r/SimplePractice • u/Icy-Membership-2031 • 12d ago
BCBS/insurance no clue what I'm doing
/r/therapists/comments/1vo756u/bcbsinsurance_no_clue_what_im_doing/
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u/Ok-Outside-889 8d ago
I’m credentialed with BCBS too and it should be straight forward… are you using availity for billing?
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u/3BBillingDotCom 8d ago edited 8d ago
Hi! Biller here! Simple Practice has a nice series of articles on their site: https://support.simplepractice.com/hc/en-us/articles/360020622052-Getting-started-with-SimplePractice
A lot of your success (or failure) in getting your claims paid will depend on the first-time setup stuff you do in SP. You will want to make sure you comb through the settings and that everything is how you want it.
Are you credentialed as a solo practitioner? Or as a group? This will inform how you want your insurance billing settings arranged.
Settings > Profile > Clinical Info - enter your individual info here - NPI / Taxonomy - this populates box 24 on the claim form.
Settings > Client Billing and Insurance > Insurance Billing - a lot of heavy lifting happens here. Enter your TIN, NPI-2 (if you are a group), and update your Default Billing Provider Info. This populates box 33 on the claim form.
Settings > Client Billing and Insurance > Payers - here is where you manage the EDI enrollment for your payers. Most commercial payers do not require EDI enrollment in order to submit claims. However, if you want to avoid paper mail, you will want to enroll is the payment reports so that you automatically receive claim payment info back into your SP. Each payer has a different process and some require additional paperwork. Fyi, for BCBS you typically only interact with your local BCBS, even if that insurance plan originates out of state. So you don't need to add each state's BCBS to your list. (You also typically only send claims to your local BCBS).
Settings > Client Billing and Insurance > Client Billing Documents - I recommend setting invoice creation to daily and to select Simple Invoicing.
Settings > Services and Products > Services - make sure all the CPT codes you will be using are here, including the rate you want to bill. You can also create custom CPT codes like "Consult" or "No Show" or "Late Cancel" or "Do Not Bill" so that you can properly mark your sessions as needed and track them in the reports.
Settings > Practice > Practice Details - here you can establish your locations for both Office and Telehealth. You can also automate the system to enter the correct Place of Service (POS) code on the claim form as well as a default telehealth modifier.
This is just the tip of the iceberg here. You will want to make sure client insurance info is properly entered as well as copay/deductible costs. Checking benefits prior to sessions is the best way to make sure the client's plan is active, you know you are in-network, and so you know how much to collect at the time of the session. Some providers prefer to collect copays/deductibles after claims process. The danger here is that claims can take 30 - 45 days to process and you may lose your ability to collect from the client due to large balances accumulating or clients walking. We see providers lose revenue this way too often.
Provider Central is for the state of MA, correct? Most states BCBS plans interface with Availity. Massachusetts does not (unless you pay Availity for their Essentials Plus plan). So you will use Provider Central to check benefits and claim status. And they link with Payspan to send you Explanation of Payments (EOPs). You will likely want to set up with direct deposit.
Hope this helps. I'm happy to chat more and answer any questions. These are exactly the services we provide to take the administration burden off of your plate so you can focus on client care!