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Kareo Help Center

Verify Patient Eligibility

If a claim was rejected due the patient's eligibility, follow the instructions below to verify their eligibility and edit the demographics as needed. When all corrective actions are completed, rebill and resubmit all affected claims. 

Verify Patient Eligibility

  1. Verify all of the following against the patient's insurance card:
    • Patient Full Name
    • Gender
    • Date of Birth
    • Policy Number
  2. If the information does not match the insurance card, follow the instructions below to edit the patient demographic, insured demographics, or policy number .
  3. When available, run an eligibility check for the patient within Kareo to check for active coverage for the claim's date of service.
  4. If eligibility could not be ran within Kareo or the report does not show active coverage, verify the patient's eligibility by calling the payer and gather the following information:
    1. Phone number for the payer
    2. Call reference number
    3. Name of the representative

If all patient demographics and eligibility are confirmed by the payer, please contact Kareo Support with the details of the call for further assistance.

Note: Kareo's clearinghouse partners require a copy of the patient's insurance card (front and back) in order to research eligibility rejections. Please ensure the insurance card has been uploaded to the patient record in Kareo.

Edit Patient Demographics

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



Patient_Demo.png

Edit Insured Demographics

  1. Click Encounters > Track Claim Status. The Find Claim window opens.
  2. Look for and double-click on the encounter that needs correcting. The Edit Claim window opens.
  3. Double-click on the Case. The Edit Case window opens.
  4. Double-click on the appropriate Insurance Policy. The Insurance Policy window opens.
  5. Update the Patient Relationship to Insured as needed.
  6. Update the insured Full Name, Address, Insured ID number, Date of Birth, and/or Gender as needed.
  7. Click Save all the way out (multiple saves may be required). 



Insurance_Policy_InsuredDemo.png

Edit Policy Number

  1. Click Encounters > Track Claim Status. The Find Claim window opens.
  2. Look for and double-click on the encounter that needs correcting. The Edit Claim window opens.
  3. Double-click on the Case. The Edit Case window opens.
  4. Double-click on the appropriate Insurance Policy. The Insurance Policy window opens.
  5. Update the Policy # and Group # as needed.
  6. Click Save all the way out (multiple saves may be required). 



Policy_Number.png

 

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