Best Practice to Avoid Claim Rejection - Kareo Settings (2024)

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Practice Information Provider Information and Settings Payer Information and Settings References
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Updated: 07/15/2021
Views: 3636

Claim denials and rejections are two of the biggest obstacles in getting electronic claims (e-claims) accepted and processed by the payer. It is impossible to avoid, however, you can reduce thenumber of denials and rejections received by your practice andensure your e-claims get paid by:

  • Verifying practice, provider, and payer information and settings
  • Creatingprovider claim settings override(s)when necessary
  • Completing all required EDI enrollments and receiving payerapprovalbefore submitting e-claims

Your practice, provider, and payer information and settings in Kareoare essential for preventing claim denials and rejections. To verify you are setting up your account correctly, first gather all the necessary information to ensure you are billing appropriately for each insurance. If unsure of any credentialing or claims billing information, contact the payer directly to confirm.

Practice Information

The practice information entered inKareo should match the practice's credentials. Payers may reject any e-claims with submitted information that does not match what they have on file. Follow the instructions below to verify and edit the information as necessary.

  1. Click Settings > Practice Information. The Practice Information window opens.
  2. Verify the following information for accuracy.
    1. Name:Verify the practice name does not exceed60 characters,including spaces.
    2. Group NPI:If credentialed to bill with a group NPI, verify the NPI entered is correct and not an individual NPI.
      Note:The individual NPIis entered in the Provider record.
    3. EIN:If credentialed to bill with an EIN or Tax ID, verify the number is correct.
      Note:For providers credentialed to bill using their SSN, the SSN is enteredin the Provider record.
    4. Address: Under theContact Informationsection, verify the practice address is correct. The addressmust be a physical address(cannot be a P.O. Box) witha valid 9-digit zip code.
      Best Practice to Avoid Claim Rejection - Kareo Settings (1)Tip: Click Addressto enter the information in the Check Address pop-up window; this ensuresthe practice address is formatted correctly. Then, clickUSPS Websiteto access the USPS zip code lookup tool to verify the 9-digit zip code is valid.
  3. Click Saveto record any changes made.

Note: Review Practice Information for more general details.

 Best Practice to Avoid Claim Rejection - Kareo Settings (2)

Provider Information and Settings

The providerinformation entered inKareo should match the provider's credentials. Payers may reject any e-claims with submitted information that does not match what they have on file.Follow the instructions below to verify and edit the information and settings as necessary.

  1. ClickSettings >Providers. The Find Provider window opens.
  2. Find the provider then double click to open.The General tab of theEdit Provider window opens by default.
    • To add a new provider, review New Provider.
  3. Under the General tab, verify the following information for accuracy.
    1. Individual NPI: Verifythe NPIentered is correct.The individual NPI should match the NPPES NPI Registry.
    2. SSN: If applicable, verify theSSN entered is correct.
    3. Specialty:Verify the specialty is correct. If necessary, click Specialty to search and select the appropriate specialty from the list of taxonomy codes.
    4. Address: Verify the provider's officeaddress is correct. The addressmust be a physical address(cannot be a P.O. Box) witha valid 9-digit zip code.
      Best Practice to Avoid Claim Rejection - Kareo Settings (3)Tip: Click Addressto enter the information in the Check Address pop-up window; this ensuresthe practice address is formatted correctly. Then, clickUSPS Websiteto access the USPS zip code lookup tool to verify the 9-digit zip code is valid.
    5. Notes:It is recommended to enter internal notes to track up-to-date provider credentialing information.
  4. Click the Claim Settings tab.
 Best Practice to Avoid Claim Rejection - Kareo Settings (4)
  1. Under the Claim Settings tab, verify the default claimsbilling information is based on how the provider is credentialed with most payers.
    1. NPI:Verify the default billing NPI is setcorrectly. If necessary, click the drop-down arrow to change the setting.
      Note:TheIndividual NPIauto-populates from theGeneraltab and the Group NPIauto-populates from thePractice Information.
      • IfBill with Group and Individual NPIis selected, but thisprovider's claims need to be sentwith a different Group NPI, click to select "Override Group NPI?" andenter the Override Group NPI.
    2. Tax ID:Verify the billingTax IDis set correctly. If necessary, click the drop-down arrow to change the setting.
      Note:TheEINauto-populates from thePractice Informationand theSSNauto-populates from theGeneraltab.
      • If thisprovider's claims need to be sent with a different EIN, click to select "Override EIN?" and enter the EINOverride.
    3. If "Enable Pay-To Address for Professional Claim" is selected because the pay-to address (e.g., P.O. Box or Lockbox) differs from the practice's address, verify the name and address is correct.
  2. Click Saveto record any changes made.

Note:If claims billing information varies for a specific payer and/or service location, override general claim settingsand override advanced settingsas necessary.

 Best Practice to Avoid Claim Rejection - Kareo Settings (5)

Payer Information and Settings

The payerinformation entered inKareo should match the information verified directly withthe payer and its records. Payers may reject any e-claims with submitted information that does not match what they have on file.

Insurance Company

Follow the instructions below to verify and edit the insurance company information as necessary.

  1. Click Settings > Insurance > Insurance Companies. The Insurance Companies window opens.
    Note: The Insurance Companies window is also known as theEnrollments Dashboard.
  2. Find the insurance company and click the name to open.The General tab of theEdit Insurance Company window opens by default.
    • To add a new insurance company, review Add Insurance Company.
  3. Under the General tab, verifythe correctInsurance Programis selected (e.g., selecting BL - Blue Cross/Blue Shield for a Medicare payer may causeclaim rejections). If necessary, click the drop-down arrow to make the appropriate selection.
  4. Click theElectronic Claimstab.
 Best Practice to Avoid Claim Rejection - Kareo Settings (6)
  1. Under theElectronic Claimstab, verify the electronic payer connection is set up correctly.
    1. Verifythe selected Clearinghouseis the clearinghouse the practice/provider is enrolled with. If necessary, click thedrop-down arrowto make the appropriate selection.
    2. Verify the correctElectronic PayerConnection isselected and Clearinghouse Payer IDdisplays.If necessary, click Electronic Payer Connection to search and select the payer connection.
      Note: Only select a UB payer for Institutional (UB-04) claims submission.
  2. Click Saveto record any changes made.
    Note:Any changes made apply to all insurance policies/plans associated with the insurance company.
 Best Practice to Avoid Claim Rejection - Kareo Settings (7)

Insurance Plan

Next, follow the instructions below to verify and edit the insuranceplan informationas necessary.

  1. Click Settings > Insurance > Find Insurance Plan. The Find Insurance Plan window opens.
  2. Find the insurance plan then double click to open. The Edit Insurance Plan window opens.
    • To add a new insurance plan, review New Insurance Plan.
  3. Insurance Company:Verify the correct insurance company is selected. If necessary, click Insurance Company to search and select the plan'scarrier/network.
  4. Address:Verify the address entered is the correct address where claims should be sent.
  5. ClickSaveto record any changes made.
 Best Practice to Avoid Claim Rejection - Kareo Settings (8)
Best Practice to Avoid Claim Rejection - Kareo Settings (2024)

References

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