> ## Documentation Index
> Fetch the complete documentation index at: https://help.clinikehr.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Insurance settings

> Add the insurance payers you bill, enrol your providers with them, and understand why claims fail until enrolment completes.

export const StillStuck = ({topic}) => <div className="ck-callout ck-callout--note" role="note">
    <p className="ck-callout__body">
      <strong>Still stuck{topic ? ` with ${topic}` : ''}?</strong>{' '}
      Check <a href="/platform/help/troubleshooting">Troubleshooting</a> first —
      it covers the failures we see most often. If that does not resolve it,{' '}
      <a href="/platform/help/contact-support">contact support</a> and include
      your workspace name and the time the problem happened, so we can find the
      matching entry in your audit log.
    </p>
  </div>;

export const TaskHeader = ({before, time, after}) => <div className="ck-task">
    {before ? <div className="ck-task__cell">
        <div className="ck-task__title">Before you start</div>
        <p className="ck-task__body">{before}</p>
      </div> : null}

    {time ? <div className="ck-task__cell">
        <div className="ck-task__title">Takes about</div>
        <p className="ck-task__body">{time}</p>
      </div> : null}

    {after ? <div className="ck-task__cell">
        <div className="ck-task__title">When you're done</div>
        <p className="ck-task__body">{after}</p>
      </div> : null}
  </div>;

export const Path = ({steps = []}) => <span className="ck-path">
    {steps.map((s, i) => <span key={i} className="ck-path__step">
        {i > 0 ? <span className="ck-path__sep" aria-hidden="true">
            ›
          </span> : null}
        {s}
      </span>)}
  </span>;

export const Availability = ({editions = ['all'], plans, roles, note}) => {
  const list = editions.includes('all') ? ['clinic', 'pharmacy', 'lims'] : editions;
  return <div className="ck-avail" role="note" aria-label="Feature availability">
      <span className="ck-avail__label">Available in</span>

      {list.map(e => <span key={e} className={`ck-pill ck-pill--${e}`}>
          {EDITION_LABELS[e] || e}
        </span>)}

      {plans ? <span className="ck-avail__label">Plan</span> : null}
      {plans ? <span className="ck-pill ck-pill--plan">{plans}</span> : null}

      {roles ? <span className="ck-avail__label">Who</span> : null}
      {roles ? <span className="ck-pill ck-pill--role">{roles}</span> : null}

      {note ? <span className="ck-avail__note">{note}</span> : null}
    </div>;
};

<Availability editions={['clinic']} plans="Solo and Team" roles="Owner, manager or accountant" />

Before you can check a client's coverage or send a claim, the insurance company has to exist in your practice and your providers have to be enrolled with it. That is what this tab is for.

<Path steps={['Sidebar', 'Settings', 'Billing', 'Insurance Settings']} />

<TaskHeader before="Your practice's billing details and each provider's NPI" time="5 minutes to add a payer; days to weeks for enrolment to complete" after="Payers you can select on a client's coverage, and providers cleared to file electronically" />

This tab exists **only on Solo and Team**. It is absent on Enterprise, which runs a different insurance system entirely — so an enterprise colleague genuinely cannot see the screen you are describing to them.

## What this tab controls

Three sub-tabs run along the top.

| Control                        | What it does                                                                                                                               | Default    |
| ------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------ | ---------- |
| **Insurance Profile Settings** | Your practice's own filing identity, and the billing profiles claims are submitted under. Add, edit or delete a profile here               | Empty      |
| **Payers**                     | The insurance companies you bill — "Manage insurance payer filing and enrollment details"                                                  | Empty      |
| **Add Payer › Payer search**   | Opens the search sheet: "Search by payer name, ID, or alias (e.g. Aetna, Blue Cross, 62308)…". Selecting a result adds it to your practice | —          |
| **Search payers you've added** | Filters the list you already have, by name, payer ID or alias                                                                              | Empty      |
| **Status** filter              | **All payers** / **Active only** / **Inactive only**                                                                                       | All payers |
| **Sort**                       | **Sort: Name** or **Sort: Recent**                                                                                                         | Name       |
| Payer row menu                 | **Deactivate** / **Activate**, **View Stedi Details** (coverage, transaction support, enrolment rules) and **Remove payer**                | —          |
| Counters                       | **Total Payers**, **Active**, **Total Claims**, **Eligibility Checks** across all payers                                                   | 0          |
| **Provider Enrollment**        | Create an enrolment, submit the draft, sync its status, upload documents and complete outstanding tasks                                    | Empty      |

Enrolments cover the transaction types a payer supports — **claim status**, **professional claims**, **eligibility** and **remittance** — and each one moves through **Draft**, **Stedi Processing**, **Action Required**, **Provisioning**, then **Live**, **Rejected** or **Canceled**.

