Page Comparison

Adding Funders into Kareo

Navigate to Settings → Insurance → Insurance Companies.

Select + Add Insurance.

The Most Commonly Requested tab will generate a list of common funders based on your geographical area. Once you find the applicable funder select + to add the funder. Once finished adding all applicable funders, select Save.

The Search Other tab is used when the funder is not listed in the commonly requested tab. This area allows searching based on funder name or payer ID. Once the appropriate funder is found, select Add then Save.

• If having difficulty finding the desired funder through the name or payer ID, try utilizing the Trizetto Payer Listas a resource.

• To add a secondary funder to your Kareo account and patient profiles refer to https://helpme.kareo.com/01_Kareo_PM/06_Patients/02_Patient_Cases/Insurance_Policies

Completing EDI enrollment for Funders

Based on funder requirements and/or practice’s needs, you may need to enroll in electronic services using the EDI enrollment wizard.

To determine if you need to enroll, refer to your insurance dashboard under Settings → Insurance → Insurance Companies.

Anything listed as “Enrollment Required” means the funder must approve you in order to receive electronic services in those areas.

Refer to the EDI Enrollment resource on the Kareo Help Center for a instructional guide on completing this enrollment: https://helpme.kareo.com/01_Kareo_PM/04_Settings/EDI_Enrollment/Enroll_for_Electronic_Insurance_Services

• Enrollment Status Indicators

  • Approved - indicates that the funder will allow electronic submission of claims, ERAs, and/or Eligibility.

  • Enrollment Required- Indicates that the funder requires completion of the EDI Enrollment process before approval will be given.

  • Denied - Indicates the enrollment request has been denied by the funder.

• For a comprehensive list of enrollment status indicators, please refer to this resource: https://helpme.kareo.com/01_Kareo_PM/04_Settings/EDI_Enrollment/Enrollment_Status_Indicators

Mapping Funders to Rethink

Mapping funders to your Rethink platform is a critical component of the setup process.

After funders have been inputted into the Kareo insurance dashboard, navigate to Settings → Insurance → New Insurance Plan.

Select Insurance Company to select the appropriate funder you wish to map from your insurance dashboard.

Next, navigate to your Rethink platform to find that associated funder in your company account.

The funder name listed in Rethink (photo above) will be seen as the Plan Name in Kareo (photo below). Recommendation is to copy and paste this name into the appropriate field in Kareo.

Next, navigate back to Rethink and copy the funder claims address to paste into the address field of that funder in Kareo and select save.

Navigate back to Rethink and select View and Edit to open up the funder details.

The funder Name and Insurance Plan in Rethink (red in photo above) should match the Plan Name in Kareo (red in photo below). If information is missing, update appropriate fields to match.

The Kareo Payer listed in the Rethink drop-down menu (yellow in photo above) should match the Insurance Company name in Kareo (yellow in photo below).

If there is not a matching funder name available in the Kareo Payer drop-down in Rethink, navigate to the Kareo Payer tab on the left and select Add to manually enter in the funder name needed.

Once inputted, navigate back to the funder details to select the new Kareo Payer in the drop-down menu and select save.

• Failure to complete mapping will result in inaccurate syncing of claims or inability to sync claims altogether.

• Recommendation is to copy and paste information from Rethink to Kareo as capitalization and punctuation matter with the mapping process.

Setting Up Claim Override Settings

Claim Override Settings can be utilized when funders require billing that differs from default processes (Group NPI, Group Tax ID, and Individual Rendering Provider NPI)

To set up Claim Override Settings, navigate to Settings → Providers → Select Provider needed for Override Settings.

Once in provider profile, select Claim Settings. From here, you can override any defaulted fields such as group NPI, Group Tax ID, and Provider NPI.

Please Note: Overriding sections in this area will apply for all funders this provider bills for.

If Claim Override Settings are only needed for certain funders, from the Claim Settings screen select Add → Insurance Company to select the appropriate funder to make the updates for. If additional settings are needed, select Show Advanced Settings.

For more information on Claim Override Settings refer to the Kareo Help Center resource here: https://helpme.kareo.com/01_Kareo_PM/04_Settings/Providers/Override_Claim_Settings

• Override settings must be set up for each applicable rendering provider that bills for the funder(s) that have unique billing requirements.