Troubleshoot Not Ready Claims

Claims that have been created but have missing information are put in the Not Ready category on the Claims Tab. The table below lists messages for issues that can cause a claim to be not ready.

Message What You Need to Do
Primary payer for subscriber ID is blank.

Insurance subscriber information is missing from the Case Information tab in the Client Editor.

Where to go and what to do

Edit menu→Clients→Select client→Case Information tab→select the specific case if the patient has more than one case.

Enter the missing information in the Relationship and/or Subscriber fields in the Primary Payer, Secondary Payer, or Tertiary Payer tab (depending on the message). If there is a payer mix you will be prompted to apply the changes to the existing payer mix or a new payer mix.

Primary payer physician ID for Block 17 is blank.

The Referring Provider ID field is missing from the CMS-1500 tab in the Edit Payers window.

Where to go and what to do

1. Edit menu→Payers→CMS-1500 tab and check the Referring Provider ID (Doctor) field to see what the payer requires (NPI or Legacy ID column).

2. Edit menu→ Contact→select contact name (doctor) and enter the missing information in the appropriate field based on what the payer required.

Primary payer federal tax ID for Block 25 is blank.

The Tax ID field is missing from the CMS-1500 tab in the Edit Payers window.

Where to go and what to do

1. Edit menu→Payers→CMS-1500 tab and check the Tax ID field to see what the payer requires.

2. Enter the missing information in the appropriate field below based on what the payer required.

Option Selected Where to Go to Set the Option
Caregiver SSN Edit menu→Staff→ SSN field
Company Tax ID Settings menu→ Company & Clinic Info→ Federal Tax ID field, ID Information section)
Referring MD Federal Employer ID # Edit menu→Contacts→ Fed. Employer ID # field
Caregiver - Payer Provider # Edit menu→Staff→ Provider # field
Clinic Tax ID Settings menu→ Company & Clinic Info→ Tax ID field, Clinic Billing Info section
  Other Edit menu→Payers→ Other→ Enter text into the Other Label field, this cannot be left blank.
Region Tax ID

Settings menu→ Company & Clinic Info→ Region →... button →, Federal Tax ID

Note: Region must be turned on for your clinic to use this. Clinics that do not use region information will not see the Region field.

Blank Leaves block 25 blank and overrides anything that is entered.
Other Billing Provider Tax ID Edit menu→Payers→ General Billing Data→ Group Provider ID field.
Primary payer signature for Block 31 is blank

The Signature field is missing from the CMS-1500 tab in the Edit Payers window.

Where to go and what to do

1. Edit menu→Payers→CMS-1500 tab and check the Signature field to see what the payer requires.

2. Enter the missing information in the appropriate field below based on what the payer required.

Option Selected Where to Go to Set the Option
Caregiver Name Edit menu→Staff→ Signature → Enter the caregiver's full name, including credentials.
Other Edit menu →Payers→ Other→ Enter text into the Other Label field, this cannot be left blank.
Clinic Name Settings menu → Company & Clinic Info→ Name field
Region Name Settings menu → Company & Clinic Info→ Region →... button → Region Name field Note: Region must be turned on for your clinic to use this. Clinics that do not use region information will not see the Region field.
Leave Blank Leaves block 31 blank and overrides anything that is entered.
Primary payer PIN # for Block 33 is blank

The Billing Provider ID field is missing from the CMS-1500 tab in the Edit Payers window.

Where to go and what to do

1. Edit menu→Payers→CMS-1500 tab and check the Billing Provider ID field to see what the payer requires.

2. Enter the missing information in the appropriate field below based on what the payer required.

Option Selected Where to Go to Set the Option
Company NPI Settings menu → Company & Clinic Info→ ID Information section → National Prov ID # field ID
  Clinic NPI Settings menu → Company & Clinic Info→ Clinic Billing Info section → National Prov ID # field ID
Leave Blank Leaves block 33 blank and overrides anything that is entered.
Region NPI

Settings menu → Company & Clinic Info→ Region →... button → National Provider ID # field

Note: Region must be turned on for your clinic to use this. Clinics that do not use region information will not see the Region field.

Caregiver NPI Edit menu→Staff→ NPI# field.
Other Billing Provider NPI Edit menu→Payers→ General Billing Data→ Group Provider ID field.
Primary payer billing address info for Block 33 is blank

The Name / Address [Paper] field is missing from the CMS-1500 tab in the Edit Payers window.

Where to go and what to do

1. Edit menu→Payers→CMS-1500 tab then check the Name / Address [Paper] field to see what the payer requires.

2. Enter the missing information in the appropriate field below based on what the payer required.

Company Settings menu → Company & Clinic Info→ Billing Name field
Clinic Billing Address Settings menu → Company & Clinic Info→Clinic Billing Info section→ Billing Address fields
Region

Settings menu → Company & Clinic Info→ Region

Note: Region must be turned on for your clinic to use this. Clinics that do not use region information will not see the Region field. Use the ... button to add a new region if you do not see the region you are looking for.

Caregiver Name + Company Address

Caregiver Name - Edit menu→ Staff →Select the caregiver listed on the claim.

Company Address - Settings menu → Company & Clinic Info→ address fields from the Company Info section.

Other Billing Provider I couldn't find what field sets this. Each time I updated a payers setting or the clinic setting when using this option, it always remained blank.
Incident to Physician Edit menu→Staff→ Incident to Physician check box must be selected and the staff member needs to be also listed in as a contact.
Pay to Address Settings menu → Company & Clinic Info→Clinic Info section→ Pay to Address Info fields
Clinic Physical Address Settings menu → Company & Clinic Info→Clinic Info section→ Physical Address fields

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