ERROR- Wrong Tax ID Used | ERROR- Dr Not On File/ Not in System

Rejection Details:

The payer rejected the claim for provider not being found in their system.

This could be due to five reasons:
1. Provider’s NPI is not part of Group NPI
2. Billing Group is not created
3. Tax ID is incorrect
4. Enrollment is not completed
5. Provider is not credentialed

Resolution:

Cause #1 Provider’s NPI is not part of Group NPI:

• Contact the insurance and have them link the doctor’s NPI to the group NPI so it is recognized as such when billing under the group NPI.

Cause #2 Billing Group is not setup

• Go to Settings > Practice > Provider Groups > Billing Provider.
• Select the insurance for which the billing group is required and see if one exists.
• If a billing group exists then check if the provider is attached.
• If the billing group does not exist for the insurance, then click on “Add” to enter a new billing group for an insurance.
• Save the billing group and resubmit

Cause #3 Tax ID entered is incorrect

Group Billing

• Go to Settings>Practice>Provider Groups>Billing Provider.
• Select the insurance for which the billing group is required and check if the tax ID is entered correctly.

Individual Billing

• Go to Settings>Practice>Provider>Practice Provider.
• Check if the tax ID is entered correctly for the concerned provider.

Cause #4 Enrollment is not complete

• Contact CureMD and we will verify the enrollment records to confirm if it was completed or not for whichever insurance the rejection occurred.

Cause #5 Provider is not credentialed:

• Verify when the credentialing will begin or when will it complete if it is on progress.