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Rejection Message Rejection Details Resolution

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This rejection has three potential causes:

Cause #1 - The patient’s insurance policy included on the claim was not eligible for the date of service billed. 

Submitter Action:

  1. (If available) run an eligibility check for the patient within Kareo to check for active coverage for the claim's DOS.
  2. Then verify all of the following (against the patient's insurance card):
    • Patient Name, Gender, and Date of Birth
    • Patient Insurance Policy #
  3. Verify the patient's eligibility with the payer for the date of service being billed. 
    • If by phone, note the case number of the inquiry and phone number called.
    • If by payer portal, print the patient eligibility.

If all patient demographics and eligibility are confirmed by the payer, please contact Kareo Support 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 this has been uploaded to the patient record in Kareo.

Cause #2: The claim was submitted to the wrong payer ID

Note: This is the most likely cause if this rejection was received on claims for multiple patients

Submitter Action:

  • Verify that the claim was submitted to the correct payer ID.
    • Cross reference the insurance/plan name listed on the patient’s insurance card against Kareo’s Electronic Payer search (Settings > Enrollments) 
    • Verify the appropriate Payer ID based on your clearinghouse

Cause #3:  The patient is a newborn or recently added to the guarantor’s insurance policy.

Submitter Action:

Contact the payer to verify the patient is active under the insured’s policy.

 

Tip: Most Kareo Billing subscription levels include access to a free eligibility check feature which can be used with many payers to verify a patient has active coverage. Utilizing this feature prior to submitting claims for a patient can help prevent this type of rejection.

Resolution Steps will vary depending on the cause:

Cause #1 - Resolution:  Follow the instructions below to edit the patient’s demographics (if needed)
  1. Click Patient > Find Patient.
  2. Look for and open the patient record that needs correcting. 
  3. Update the patient Full Name, Date of Birth, and/or Gender as needed.
  4. Click Save.

Then, rebill and resubmit all affected claims. 

OR

Follow the instructions below to edit the patient’s policy number (if needed)

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

Then, rebill and resubmit all affected claims. 

Cause #2 - Resolution: Follow the instructions below to verify (or edit) the payer ID associated with the claim

  1. Click Encounters > Track Claim Status.
  2. Look for and double-click on the encounter that needs correcting.
  3. Double-click on the Case.
  4. Double-click on the appropriate Insurance Policy.
  5. Double-click on the Insurance name to open the Edit Insurance Plan page.
  6. Double-click on the Insurance Company name to open the Edit Insurance Company page.
  7. Click the Electronic Claims tab.

The current payer ID is listed in the Clearinghouse Payer ID field. If the payer ID the claim is being billed to is incorrect it can be updated in two ways

  1. By changing the payer ID associated with this insurance company: 

Note: Changes made within the Edit Insurance Plan or Edit Insurance Company pages will apply to ALL insurance policies and claims tied to that Insurance Plan or Company within the practice.

  1. Click the Electronic Payer Connection button.
  2. Search for and select the correct payer ID for the claim.
  3. Click Save all the way out (multiple saves may be required).
  1. By associating the insurance policy with another insurance company (with the correct payer ID):
  1. Exit back to the Insurance Policy page. 
  2. Click the Insurance button.
  3. Look for an Insurance Plan with the correct payer ID (listed under the “EDI Payer Number” column).
  • If there are no insurance plans associated with the correct payer ID a new insurance plan and insurance company will need to be created. 
  1. ​​Double-click on the appropriate insurance plan to associate it with the patient’s insurance policy.
  2. Verify all other information listed on the policy is correct.
  3. Click Save all the way out (multiple saves may be required).

Then, rebill and resubmit all affected claims. 

Note: Please verify enrollment is completed (or not needed) before submitting e-claims to a new Payer ID.

Cause #3 - Resolution: No corrective actions within Kareo. Please contact the payer to verify the patient is active under the insured’s policy.

 

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