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Kareo Help Center

Patient : Entity not eligible for benefits for submitted dates of service

Rejection Message Rejection Details Resolution

Patient : Entity not eligible for benefits for submitted dates of service 

Resolution Steps will vary depending on the cause:

Cause #1 - Resolution: Follow the instructions below to edit the patient’s demographics (if needed) 

  1. Click Patient > Find Patient.
  2. Look for and open the patient record that needs correcting. 
  3. Update the patient Full Name, Date of Birth, and/or Gender as needed.
  4. Click Save.

Then, rebill and resubmit all affected claims. 
 OR
Follow the instructions below to edit the patient’s policy number (if needed)

  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. Correct the Policy # and Group # as needed.
  6. Click Save all the way out (multiple saves may be required).

 Then, rebill and resubmit all affected claims. 

 

Follow the instructions below to change the insurance program code:

  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 Insurance Program dropdown to 
     update the insurance program code.
  8. Click Save all the way out (multiple saves may be required).

Then, rebill and resubmit all affected claims.

Follow the instructions below if there is a Self-Pay policy attached to the Case with the insurance policy: 

  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 self-pay policy.
  5. Uncheck the "Active" box on the right.
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