Claims FAQs
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Answers to the most common questions about billing and submitting claims through Kareo.
Claims FAQs |
| Question | Answer |
| How soon can I start submitting claims? | Once a payer enrollment status shows "Approved" on the Enrollments Dashboard, you can begin submitting claims. Note: Prior to submitting claims, ensure Insurance Company Electronic Claims and Practice Settings are properly configured to avoid claim rejections and delays in claim processing and payment. |
| How do I add a message on secondary CMS-1500 paper claim forms? | You can enter up to 71 characters to identify additional information about the patient’s condition or claim in the Add'l Claim Info (Box 19) field under the Miscellaneous (CMS-1500) section of the Encounter record. |
| How do I bill claims to the tertiary insurance? | The Kareo Desktop Application (PM) and partner clearinghouses (e.g., Trizetto Provider Solutions) do not support electronic claims submission for tertiary insurances. If you need to send claims to a tertiary payer, they need to be sent as paper claims. |
| How do I add an additional provider number required by the payer for electronic claims submission? | You can enter additional provider or group numbers for a specific payer under the Advanced E-Claim Settings section of the Advanced Provider Override Settings. |
| How do I set up an override to populate box 33b (group provider number) on paper claims? | You can enter additional provider or group numbers for a specific payer under the Advanced Paper Claim Settings section of the Advanced Provider Override Settings. |
| How do I set up Medicare claims to bill with the provider's SSN? | You can override the provider's general claim settings for any insurance company. Add an override for Medicare and select to Bill with SSN in the Tax ID drop-down menu. |
| How do I add the Mammography Certification Number on electronic claims (Loop 2300 REF02)? | In the Service Location record associated with the encounter/claim, select EW Mammography Certification Number in the Legacy Number Type drop-down menu, then enter the number in the Legacy Number field. Note: Each service location can only have one Legacy Number Type. |
| How do I add the referring provider and the last date they saw the patient on claims? | First, enter the appropriate provider as the Referring Provider under the Provider section of the Encounter record. Then, enter the Date Last Seen under the Dates section on the Condition tab of the patient's case (associated with the encounter). Note: The referring provider populates box 17 and the date last seen populates box 14 of the claim form. |
| The Nurse Practitioner rendering services is not credentialed with payers, but the physician supervising them is credentialed. How can I associate the Nurse Practitioner to claims for reporting purposes and avoid them from being rejected by the payers? | You can enter the Nurse Practitioner as the Scheduling Provider and the physician supervising the practitioner as the Rendering Provider under the Provider section of the Encounter record. The Scheduling Provider is not submitted on claims to the payer, however, you can run Kareo reports (e.g., Encounters Summary, Encounters Detail, Charges Summary) customized by the Scheduling Provider to generate what encounters or services they are associated with. |
| Why can't I bill 12 diagnosis codes for one service line/procedure? | Version 5010 (of the X12 standards for HIPAA transactions) implements support of up to 12 diagnosis codes per claim (while maintaining the limit to four diagnosis pointers) as a means to reduce paper and electronic claims from splitting. This change was not intended to increase the number of diagnosis codes per service line/procedure. |
| Why does the claim allow 12 diagnosis codes if the service line/procedure only supports up to four diagnosis codes? | There are times when having more than four diagnosis codes on a claim is vital to documenting the full extent of a patient’s illnesses or injuries. While there are 12 slots for diagnosis codes, only a maximum of four is allowed for a single service line/procedure. The additional diagnosis code slots are intended for multiple service lines/procedures to capture up to four unique diagnosis codes each. |
| Will Kareo be updated to allow more than four diagnosis codes for one service line/procedure? | Kareo will continue to follow the official 837 specification published by CMS that supports four diagnosis codes per service line/procedure. |
| How do I report more than four diagnosis codes for one service line/procedure? | Some payers recognize the need to include more than four diagnosis codes for a service line/procedure and provide alternate reporting methods. If you need to include more than four diagnosis codes for a service line/procedure, review this commonly used alternative method for submitting the claim. Note: This method does not apply to all payers. To avoid claim rejections and delays in claim processing and payment, verify with the payer directly if they accept this method. |