Skip to main content

 

Kareo Help Center

Electronic Claim Submission Checklist

Follow these guidelines to ensure your practice is set up and ready to send electronic claims successfully. Spending a little extra time ensuring correct setup before submitting claims will save considerable time and effort troubleshooting, correcting and resubmitting rejected, denied, or no-response claims. It will also help ensure your claims get processed and paid as quickly as possible!

Contents

 

Practice Setup Checklist

Steps to take both in and out of the Kareo software when initially setting up your practice to bill electronically via Kareo Practice Management (PM).
Submitting to a Payer for the First Time Steps to take prior to claim submission to ensure you are setup and fully prepared to bill to a payer for the first time through Kareo PM.
Claim Submission Best Practices Steps to take prior to claim submissions for all patients. Building a workflow in your practice that incorporates these steps will help reduce rejections and get you paid more quickly.

 

Helpful Resources

  • Kareo Payer Search Tool: Search a list of all payers Kareo supports to identify their Payer ID, determine if the payer requires EDI Enrollment, and download any necessary Payer Agreements
  • Kareo Common Claim Rejections Guide: A guide to troubleshooting claim rejections, including a list of the top rejections received by Kareo customers, a description of possible causes, and suggestions for correcting in Kareo. 

 

Practice Setup Checklist

Outside Kareo PM

  • Verify Payer Information (all payers)

checkmark icon plain tiny.png Payer address (with 9-digit zip)
checkmark icon plain tiny.pngPayer ID (Use the Kareo Payer Search Tool)
checkmark icon plain tiny.pngCredentialing Information – Determine NPI and Tax ID/SSN that each provider bills under for each payer

  • Complete Enrollments

checkmark icon plain tiny.pngComplete and return Payer EDI Enrollment Echosign Form
checkmark icon plain tiny.pngSign and return any required Payer Agreements
checkmark icon plain tiny.pngTrack payer approvals as you receive them 

 

In Kareo PM

  • Verify Correct Practice Information (Settings> Practice Information)

checkmark icon plain tiny.pngName (Cannot be more than 35 characters)
checkmark icon plain tiny.pngGroup NPI and EIN
checkmark icon plain tiny.pngAddress (with 9-digit zip)

  • Verify Provider Setup (Settings> Providers> Double-click on provider)
    • General tab

      checkmark icon plain tiny.pngIndividual NPI (Rendering)
      checkmark icon plain tiny.pngAddress (with 9-digit zip)

    • Claim Settings tab

checkmark icon plain tiny.pngVerify default billing information (NPI and Tax ID/SSN) based on how the provider is credentialed with most payers
checkmark icon plain tiny.pngVerify Claim Settings Overrides are set up properly if billing information for the provider varies for a specific payer or service location

 

Submitting to a Payer for the First Time


Outside Kareo PM

  • Verify Enrollment Approval Received from the Payer (If applicable)

checkmark icon plain tiny.pngReceived approval email from Kareo Enrollments or directly from the payer

 

In Kareo PM

  • Verify Insurance Setup in Kareo (Settings> Insurance> Find Insurance Plan)

checkmark icon plain tiny.pngInsurance Plan Information
checkmark icon plain tiny.pngAddress (with 9-digit zip)

  • Insurance Company Information (Double-click on the Insurance Company name to open the Edit Insurance Company window)

checkmark icon plain tiny.pngVerify correct Insurance Program is selected (e.g. selecting “CI” for a Medicare payer will result in a rejection)

  • Insurance Company EDI Information (Edit Insurance Company> Electronic Claims tab)

checkmark icon plain tiny.pngEnsure “This payer accepts electronic claims” box is checked
checkmark icon plain tiny.pngEnsure the correct Clearinghouse is selected
checkmark icon plain tiny.pngEnsure the correct Payer ID is selected (Use the Kareo Payer Search Tool)

  • Insurance Company Enrollment/Settings Information (Edit Insurance Company> Practice Settings tab)

checkmark icon plain tiny.pngEnsure Enrollment Status is set to “Enrolled in live mode
checkmark icon plain tiny.pngVerify enrollment has been approved by the payer first (if applicable)
checkmark icon plain tiny.pngEnsure the “Disable electronic claims for this payer” box is unchecked
checkmark icon plain tiny.png(If billing to this payer as secondary) Ensure the “Use electronic billing when this payer is secondary” box is checked

  • Submit One Claim as a Test (to avoid multiple rejections)

 

Claim Submission Best Practices

Outside Kareo PM

  • Verify Patient Information

checkmark icon plain tiny.pngCopy or scan patient insurance card (front and back) and ID

 

In Kareo PM

  • Verify Patient Information (Patient> Find Patient> Double-click on patient)

checkmark icon plain tiny.pngAttach copy of patient’s insurance card and ID to patient record (Documents tab)

  • Demographic Information (General tab)

* Verify against patient ID *
checkmark icon plain tiny.pngName
checkmark icon plain tiny.pngDate of Birth
checkmark icon plain tiny.pngAddress (with 9-digit zip)

  • Policy Information (Cases tab> Double-click on appropriate Case> Double-click Insurance being billed)

* Verify against patient insurance card *
checkmark icon plain tiny.png(If billing to Medicare as secondary) Insurance Type
checkmark icon plain tiny.pngPolicy #
checkmark icon plain tiny.pngEffective Start date (Cannot be a date prior to Date of Service)
checkmark icon plain tiny.png(If applicable) Insured

  • Run Eligibility Check (If available)
  • Was this article helpful?