Add Institutional Claim

Follow the steps below to add a new Institutional (UB-04) claim.

1. Select Claim > Claim.

2. Click the Add Institutional Claim button. 

   Click the    icon to the right of the Add Professional Claim button to quickly create a new claim for one of your Recently Opened patients. 

3. Claim# will populate once saved.

   Hovering over the Claim is incomplete icon will open a window letting you know which required fields are missing.

4. Add the Type of Bill. Or use the icon to search.

   These Type of Bill codes are consistent with what is published by the American Hospital Association (AHA).

   1. Select the Facility Type from the drop-down menu.

   2. Select the Type of Care from the drop-down menu.

   3. Select the Frequency from the drop-down menu.

5. Begin adding claim information. 

   Some fields may be auto-populated based on the patient’s information. Click on the icon to the far right of the field to pull the complete record information.

   1. Patient: Click the  icon and select the patient’s name.    

   2. Attending Provider: Click the  icon and select the attending provider name.

      This field is used for reporting and CollaborateMD invoicing purposes only. Best practice is to have the Attending Provider and the Billing Provider match based on the configuration in the Provider section.

   3. Billing Provider: Click the  icon and select the billing provider name.

      This field will populate Box 56 and 76 based on the configuration within the Provider section. In order to populate the Group/Practice NPI number in Box 56, the Bill Mode within the Provider or Payer section must be set to Group.

   4. Operating Provider: Click the  icon and select the operating provider name.

   5. Other Provider: Click the  icon and select the other provider name.

   6. Referring / PCP Provider: Click the  icon and select the referring/pcp provider name.

      1. Choose whether Referring (Ref) or PCP from the drop-down menu.

   7. Optional: Sales Rep: Click the  icon and select the Sales rep from your referring provider list.

      The Sales Rep Field can be enabled by enabling the DME option under Claim Settings. This field is not sent on the claim and is used only for internal reporting purposes.

   8. Facility: Click the  icon and select the facility name. 

   9. Office Location: Select the office location from the drop-down menu if different the Office location tied to the provider. 

   10. Add the Primary Insurance: Click the  icon and select the primary insurance.

       1. Orig Claim #: If the claim is being resubmitted, add the TCN (Transaction Control Number) of the original claim here.

       2. Was a Prior Authorization number obtained? Click Copy Auth from Patient and select the Use on claim link next to the authorization#.

          This field will only be available if the patient has an active authorization, and will update the number of visits used upon saving the claim.

       3. Use the Referral Type drop-down menu to select the type of referral.

       4. The Copay Due field populates the copay amount based on the patient’s policy information.

   11. Optional: Add the Secondary Insurance: Click the  icon and select the secondary insurance.

       1. Orig Claim #: If the claim is being resubmitted, add the TCN (Transaction Control Number) of the original claim here.

       2. Was a Prior Authorization number obtained? Click Copy Auth from Patient and select the Use on claim link next to the authorization#.

          This field will only be available if the patient has an active authorization, and will update the number of visits used upon saving the claim.

       3. Use the Referral Type drop-down menu to select the type of referral.

       4. The Copay Due field populates the copay amount based on the patient’s policy information.

   12. Optional: Add the Tertiary Insurance: Click the  icon and select the tertiary insurance. 

       1. Orig Claim #: If the claim is being resubmitted, add the TCN (Transaction Control Number) of the original claim here.

       2. Was a Prior Authorization number obtained? Click Copy Auth from Patient and select the Use on claim link next to the authorization#.

          This field will only be available if the patient has an active authorization, and will update the number of visits used upon saving the claim.

       3. Use the Referral Type drop-down menu to select the type of referral.

       4. The Copay Due field populates the copay amount based on the patient’s policy information.

6. Click Save.

7. To add charges to the claim, click on the Charges tab and reference our Add Charges to an Institutional Claim Help Article.