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Kareo Help Center

Override Claim Settings

You can override claim settings for any insurance company or service location that has exceptions to your general claim settings. You can set overrides for a practice, paper and electronic claims and for a submitter number.

To override claim settings

  1. Open a Provider record and click the Claim Settings tab.
  2. Under the Override Claim Settings section, click Add on the right.
  3. Make your override selections. See below.
  4. When finished, click Save on each window until you are back at the Find Provider window.

Override Claim Settings.jpg

  1. Insurance Company: Click to select the insurance company for which you want to override general claim settings. To override general claim settings for a specific location and all insurance companies, leave this field blank.
  2. Location: Select the location for which you would like to override general claim settings.
  3. NPI:
  • Bill with Group and Individual NPI - Select if the provider is credentialed with this payer to send claims with both a Group and Individual NPI.
  • Bill with Individual NPI - Select if the provider is credentialed with this payer to send claims with only an Individual NPI.
  1. Override NPI?: Check this box if you need to enter a Group or Individual NPI that is different than your general claim settings. Enter the override NPI in the field provided.
  2. Tax ID:
  • Bill with EIN - Select if the provider is credentialed with this payer to send claims using an EIN. This applies to any business entity including a Corporation, LLC, LLP, Partnership, or other taxable business entity.
  • Bill with SSN: Select if the provider is credentialed with this payer to send claims using the provider's Social Security Number (SSN). This might be the case if your practice is a sole proprietorship and has not been assigned an EIN from the IRS.
  1. Override EIN or Override SSN?:
  • Override EIN - Check this box if you previously selected Bill with EIN in the Tax ID field and you need to send claims for this provider with an EIN that is different than the EIN entered under Practice Information. Enter a different EIN in the field provided.
  • Override SSN - Check this box if you previously selected Bill with SSN in the Tax ID field and you need to send claims for this provider with an SSN that is different than the SSN entered under the Provider record. Enter a different SSN in the field provided.
  1. Show advanced settings: Check this box to view additional options.
  2. Practice Settings:
  • Override practice name - Check this box if you want to send claims with a different practice name than entered under Practice Information. Enter different name in the field provided.
  • Override practice address - Check this box if you want to send claims with a different address than entered under Practice Information. Enter a different address in the field provided.
  • Pay-to-Name - This field becomes available when you enable the Pay-To Address box. See Claim Settings.
  1. If the payer requires legacy group or provider numbers, or a submitter number on their claims:
  • Advanced Paper Claim Settings - This section is used for payers that require legacy numbers on paper claims. Using the drop down menu select the type of number the payer requires, then enter the corresponding number on the right.
  • Advanced Electronic Claim Settings - This section is used for payers that require legacy numbers on electronic claims. Using the drop down menu select the type of number the payer requires, then enter the corresponding number on the right.
  • Submitter Number: This field is used for payers that require a submitter number in addition to the group and/or provider NPI number on their electronic claims. The submitter number is assigned by the payer once they receive, process, and approve your payer agreement; once your agreement is approved by the payer, an approval letter will be sent to you with the submitter number. Enter that number in this field.
  1. Advanced Eligibility Settings: This section is used for payer-specific eligibility settings. You can modify the NPI and the Tax ID options for eligibility verification if these are different from how claims are billed. For example, a payer may be billed with the NPI set to "Bill with Group and Individual NPI" but for verifying eligibility, the NPI must be set to "Bill with Individual NPI Only". If applicable, check the box and make the appropriate selections.
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