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Kareo Help Center

Your claims cannot be submitted to the secondary insurance because the charge amount does not equal the sum of the paid amount and all line adjustment amounts

Rejection Message Rejection Details Resolution

Your claims cannot be submitted to the secondary insurance because the charge amount does not equal the sum of the paid amount and all line adjustment amounts. This would result in a rejection at the clearinghouse. Please open Encounters > Track Claim Status, then find the claim ID above, review the transaction history, locate and open the payment from the primary insurance, and finally, review the amount paid by the primary and all line adjustments amounts and make any necessary corrections. The primary paid amount + all line adjustments must equal the original service line charge.

Kareo Validation Error

This rejection indicates that the sum of the paid amount and all line adjustment amounts does not equal to the charge amount.

Claims billed with an invalid paid and adjustment amount will reject at the clearinghouse; therefore Kareo has held the claim until the error has been corrected. You must correct the error and resubmit the claims in order for them to be delivered to the payer.
 
Note: Since claims rejected within Kareo are not forwarded to the clearinghouse you will be unable to generate timely filing for that submission until validation errors have been corrected and the claim

 

Follow the steps below to correct the payment:

  1. Click Encounters > Track Claim Status.
  2. Look for and double-click on the encounter that needs correcting.
  3. Double-click on the insurance payment in the Transactions to open the Edit Payment window.
  4. Click Apply Now.
  5. Find the patient and the date of service.
  6. Once you have the date of service selected, ensure that the calculations on the Simple EOB follows these formulas:
    1. Allowed + Contractual Adjustment + Secondary Adjustment = Charge
    2. Paid + Deductible + Coinsurance + Copay = Allowed
  7. All service lines of the claim must follow the formula above.
  8. Click Save all the way out.

Then, rebill and resubmit all affected claims.

See example "Simple EOB" below with the following data entered:

  • Charge $85, Allowed $70, Contractual Adjustment $15, Paid $50, and Coinsurance $20.