Claim Settings Guide May 2012

Transcription

1 Claim Settings Guide May 2012 Kareo Claim Settings Guide April

2 Table of Contents 1. INTRODUCTION CONFIGURE PRACTICE SETTINGS CONFIGURE PROVIDER CLAIM SETTINGS Enter General Provider Information Configure Claim Settings Override Claim Settings...7 Kareo Claim Settings Guide May 2012 i

3 1. Introduction This guide provides instructions on how to set your practice information, provider numbers and claim settings in Kareo that are used for formatting electronic claim submissions and paper claim printing. For claim submissions, most payers only require a tax ID number (either an Employer s Identification Number or Social Security Number ) and the provider s group and individual NPI numbers. Complete and accurate information is important to avoid some of the common configuration problems that may result in claim rejections. Kareo Claim Settings Guide May

4 2. Configure Practice Settings Correct practice information is important for successful electronic claim submissions and paper claim printing. Practice information is entered during the New Practice setup wizard. However, you can review and edit the information at any time. To edit practice information 1. Click Settings > Find Practice. 2. Once you find the practice record, double-click to open it. 3. On the Edit Practice window, enter the practice details. See below. Note: If any of field is disabled (grayed out), you will need to contact your Kareo company administrator. 4. When finished, click Save. a. Name: The practice name cannot exceed 35 characters and will populate Box 33 of the claim form. b. Group NPI: The Group NPI will populate Box 33a of the claim form. c. EIN: The EIN will populate Box 25 of the claim form. Kareo Claim Settings Guide May

5 Configure Practice Settings d. Subscription Edition: Upgrade or downgrade your subscription plan. e. Contact Information: The address and phone number will populate Box 33 of the claim form. The address entered must be a physical location (not a PO Box) and must include a 9 digit zip code. Click Address and enter the information in the pop-up window; this will ensure that the practice address is formatted correctly within the Kareo. Other fields in this section are optional and are for internal use. f. Administrator: Optional. Can be used for the Return Address or Remit Address for patient statements - for example, if you prefer your patient statement remittances to go to a PO Box or to an address other than the one entered under Contact Information. g. Billing Contact: Contact information applies to all electronic claim submissions to ensure your payers have the correct point-of-contact, including phone number. Can be used for the Return Address or Remit Address for patient statements - for example, if you prefer your patient statement remittances to go to a PO Box or to an address other than the one entered under Contact Information. h. Notes: Optional. i. kfax #: Get or release a kfax number. See section kfax Number in the Help Center. Kareo Claim Settings Guide May

6 3. Configure Provider Claim Settings This section covers how to configure the provider settings that are required for proper formatting of electronic claim submissions and paper claim printing. Repeat the steps for each provider. 3.1 Enter General Provider Information The fields highlighted below on the General tab must be completed accurately in order to process paper and electronic claims. For detailed information on completing all fields on the General tab, refer to the Help Center article, New Provider. NPI: Enter the provider's individual National Provider Identifier (NPI) number (not the group National Provider Identifier (NPI) number). SSN: Enter the provider's 9-digit Social Security number ( not the Employer's Identification Number (EIN)). Specialty: Click the Specialty button and select the provider's main specialty from the list of Provider Taxonomy Codes. Note: The Taxonomy Codes are defined by the American Medical Association and the Department of Health and Human Services, Centers for Medicare and Medicaid Services. The list of Taxonomy Codes are updated and maintained by Kareo. Degree: Enter the provider's degree (e.g., MD, DO, PhD, MET). Kareo Claim Settings Guide May

7 Configure Provider Claim Settings 3.2 Configure Claim Settings To set up claim settings 1. On the provider record window, click the Claim Settings tab. Select your settings. See below. 2. When finished, click Save. a. NPI: Select one of the following in the drop-down menu: Bill with Group and Individual NPI: Select if the provider is credentialed with payers to send claims with both a Group and Individual National Provider Identifier (NPI). Enter the Individual NPI and the Group NPI in the fields provided. Bill with Individual NPI Only: Select if the provider is credentialed with payers to send claims with only an Individual NPI. Enter the Individual NPI in the field provided. b. Override Group NPI?: If "Bill with Group and Individual NPI" was selected for the NPI field, check this box if you need to send claims for this provider with a different Group NPI than was entered for the practice. Enter the alternate Group NPI in the Override Group NPI field. c. Tax ID: Select one of the following in the drop-down menu: Bill with EIN: Select if the provider is credentialed with payers to send claims using an Employer Identification Number (EIN) assigned by the IRS to the practice. This applies to any business entity including a Corporation, LLC, LLP, Partnership, or other taxable business entity. Enter the EIN in the field provided. Kareo Claim Settings Guide May

8 Configure Provider Claim Settings Bill with SSN: Select if the provider is credentialed with payers 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. Enter the SSN in the field provided. d. Override EIN?: If "Bill with EIN" was selected in the Tax ID field, check this box if you need to send claims for this provider with a different EIN than what was entered for the practice. Enter the alternate EIN in the Override EIN field. e. Enable Pay-To Address: If the pay-to address is a PO Box or Lockbox, check this box and enter the name and address in the fields provided. Checking this box enables the pay-to address you enter for all payers. To add a pay-to address for specific payers only, see next section. f. Override Claim Settings: Add, edit or remove any insurance companies or service locations that have exceptions to your general claim settings. See next section. To add a pay-to address for a specific payer 1. On the Claims Settings tab, click Add on the right. The Override Claim Settings window opens. 2. Click the Insurance Company button. The list of insurance companies opens. 3. Double-click on a payer to which you want to apply the pay-to address override. 4. To ensure that your NPI is submitted correctly to your specific payer, confirm that the NPI scenario selected matches your scenario for the payer. 5. Check the Show advanced settings box. 6. Check the Override pay-to address box. 7. Enter the address to where payments are to be sent. 8. In the Pay-to Name field, enter the name for the pay-to address if desired. 9. Click Save in the Override Claims Settings window. 10. Click Save in the Edit Provider window. Kareo Claim Settings Guide May

9 Configure Provider Claim Settings 3.3 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. a. 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. b. Location: Select the location for which you would like to override general claim settings. c. 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. d. 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. e. 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. f. 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. g. Show advanced settings: Check this box to view additional options. h. Practice Settings: Kareo Claim Settings Guide May

10 Configure Provider Claim 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. S e e C l a i m S e t t i n g s. Kareo Claim Settings Guide May

11 Configure Provider Claim Settings i. 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. j. Advanced Eligibility Settings: This section is used for payer-specific eligibility settings. Please refer to the Real-Time Patient Eligibility ( guide. Kareo Claim Settings Guide May