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Kareo Help Center

Enrollments FAQs

Below are some frequently asked questions regarding enrollments. If your question is not shown or if you require further assistance, please email enrollments@kareo.com.

Question Answer

Does a new provider in the practice need to be enrolled with our established insurance companies?

If your practice claims are billed with the Group NPI, new providers do not need to be enrolled. However, the new provider's Individual NPI must be credentialed with the insurance companies and linked to the group.

If your practice bills claims with an Individual NPI only, the provider does need to be enrolled with each insurance company.

How do I enroll a new provider in our practice with electronic services?

If claims are billed with the Group NPI, new providers do not need to be enrolled. They only need to make sure that the provider's Individual NPI is credentialed and linked to the group.

If claims are billed with the Individual NPI only, the provider does need to be enrolled.

How do I enroll for an electronic service with an existing insurance company?

Use the Enrollment Wizard to submit an enrollment request for the electronic services. Learn more here.

How do I enroll for electronic funds transfer (EFT)?

Enrolling to receive EFTs as payment is an arrangement made between the provider and the insurance company. Contact the insurance company directly for EFT enrollment instructions.

How do I find out what is needed from me if the status says "Pending Practice"?

Please check your email for additional information from Kareo. Reasons for a Pending Practice enrollment status include missing information, instructions for you to complete, or agreements for you to sign and return.

How do I know which company to choose when there are multiple results for a insurance company?

Review the results and choose the company that most closely matches the insurance company you need. If available, check the patient's insurance card for a specific insurance company name or ID number.

How do I request that Kareo offer a new insurance company or electronic service type?

To request a new insurance company or electronic service type with an existing insurance, submit the following information to enrollments@kareo.com for processing:

  • Insurance company name
  • Insurance company address
  • Insurance company ID number
  • Transaction type(s)
  • Number of claims and remit files you send/receive each month

Please note that new insurance company and service connections are not guaranteed and may take several months to establish.

How long does it take to receive insurance company approval?

Each insurance company has their own processing time that typically ranges between one and eight weeks. Some insurance companies, such as Medicare and Medicaid, may take longer than average to complete the enrollment process.

If the provider is migrating from one Kareo account to another, does the provider have to re-enroll for electronic services?

Enrollment for electronic services is based on the povider’s Tax ID, Billing NPI, and clearinghouse. If any of the three have changed, enrollment paperwork may be needed to update the information on the insurance company's system.

Is it okay to enroll using a different clearinghouse if mine doesn't support a payer?

Yes, you have the option to register with another clearinghouse if the insurance company is not available with your primary clearinghouse choice.

Should I contact my clearinghouse for assistance with enrollments?

All enrollment inquiries should be directed to Kareo and not the clearinghouse. Please contact the Kareo Enrollment Team for assistance at enrollments@kareo.com or by calling 888-775-2736, option 2.

The enrollment status is "Ready," so why am I not able to submit claims?

Once a payer enrollment status shows as Ready on the Enrollment Dashboard, it's important to configure the insurance company's settings in Kareo. Insurance company settings that are not properly configured may prevent claim submission or result in claim rejection or delayed payment. Read our Configure Insurance Company/Payer Settings help article to learn more.

What happens if I answer that I am not credentialed with a insurance company?

Enrollment is submitted to insurance companies with the information you enter in the Kareo Enrollment Wizard. The insurance company then matches the request to a record in their system. If a matching record is not found, the enrollment request for electronic services may be denied.

To ensure that your enrollment request is processed correctly, we recommend contacting the insurance company in advance to confirm that your Tax ID and NPI are on file.

What is a group/individual provider number and where can I find it?

Group or individual provider numbers are assigned by the payer when you are credentialed. This number can be found on your credential paperwork or by contacting the insurance company directly. Insurance companies will not release group or individual provider numbers to Kareo.

What is EDI enrollment and why is it required?

EDI enrollment is the process through which a provider/practice completes the setup to submit electronic (EDI) services to a specific payer via a clearinghouse. EDI enrollment may be required for the following EDI services: Electronic Claim submission, Electronic Remittance Advice (ERA)/Electronic Funds Transfer (EFT) reports, Real-Time Eligibility (RTE) checks.

What is the difference between Clearinghouses?

Kareo partners with two fully integrated medical clearinghouse services: Trizetto Provider Solutions (formerly Gateway EDI) and Change Healthcare (formerly Capario). Although the clearinghouses essentially provide equivalent electronic services, there are two main differences to note.

  • Each clearinghouse has a different set of payer IDs. A payer ID used by Change Healthcare may not be the same number used by Trizetto.
  • Each clearinghouse maintains their own network of payer connections and transaction types.

Contact the Kareo Enrollments Team for additional clearinghouse information at enrollments@kareo.com or by calling 888-775-2736, option 2.

Where is the clearinghouse submitter number located?

The clearinghouse submitter numbers are located on the payer agreements. These numbers are pre-filled by the clearinghouse. The payers assign this number to each clearinghouse and it differs for each payer and clearinghouse. The submitter number identifies the clearinghouse with the payer.

Why can't I find a specific insurance company?

There are several reasons why an insurance company may not be found in Kareo. Below are some common causes:

  • An insurance plan name is searched instead of an insurance company name. Be sure to search by company name only.
  • The insurance company does not accept electronic claims.
  • The insurance company does not have a connection with Kareo's clearinghouses. Some insurance companies have exclusive vendor relationships and are not able to work with other clearinghouses.

Why is the transaction status "Available" when it was approved a long time ago?

Due to a change in Kareo's enrollment processes, active insurance companies that were enrolled prior to late 2013 may show an Available status on the Enrollments Dashboard.

Why was my electronic service enrollment denied?

Enrollment denials can result for many reasons. Below are some common causes:

  • Invalid provider: Tax ID and NPI does not match any records in the payer system
  • Address submitted on request does not match what is on file
  • Agreements signed by an unauthorized contact who is not on file
  • Missing information on the forms, such as a notary stamp or business titles

Check your email for enrollment denial details from Kareo.

Do I need to re-enroll if I have a new Tax ID or Group NPI?

Yes, all affected providers need to re-enroll for electronic services with insurance companies. Please update your Practice/Provider Settings and complete the Enrollment Wizard. If duplicate insurance company entries appear on the Enrollment Dashboard, review our help article to merge the insurance companies.

Do I need to re-enroll if my previous practice management software used Change Healthcare or Trizetto as a clearinghouse?

Yes, each payer must be added into Kareo through the Enrollment Wizard. When enrolling payers, it's important to enter the clearinghouse you used (Change Healthcare or Trizetto) with your previous practice management software. Kareo will complete a change of vendor request with the clearinghouse and transfer any existing payers and transactions into Kareo that are requested through the Enrollment Wizard. No additional payer agreements are required for pre-existing insurance companies that are moved over to Kareo.