Add Professional Claim

Follow the steps below to add a new Professional (CMS-1500) claim.

  1. Select Claim > Claim.

  2. Click the Add Professional Claim button. 

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

  1. Claim# will populate once saved.

  2. The Reference # field can be populated and used for tracking or reporting purposes.

  3. Claim Frequency defaults to 1 - Original Claim.

    1. If replacing a claim that the payer has already received, choose one of the following based on the payer requirements:

      • 7 - Replacement of Prior Claim: This is replacing a prior claim.

      • 8 - Void/Cancel Prior Claim: This will void/cancel a prior claim.

        When the Frequency is set to 7 or 8, CMD will automatically send this information out on electronic claims and print the number in Box 22 of the CMS-1500 form, unless something else is populated in the Resubmit Reason code.

  4. 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 up the record’s complete information. 

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

    2. Rendering Provider: Click the  icon and select the rendering provider name.

      This field is used for reporting and CollaborateMD invoicing purposes only. Best practice is to have the Rendering and Billing Provider field 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 24J and 33A based on the configuration in the Provider section.

    4. Supervising Provider: Click the  icon and select the supervising provider name.

    5. Ordering Provider: Click the  icon and select the ordering 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 on the  icon and select the facility name. 

      If the Place of Service Code (POS) is set to 12 (Home), box 32 will populate with the patient's address. 

    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.

      If necessary, you can edit the Member ID, Policy Type, Group Number field.

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

      2. If a Prior Authorization number was obtained, populate the Authorization# field.

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

    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. If a Prior Authorization number was obtained, populate the Authorization# field.

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

    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. If a Prior Authorization number was obtained, populate the Authorization# field.

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

  5. Click Save.