## Set it up

<Steps>
  <Step title="Fill in your insurance profile">
    Open **Insurance Profile Settings** and complete your practice's filing details and at least one billing profile. Claims are submitted under this identity, so a wrong value here fails every claim, not one.
  </Step>

  <Step title="Add your first payer">
    Go to **Payers**, select **Add Payer › Payer search**, and search by name, payer ID or alias. Select the payer and it is added to your practice — a "\{Payer} added to your clinic" toast confirms it.
  </Step>

  <Step title="Check what that payer supports">
    Open the row menu and select **View Stedi Details**. This tells you which transactions the payer supports and whether enrolment is required for each — a payer marked "No enrollment required" for claim filing needs no further work.
  </Step>

  <Step title="Enrol your providers">
    Move to **Provider Enrollment** and create an enrolment for the provider and payer, choosing the transaction types you need. It starts as a **Draft**.
  </Step>

  <Step title="Submit it">
    Submit the draft. It moves to **Stedi Processing** and leaves your hands.
  </Step>

  <Step title="Clear anything asked of you">
    A status of **Action Required** means the payer needs something from you — usually a signed form. Upload it against the task ("Upload PDF"), then use the sync action to refresh the status. Enrolments do not update themselves on a schedule.
  </Step>
</Steps>

## What changes once you save

**Adding a payer** makes it selectable in two places: when you record a client's insurance coverage on their chart, and when you create a claim. An **inactive** payer stays in the list, greyed, and drops out of both pickers — that is how you retire a payer you no longer bill without losing its claim history.

**Enrolment is the part that actually permits submission.** Adding a payer alone does not let you file with it. Until the enrolment for that provider, payer and transaction type reaches **Live**, claims to that payer will fail — and they fail at submission, not at the point you build them, so the first sign is usually a rejected claim rather than a blocked button. Plan for it: enrolment is a real-world approval process measured in days or weeks, not a save.

**Removing a payer behaves differently depending on its history.** If it has claims against it, the confirmation says so — "This payer has existing claims and will be deactivated (not deleted)" — and it is deactivated so the claim record stays intact. A payer with no claims is removed permanently.

Nothing on this tab changes an existing claim. Claims already submitted keep the payer and profile they were filed with.

<Warning>
  Eligibility checks and claim submissions are **charged per use**. What each one costs depends on your plan — see [Plans overview](/platform/plans/overview). Adding payers and creating enrolments costs nothing; running checks and filing claims does.
</Warning>

## Check it worked

Open any client's chart and start recording insurance coverage. The payer you added should appear in the picker. Then return to **Provider Enrollment** — the enrolment you submitted should show a status other than **Draft**, and the **Payers** tab's **Total Payers** and **Active** counters should have moved.

## Common issues

<AccordionGroup>
  <Accordion title="I cannot find this tab at all">
    **Insurance Settings** only exists on Solo and Team plans. If your practice is on Enterprise, insurance is handled elsewhere and this tab is deliberately hidden.
  </Accordion>

  <Accordion title="I added the payer but it does not appear when I record coverage">
    It is inactive. Open the row menu on the **Payers** list and select **Activate** — only active payers appear in the coverage and claim pickers.
  </Accordion>

  <Accordion title="My claims to a payer keep failing">
    Check the enrolment for that provider and payer under **Provider Enrollment**. Anything short of **Live** — especially **Action Required** — means you are not yet cleared to file with them. Clear the outstanding task, upload the document it asks for, then sync the status.
  </Accordion>

  <Accordion title="An enrolment has been stuck on the same status for days">
    Statuses do not refresh on their own. Use the sync action on the enrolment to pull the current state. If it genuinely has not moved, **Action Required** is the status worth re-reading — it usually names a document only you can supply.
  </Accordion>

  <Accordion title="Removing a payer only deactivated it">
    That is deliberate. A payer with claims against it is deactivated rather than deleted so the claim history stays readable and auditable. Only a payer with no claims is removed outright.
  </Accordion>
</AccordionGroup>

For building, submitting and chasing the claims themselves, see [Insurance claims](/practice/money/insurance-claims).

<StillStuck />