimplePractice is a powerful platform, but the tool is only as effective as the billing workflow behind it. Many behavioral health providers using SimplePractice still struggle with denial rates, aging A/R, and time spent on billing that could be spent with clients. Verimedix provides medical billing services that work alongside SimplePractice to fill those gaps.

• Batch eligibility verification across active client rosters — identifying coverage lapses and authorization gaps before they generate denials.
• CPT and ICD-10-CM coding review for behavioral health sessions — ensuring time-based codes are supported by documentation and diagnosis codes meet payer specificity requirements.
• Systematic denial management — working CARC/RARC denial queues to resolution, with formal appeal support for CO-50 and authorization-related denials.
• A/R aging follow-up — proactive outreach on unpaid claims aged 30+ days to prevent timely-filing losses.
• Integration with revenue cycle management reporting — monthly dashboards showing clean-claim rate, denial rate by payer, and collection performance.

Frequently asked questions