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Kareo Help Center

EDI PROFESSIONAL CLAIMS ARE NOT AVAILABLE FOR THIS PAYER ID

Rejection Message Rejection Details Resolution
EDI PROFESSIONAL CLAIMS ARE NOT AVAILABLE FOR THIS PAYER ID

This rejection means that the claim was submitted to the wrong payer ID.

Note: This is the most likely cause if this rejection was received on claims for multiple patients.

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.

Tip: Most Kareo Billing subscription levels include access to a free eligibility check feature which can be used with many payers to verify a patient has active coverage.

Utilizing this feature prior to submitting claims for a patient can help prevent this type of rejection.

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 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:

1. By changing the payer ID associated with this insurance company: 

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.

a. Click the Electronic Payer Connection button.

b. Search for and select the correct payer ID for the claim.

c. 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):

a. Exit back to the Insurance Policy page. 

b. Click the Insurance button.

c. 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. 

d. ​Double-click on the appropriate insurance plan to associate it with the patient’s insurance policy.

e. Verify all other information listed on the policy is correct.

f. 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.