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Scrub errors when trying to file insurance claims

Scrub errors when trying to file insurance claims

When a claim is submitted, it gets scrubbed for any common errors that could cause it to be automatically rejected prior to being sent to the payer. If any errors are detected, the claim will be scrubbed and won’t be submitted to the payer. Scrubbed claims won’t result in a $0.25 fee.

In this guide, we’ll cover some common scrub errors and how to resolve them: 


NPI not yet enrolled

Certain insurance payers require that you have an accepted claim filing enrollment before being able to file claims electronically. See How do I submit an enrollment to file claims or receive payment reports? for more information on submitting a claim filing enrollment. 

If you attempt to submit a claim to a payer that requires a claim filing enrollment and your claim is scrubbed with an NPI must be enrolled error, this means that your enrollment hasn’t been accepted. 

Navigate to Settings > Insurance > Enrollments to check the status of your enrollment. If the status says Submitted, the enrollment is still being processed.

enrollmentsubmitted.simplepractice.enrollment.png

We'll email you when your enrollment has been completed or if there are any other steps needed from you in order to complete this process. 

If your enrollment is accepted and you’re still receiving this scrub error, it’s because the claim is being submitted with a different billing provider NPI (Box 33) than the NPI the enrollment is accepted under. To check the enrollment’s details: 

  • Navigate to Settings > Insurance > Enrollments
  • Click the Accepted status

acceptedenrollment.simplepractice.insurance.png

  • Click Review Enrollment Details to see the billing information the enrollment is accepted under

reviewenrollmentdetails.simplepractice.enrollments.png

If the NPI listed on the enrollment is different from the one needed to submit claims:

  • Delete the scrubbed claim
  • Navigate to Settings > Billing and Services > Insurance
  • Update the NPI in your Billing Provider Info to match the NPI the enrollment is accepted under

box33NPI.simplepractice.insurance.png

  • Click Save
  • Recreate the claim so that the correct NPI populates Box 33
  • Submit the claim

If you need to update the enrollment so that it’s accepted under a different NPI, see How to update your enrollment information in SimplePractice.


Rendering provider's last name required

If you receive a scrub stating that the claim’s service line(s) rendering provider’s last name is required, it means one of the service lines was manually removed from the claim. 

Manual edits to service lines often cause processing issues. If you need to submit a claim without one of the service lines that was previously included, follow these steps: 

  • Delete the scrubbed claim
  • Navigate to the client's Billing tab
  • Click New > Claim/CMS1500

newclaim.simplepractice.billingoverview.png

  • Select only the appointment(s) that are being billed to the client's insurance

createclaimdates.simplepractice.claim.png

Tip: If you aren't seeing an appointment, try expanding the date range. 

  • Create and submit the claim

Address & zip code errors

Some of the most common scrub errors occur when there’s an invalid client or billing provider address. This includes:

  • Extra characters in the street address
  • Street address abbreviations that don’t match the USPS database's record (i.e., you've entered "Lane" and the official address is "LN")
  • An incorrectly entered full 9-digit zip code

When filing claims electronically, most payers require a full 9-digit zip code for the client’s and billing provider address. Our system automatically validates the addresses on a claim and populates the 4-digit extension for you. You may also manually edit the zip code after our validation, or use Look Up a ZIP Code by USPS. 

Because most payers require a full 9-digit zip code, we recommended always including this information on claims. 


Diagnosis code

Up to 12 diagnosis codes can be listed on a single claim. These populate Box 21 and are pulled from information entered in the client’s settings. See How do I include multiple diagnoses on claims/superbills? for more information. 

The diagnosis pointers in Box 24e indicate which of the codes in Box 21 are associated with each appointment. Insurance payers won't accept more than 4 diagnosis pointers per service line, and if more than 4 pointers are checked, the claim is scrubbed.

24epointers.simplepractice.claim.png

To resolve this: 

  • Click Edit at the top of the claim
  • Uncheck any additional pointers
  • Make sure only 4 are checked

diagnosispointer.simplepractice.claim.png

Note: More than 4 codes can be entered in Box 21. Only the pointers have a maximum of 4. 

  • Click Save
  • Submit the claim

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