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Kareo Help Center

Best Practice to Avoid Rejection - Override Claim Settings

Intro

Claim denials and rejections are two of the biggest obstacles in getting electronic claims processed and accepted by the payer. Unfortunately they are a fact of life in medical billing and impossible to avoid. However, there are steps that can be taken to reduce the number of denials and rejections received by your practice to a minimum and ensure your electronic claims are paid:

Settings Up Claim Overrides

If the provider needs to bill to a specific insurance (or for a specific location) under a different billing NPI, EIN, or identifier you can set up a Claim Settings Override:

  1. Click Settings > Providers.
  2. Look for and open the provider record that needs editing.
  3. Click on Claim Settings tab.
  4. Click the Add button.
  5. If the override should apply to all payers, do not click on the Insurance Company button.
    1. Select a Location from the drop down to set up an override for all payers.
    2. Notes:
      1. An override cannot be set for all payers and all locations.
      2. An override set for All payers will supersede all other overrides set up for this provider.
    3. Proceed to step 7.
  6. If the override should apply to one specific payer, click on the Insurance Company button.
    1. Look for and select the insurance company.
    2. If the override should apply to one specific service location for this payer, select the appropriate facility from the Location dropdown.
  7. Click the NPI dropdown to select either "Bill with Group and Individual NPI" or "Bill with Individual NPI Only".
    1. Notes:
      1. The Group NPI pulls from the following location: Settings > Practice Information page.
      2. The Individual NPI pulls from Settings > Providers > General tab.
    2. If necessary, check the Override NPI? box to enter a different NPI.
  8. Click the Tax ID dropdown to select either "Bill with EIN" or "Bill with SSN"
    1. Notes:
      1. The EIN pulls from the Settings > Practice Information page.
      2. The SSN pulls from the Settings> Providers> General tab.
    2. If necessary, check the Override EIN? box to enter a different Tax ID.
  9. Check the Show advanced settings check box.
  10. If necessary, check the Override practice name box to enter a different practice name.
    1. Notes:
      1. The practice name pulls from the Settings > Practice Information page.
      2. The practice name needs to be 35 characters or less including space.
  11. If necessary, check the Override practice address box to enter a different practice address.
    1. Notes:
      1. The practice address pulls from the Settings > Practice Information page.
      2. The practice address needs to be a physical address with a 9-digit zip code. If you do not have the full 9-digit zip code, we recommend searching the USPS website.
  12. If necessary, check the Override pay-to-address box to enter a different address to receive payment from the payer.
    1. Notes:
      1. The pay-to-address may be a physical address or a P.O. Box with a 9-digit zip code. If you do not have the full 9-digit zip code, we recommend searching the USPS website.
  13. Information under the "Advanced Paper Claim Settings" section should only be populated if paper claims are being submitted for this payer.
    1. Select the qualifier from the dropdown next to the corresponding box that needs to be populated and enter the information the open field.
  14. Information under the "Advanced Electronic Claim Settings" section should only be populated if the payer requires a secondary identifier.
    1. If the payer is being billed with the individual NPI, choose G2 as the Type and enter the secondary identifier into the Value field in the top table.
    2. If the payer is being billed with the group NPI, choose G2 as the Type and enter the secondary identifier into the Value field in the bottom table.
  15. If the submitted ID is needed, enter the information in the Submitter Number field.
  16. If a group taxonomy is needed, click on the Group Specialty button.
    1. Look for and select the correct group taxonomy.
    2. Click Ok.
  17. Click Save all the way out (multiple saves required).
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