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Kareo Help Center

Claim must be billed direct to Blue Shield CA

Rejection Message Rejection Details Resolution

Claim must be billed direct to Blue Shield CA

 

The policy ID information submitted on your claim belongs to a Blue Shield CA plan.

Submitter Action:

  1. Verify that the claim was submitted to the correct payer ID.
  2. Cross reference the insurance/plan name listed on the patient’s insurance card against Kareo’s Electronic Payer search (Settings > Enrollments).
  3. Verify the appropriate Payer ID based on your clearinghouse.

The prefix used on the member ID card will indicate what payer should be used for this type of subscriber.

Follow the instructions below to verify (or edit) the payer ID associated with the claim:

  1. Click Encounters > Track Claim Status.
  2. Look for and double-click on the encounter that needs correcting.
  3. Double-click on the Case.
  4. Double-click on the appropriate Insurance Policy.
  5. Double-click on the Insurance Plan name to open the Edit Insurance Plan page.
  6. Double-click on the Insurance Company name to open the Edit Insurance Company page.
  7. Click the Electronic Claims tab. The current payer ID is listed in the Clearinghouse Payer ID field.

If the payer ID the claim is being billed to is incorrect it can be updated in two ways:

Note: Changes made within the Edit Insurance Plan or Edit Insurance Company pages will apply to ALL insurance policies and claims tied to that Insurance Plan or Company within the practice.

  1. By changing the payer ID associated with this insurance company:
    1. Click the Electronic Payer Connection button.
    2. Search for and select the correct payer ID for the claim.
    3. Click Save all the way out (multiple saves may be required).
  2. By associating the insurance policy with another insurance company (with the correct payer ID):
    1. Exit back to the Insurance Policy page.
    2. Click the Insurance button.
    3. Look for an Insurance Plan with the correct payer ID (listed under the “EDI Payer Number” column).
      • If there are no insurance plans associated with the correct payer ID a new insurance plan and insurance company will need to be created.
    4. Double-click on the appropriate insurance plan to associate it with the patient’s insurance policy.
    5. Verify all other information listed on the policy is correct.
    6. Click Save all the way out (multiple saves may be required).

Then, rebill and resubmit all affected claims.

Note: Please verify enrollment is completed (or not needed) before submitting e-claims to a new Payer ID.