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Kareo Help Center

Clearinghouse Reports

Clearinghouse reports help you manage and monitor various billing workflow tasks; from claim processing to posting payments. These reports are generated on a daily, weekly or monthly basis depending on the type of report. From the Clearinghouse Reports section, you can search, review and print clearinghouse reports.

To access a clearinghouse report

  1. Click Encounters>Clearinghouse Reports.
  2. Click a tab to select the type of report you want to view.
  3. Double-click a report. See Tips below.

 

Find Clearinghouse Report.jpg

  1. Click to view a list of all clearinghouse reports.
  2. Click to view a list of daily claims reports (verification reports from the clearinghouse indicating receipt of claims), internal validation reports, and payer responses (acknowledgment/acceptance notifications from insurance companies) from Kareo PM (Internal), clearinghouse and payer.
  3. Click to view a list of Electronic Remittance Advice (ERA) notifications and Electronic Funds Transfer (EFT Check) reports.
  4. Click to view patient statement batch reports.
  5. Click to view a list of payer-provided EOBs (Explanation of Benefits).
  6. To search for a specific report, type all or part of a word, date or ID number, then click Find Now.
  7. To search in a specific field, select from the drop-down list, then click Find Now.
  8. Check to view unreviewed reports only.
  9. Click to view the next page.

Tips

  • It is recommended that someone in your business office is assigned the responsibility to monitor clearinghouse reports and take action on a daily basis.
  • You can access the original encounter record on most clearinghouse and payer reports by clicking the Claim ID number listed on the report.
  • You can post a payment directly from an ERA by clicking Post Payment at the bottom of the report. See Posting a Payment from an ERA.
  • After reviewing a report and no further action is needed, it is recommended to mark the report as reviewed by clicking Mark as Reviewed at the bottom of the report.

Note: An EOB (Explanation of Benefits) contains the same information that is included in an ERA (Electronic Remittance Advice). The ERA is used to post payments; the EOB is simply in the original format provided by the payer and can be printed for your records.

View a Clearinghouse Report

Prior to transmitting claims to the payer, the clearinghouse runs a series of checks for missing or invalid payer-required information. When detected, the claim will be rejected so that you can make the necessary corrections. The clearinghouse report includes both rejections and acknowledgements.  For the most common rejections and resolutions, see the Claim Rejection Troubleshooting Guide.

Note: If a claim is rejected from the clearinghouse, all claims associated with the encounter are rejected.

Example of Clearinghouse Checks:

  • Missing or invalid Practice or Service Location primary and secondary IDs
  • Missing or invalid ID qualifiers
  • Missing submitter IDs when payer requires a unique submitter ID
  • Missing or invalid payer ID
  • Missing or invalid procedure, modifier, or diagnosis code
  • Missing or invalid adjustment code
  • Missing or invalid subscriber’s identification number (policy number)
  • Missing provider specialty code

  1. Click to access the encounter record.
  2. Reason for rejection.
  3. REJ = claim rejected; make corrections and rebill.
  4. ACK = acknowledged; claim forwarded to payer.
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