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Kareo Help Center

Best Practice to Avoid Rejection - Practice Setup

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:

Practice Setup

Your practice setup in Kareo is essential for avoiding claim denials and rejections. To verify you are setting up your account correctly, first gather all the necessary information to ensure you are billing appropriately to each insurance:

 

Practice Information

The practice information entered into Kareo should match the practice's credentials. Payers may reject any claims with submitted information that does not match what they have on file.

  1. Practice Name
    • For electronic claim submission the name entered in this field cannot exceed 35 characters. Doing so, will result in a claim rejection. This information will populate to Box 33 of the CMS-1500 form.
  2. Group NPI and Tax ID
    • The credentialed group NPI and Tax ID (EIN) should be entered into the practice information. This will populate Box 33A and 25 of the CMS-1500 form.
  3. Practice Address
    • The practice address must be a physical address and not a P.O. Box. A 9-digit zip code is also required.
    • Zip code rejections are among the most common and easiest to avoid. Most payers (including Medicare) will reject claims with an invalid or 5-digit zip. If you do not have the full 9-digit zip code, we recommend searching the USPS website.

Follow the instructions below to verify and edit the practice information:

  1. Click Settings > Practice Information. The Practice Information window opens.
  2. Verify the practice name is 35 characters or less including spaces.
  3. Verify the Group NPI is correct. Enter or edit the number as needed.
  4. Verify the EIN is is linked to the practice. Enter or edit the number as needed.
  5. Verify the practice address is correct under Contact Information and has a valid 9 digit zip code. Enter or edit the address as needed.
  6. Click Save
PracticeInfo.png

Provider Setup

The provider's information entered into Kareo should match the provider's credentials. Payers may reject any claims with submitted information that does not match what they have on file.

  1. General Tab
    • The individual NPI should match the NPPES NPI Registry. This will populate Box 24J and 33A (if billing individually) of the CMS-1500 form.
    • The provider address must be a physical address and not a P.O. Box. A 9-digit zip code is also required.
    • Zip code rejections are among the most common and easiest to avoid. Most payers (including Medicare) will reject claims with an invalid or 5-digit zip. If you do not have the full 9-digit zip code, we recommend searching the USPS website.
  2. Claim Settings Tab
    • The default billing information (NPI and Tax ID/SSN) is based how the provider is credentialed with most payers. This will populate Box 24J and 33A of the CMS-1500 form.
    • If the billing information varies for a specific payer or service location, the Override Claim Settings will need to created or validated.

Follow the instructions below to verify provider’s settings:

  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. Verify that the Individual NPI is correct. Enter or edit the number as needed.
  4. If applicable, verify that the SSN is correct. Enter or edit the number as needed.
  5. Verify that the Specialty is correct. Enter or edit the number as needed.
  6. Verify the address is correct and has a valid 9 digit zip code. Enter or edit the address as needed.
  7. Click the Claim Settings tab.
  8. Verify the NPI is set to bill correctly. Click the drop-down arrow to change the setting as needed.
    1. Click "Override Group NPI" to enter a different Group NPI for just this provider.
  9. Verify the Tax ID is set to bill correctly. Click the drop-down arrow to change the setting as needed.
    1. Click "Override EIN" to enter a different EIN for just this provider.
  10. If "Enable Pay-To Address for Professional Claim" is checked, verify the name and/or address with a valid 9 digit zip code is correct.
  11. Click Save
 

EditProvider_ClaimSettings.png

Payer Information

Gathering the correct payer information before billing will ensure the claims will not reject for invalid setup information.

  1. Payer ID
    • Verify you have the correct payer ID for all insurances your practice/provider will be billing in the insurance company record. Also verify the correct insurance company is attached to the patient's insurance policy.
    • Submitting claims to the wrong payer ID can lead to the claims either being rejected or processed by the wrong payer.
  2. Payer Address
    • Ensure you have the correct billing address for all insurances your practice/provider will be billing in the insurance plan record.
    • Zip code rejections are among the most common and easiest to avoid. Most payers (including Medicare) will reject claims with an invalid or 5-digit zip. If you do not have the full 9-digit zip code, we recommend searching the USPS website.
  3. Payer Credentialing Information
    • Ensure you have the correct billing/contract information (Billing NPI and Tax ID/SSN) that each provider bills under for each payer.
    • Unsure where to find the correct payer/credentialing information?
      • Contact the payer's Provider Services department
      • Have a copy of a paper claim paid on by the payer?
        • Payer Address: Top right of CMS-1500 form
        • BIlling NPI: Box 33a
        • EIN/SSN: Box 25

Follow the instructions below to enter the verified payer ID:

  1. Click Settings > Insurance > Insurance Companies. The Enrollments dashboard opens.
  2. Look for and open the payer that needs correcting. Or create a New Insurance Company. The Edit Insurance Company window opens.
  3. Click on the Electronic Claim tab.
  4. Verify that the payer name/payer ID matches the information on the patient's insurance card.
  5. Click Save.

Note: Any changes made on the Edit Insurance Company settings will apply to ALL insurance policies and plans within the practice tied to this insurance company.

Make sure to only select a UB Payer ID for Institutional (UB-04) claims submission. Do not select a UB Payer ID for Professional (CMS-1500) claims.

Payer_ID.png

Follow the instructions below to enter the verified payer’s address:

  1. Click Settings > Insurance > Find Insurance Plan. The Find Insurance Plan window opens.
  2. Look for and open the payer that needs correcting. Or create a New Insurance Plan. The Edit Insurance Plan window opens.
  3. Enter the payer's address from the patient's insurance card in the Address field.
  4. Enter the address into the USPS Zip Code Look Up tool to validate the 9-digit zip-code.
  5. If the 9-digit zip-code is not correct, enter the correct information into the Address field.
  6. Click Save.
  7. Follow steps 2-6 for each existing insurance plan.
Insurance_Plan_Address.png

We recommend tracking the credentialing information in Kareo in either of the following areas:

  1. Provider Record
    1. Click on Settings > Providers.
    2. Look for and open the provider that needs editing.
    3. Enter the information in the Notes section.
    4. Click Save.
  2. Insurance Company Record
    1. Click Settings > Insurance > Find Insurance Plan.
    2. Look for and open the payer that needs editing.
    3. Enter the information in the Notes section.
    4. Click Save.
EditProvider_Notes.png

Insurance_Plan_Notes.png

Complete Enrollments

All enrollment payer will need to be completed and signed by the practice and approved by the payer before claim submission can begin. This will ensure that the claims will not be rejected for setup information.

Do not submit claims to a payer until you have confirmed claims enrollment is approved if they required. Follow the instructions in the article to Submit Payer Enrollment Requests.

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