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Best Practice to Avoid Rejection - Override Claim Settings

Claim denials and rejections are two of the biggest obstacles in getting electronic claims processed and accepted by the payer. It is impossible to avoid. However, there are steps that can be taken to reduce the number of denials and rejections received by your practice and ensure your electronic claims are paid:

Settings Up Claim Overrides

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

  1. Click Settings > Provider. The Find Provider window opens.
  2. Look for and open the provider record that needs correcting. The Edit Provider window opens.
  3. Click on the Claims Settings tab.
  4. Click Add. The Override Claim Setting window opens.
  5. Click Insurance Company. The Select Insurance Company window opens.
    Note:
    • An override set for All payers will supersede all other overrides set up for this provider.
  6. If necessary, click the Location drop-down arrow to select a service location. If one is selected, the override will only apply to encounters billing the selected payer and service location.
  7. Click the NPI dropdown to select either Bill with Group and Individual NPI or Bill with Individual NPI Only.
    1. If necessary, click "Override NPI?" to enter a different NPI.
      Note:
      • The Group NPI pulls from the Settings > Practice Information window.
      • The Individual NPI pulls from the Settings > Providers > General tab.
  8. Click the Tax ID drop-down to select either Bill with EIN or Bill with SSN.
    1. If necessary, click "Override EIN?" to enter a different  Tax ID.
      Note:
      • The EIN pulls from the Settings > Practice Information window.
      • The SSN pulls from the Settings > Providers > General tab.
  9. Click "Show advanced settings" to display advanced settings.

ProviderOverride_General.png
  1. If necessary, click "Override practice name" to enter a different practice name.
    Note:
    • The practice name pulls from the Settings > Practice Information window.
    • The practice name needs to be 35 characters or less including space.
  2. If necessary, click "Override practice address" to enter a different practice address.
    Note:
    • The practice address pulls from the Settings > Practice Information window.
    • 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.
  3. If necessary, click "Override pay-to-address" to enter a different address to receive payment from the payer.
    Note:
    • 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.
  4. Information under the Advanced Paper Claim Settings section should only be populated if paper claims are being submitted for this payer.
  5. 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, select 0B for a state license number or G2 for all others as the Type and populate Value with the identifier in the top table.
    2. If the payer is being billed with the group NPI, select 0B for a state license number or G2 for all others as the Type and populate Value with the identifier in the top table.
      Note:
      • Only Type "0B - State License Number" and "G2 - Provider Commercial Number" are valid for electronic submission.
  6. If the submitted ID is needed, enter the information in the Submitter Number field.
    • This field is only used for Nordian.
  7. If a group taxonomy is needed, click Group Specialty.
    1. Look for and select the correct group taxonomy.
    2. Click Ok.
  8. If necessary, click "Override settings for eligibility" to select which NPI the payer will use to run eligiblity.
  9. Click Save all the way out (multiple saves required).

ProviderOverride_Advanced.png
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