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Submitter : No agreement with entity

Rejection Message Rejection Details Resolution

Submitter : No agreement with entity

There are five possible reasons why the claim is rejecting for this reason:

Cause #1:  Claims are being sent out with the incorrect billing information (NPI/Tax ID)

Submitter Action:

  1. Verify how the provider is credentialed to bill to this payer:
    • What is the Billing NPI?
    • Are they credentialed under the practice's Tax ID or the provider's Social Security Number?
  2. Review the provider's Claim Settings to ensure claims to this payer are set up to bill as credentialed

Cause #2:  The clearinghouse is not authorized to submit claims on the provider's behalf

  • The provider needs to complete the necessary EDI claims enrollment for both the group and individual provider. 

Submitter Action:

  1. Go to Settings > Enrollments
  2. Determine if the Payer Name/Number affected claims were submitted to is listed as "Ready" for claims

Cause #3:  Claims are being submitted to the wrong payer ID

Submitter Action:

  1. 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 #4:  The provider is not credentialed with this payer

Submitter Action:

  1. Contact Provider Services for this payer to ensure the provider is set up to bill to the payer.
  2. Verify if there are any additional payer-assigned Provider IDs that also need to be submitted on the claims.

Cause #5:  The billing provider is set up in the payer's system but the rendering provider is not linked.

  • Some payers require yearly recertification.

Submitter Action:

  1. Please ensure you are checking all providers submitted on the claim match the payer's file
  2. Please have the provider contact the payer and make sure that they are set up in the payer's system.

The resolution instructions below correspond with the numbered “reasons” to the left:

Cause #1 - Resolution:  Update the provider's Claim Settings

  1. Click Settings > Providers.
  2. Look for and open the provider record.
  3. Click on the Claim Settings tab.
  4. Review the Override Claim Settings section to determine if an override exists for the affected insurance
  5. Click Add.
    • ​If an override already exists for the payer, highlight and click Edit
  6. Click Insurance Company.
  7. Look for and select the insurance company.
  8. Change the NPI dropdown to the appropriate option (depending on how you need to bill).
    • (If necessary) Check “Override NPI” if a different Group or Individual NPI needs to be entered.
  9. Change the Tax ID dropdown to the correct option (depending on how you need to bill).
    • (If necessary) Check “Override EIN” if a different tax ID needs to be entered.
  10. Click Save all the way out (multiple saves may be required).

Then, rebill and resubmit all affected claims.

Cause #2 - Resolution:  Request Claims enrollment for this payer 

  1. Go to Settings > Enrollments
  2. Click Add New Electronic Payers
  3. Follow the prompts to complete the Claims enrollment request

Once enrollment approval has been received, rebill and resubmit all affected claims.

Cause #3 - Resolution:  Update 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).

OR

  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 #4 - Resolution:  If the practice is not credentialed with the payer, please contact the payer for further assistance. No steps to correct within Kareo.
Cause #5 - Resolution:  If the provider is not set up in the payer's system, please contact the payer for further assistance. No steps to correct within Kareo.