Claims are usually submitted electronically as to a third-party clearinghouse

Electronic claims processing helps you get paid faster by submitting your insurance claims electronically. You can send electronic claims to more than 2,500 government payers and commercial insurance companies and receive claim processing reports with status updates on your claims. By using medical billing software with a tightly integrated electronic claim submission process, you'll save time and get paid faster from insurance companies so you can avoid the costly delays and disruptions to your cash flow.

Submit Primary and Secondary Electronic Claims

After you enter charges and check your claims against payer reimbursement rules, you can immediately send primary and secondary electronic claims in the industry-standard ANSI 837P format directly from Kareo to more than 2,500 government payers and commercial insurance companies nationwide. Kareo automatically transfers the coordination of benefits (COB) information from your primary to your secondary claims. You do not need an account with a third-party medical clearinghouse. Instead, Kareo provides you with the clearinghouse services you need to submit electronic claims directly from within Kareo. We also help you set up connections to thousands of commercial insurance companies so you can begin sending electronic claims within 2 business days. Certain payers, such as Medicare, Medicaid, Blue Cross, Blue Shield, and Tricare, require you to complete an enrollment form before submitting electronic claims. For these payers, you can download the enrollment forms directly from our website, complete and send the forms directly to the payer, and receive an approval on your enrollment directly from the payer within 5 to 15 business days.

Receive Claim Processing Reports

Kareo provides multiple levels of reporting as your electronic claims make their way through the claim submission and adjudication process. Once you submit your claims, our integrated clearinghouse services automatically reviews all of your claims and return internal validation reports to highlight claims with missing information, such as missing provider or group numbers, missing patient information, or incorrect policy numbers. Once your claims pass our internal validation, we forward your claims through one of several clearinghouse partners who also review your claims and return daily reports that highlight claims that have been rejected for various payer-specific reasons. Once your claims are delivered to payers, the payer may respond with reports highlighting claims that have been rejected for various reasons prior to the adjudication process. Finally, you may receive electronic remittance advice (ERA) reports once payers process your claims and issue payment. You can use electronic remittance advice to Payment Posting automatically post payments.

Resolve Rejections and Denials

Kareo automatically posts and tracks information about rejections and denials that have been reported back to you on processing and electronic remittance advice reports from insurance companies. You can use rejection and denial management reports and our collections management tools to efficiently resolve rejections and denials by gathering missing information, correcting data entry errors, and resubmitting your claims within each payers' timely filing deadlines.

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How to Submit Claims: Claims may be electronically submitted to a Medicare Administrative Contractor (MAC) from a provider using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & certification category area of this web site and the EDI Enrollment page in this section of the web site. Providers that bill institutional claims are also permitted to submit claims electronically via direct data entry (DDE) screens.

How Electronic Claims Submission Works: The claim is electronically transmitted from the provider's computer to the MAC. The MACs initial edits are to determine if the claims meet the basic requirements of the HIPAA standard. If errors are detected at this level, the entire batch of claims would be rejected for correction and resubmission. Claims that pass these initial edits, commonly known as front-end edits, are then edited against implementation guide requirements in those HIPAA claim standards. If errors are detected at this level, only the individual claims that included those errors would be rejected for correction and resubmission. Once the first two levels of edits are passed, each claim is edited for compliance with Medicare coverage and payment policy requirements. Edits at this level could result in rejection of individual claims for correction, or denial of individual claims. In each case, the submitter is sent a response that indicates the error to be corrected or the reason for the denial. After successful transmission, an acknowledgment report is generated and is either transmitted back to the submitter of each claim or placed in an electronic mailbox for downloading by that submitter.

HIPAA TR3s can be purchased at the official Washington Publishing Company (WPC) website.

For more information please contact your local MAC or refer to the Medicare Claims Processing Manual (IOM Pub.100-04), Chapter 24.