Skip to main content

 

Kareo Help Center

Provider ID Not on File

Rejection Message Rejection Details Resolution

Provider ID not on file.

There are four possible reasons why the claim is rejecting for this reason:

  1. The practice is not credentialed with this payer.
  2. The enrollment paperwork for this payer has not been completed.
  3. Claims are being sent out with the incorrect billing information.
  4. Claims are being submitted to the wrong payer ID.
     

Submitter Action:
Please contact the payer’s EDI department for the following information:

  1. Verify the payer has approved enrollment for electronic claim submission.
  • Are we approved for electronic claims submission through TriZetto or Capario/Emedon? (Specify your clearinghouse)
  • What is the effective date of approval?
  1. Verify the Provider IDs that the payer has on file (to determine what information the claimed should be billed under).
  • Is the Provider enrolled with their Group NPI or Individual NPI?
  • Is the Provider enrolled with their Tax ID or SSN?
  1. Verify if there are any additional payer-assigned Provider IDs that also need to be submitted on the claims.

The resolution instructions below correspond with the numbered “reasons” to the left:

  1. If the practice is not credentialed with the payer, please contact the payer for further assistance.
  2. If the enrollment paperwork has not been completed, contact the Kareo Enrollments Team for further assistance.
    If the claims were being submitted before the enrollment approval date with the correct billing information. Please rebill and resubmit all affected claims.
  3. If the payer confirmed enrollments for the practice and the approval date, but the billing information was sent incorrectly, please follow the instructions below to update the billing information for a specific provider and specific insurance company:
  1. Click Settings > Providers.
  2. Look for and open the provider record.
  3. Click on the Claim Settings tab.
  4. Click Add.
  5. Click Insurance Company.
  6. Look for and select the insurance company.
  7. Change the NPI dropdown to the appropriate option (depending on how you bill).
  8. (If necessary) Check “Override NPI” if a different Group NPI or Individual NPI needs to be entered.
  9. Change the Tax ID dropdown to the correct option (depending on how you bill).
  10. (If necessary) Check “Override EIN” if a different tax ID needs to be entered.
  11. Click Save all the way out (multiple saves may be required).

Then, rebill and resubmit all affected claims.

  1. If the claims are being submitted to the wrong payer ID:

    Follow the instructions below to 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.***
  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).

OR

  1. 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 an insurance company will need to be created.
  1. Double click on the appropriate insurance plan to associate it with the patient’s insurance policy
  2. Verify all other information listed on the policy is correct.
  3. 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.