Electronic Claim Submission Checklist
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Follow these guidelines to ensure your practice is set up and ready to send electronic claims (e-claims) successfully. Spending a little extra time verifying correct setup before submitting claims saves considerable time and effort troubleshooting, correcting and resubmitting rejected, denied, or no-response claims. It also helps ensure claims are processed and paid as quickly as possible!
Review Claim Rejections which includes a list of the top rejections received by Kareo customers, a description of possible causes, and suggestions for correcting in Kareo.
Practice Setup Checklist
Steps to take when initially setting up the practice to bill electronically through Kareo.
- Verify the following with each payer - for all payers.
- Payer ID
- Credentialing information - confirm the NPI and Tax ID/SSN that each provider bills under for each payer
- Claim submission addresses with valid 9 digit zip-code
- Complete Electronic Data Interchange (EDI) enrollment.
- Verify the Practice Information.
- Name does not exceed 35 characters, including spaces
- Group NPI and EIN
- Contact Address is a physical address with a valid 9-digit zip code
- Verify the Provider information and claim settings.
- Individual NPI
- Address is a physical address with a valid 9-digit zip code
- The default claims billing information (NPI and Tax ID) is based on how the provider is credentialed with payers
- The claim settings overrides are set up properly if billing information for the provider varies for a specific payer and/or service location
First E-Claims Submission
Steps to take prior to submitting e-claims to ensure proper set up to bill the payer for the first time through Kareo.
- Verify enrollment approval received from the payer (if applicable).
- Received approval email from Kareo Enrollments or directly from the payer
- Verify insurance setup.
- Insurance Plan
- Address with a valid 9-digit zip code
- Insurance Company
- Insurance Program (e.g., selecting CI for a Medicare payer may result in claim rejection)
- Electronic Claims Settings
- “This payer accepts electronic claims” checkbox is selected
- Payer ID
- Practice Settings
- Enrollment is approved by the payer (if applicable)
- The Enrollment Status is set to Enrolled in live mode
- The “Disable electronic claims for this payer” checkbox is not selected
- If billing to this payer as secondary, the “Use electronic billing when this payer is secondary” checkbox is selected
- To avoid multiple rejections, submit one claim first. Once successfully acknowledged, submit the rest of the claims.
E-Claims Submission Best Practices
Steps to take prior to e-claim submissions for all patients. Building a practice workflow that incorporates these steps help reduce rejections and delays in claims payment.
- Verify patient eligibility information.
- Attach a copy of the patient’s insurance card (front and back) and ID to their Patient record
- Verify the patient's name, date of birth, and address against the patient's ID
- Verify the patient's policy information against the insurance card
- Insurance Type if billing to Medicare as secondary
- Policy #
- Effective Start date is not after the date of service
- Insured information (if applicable)
- Run real-time patient eligibility check if available in Kareo or verify eligibility directly with the payer.