Claim FAQs

How do I submit a corrected, voided or replacement claim?

Users should always contact the payer to understand their billing specifications as CollaborateMD will only provide the instructions on how to make the changes in the application. Users must always ensure they are following the payers' billing rules to increase the chances of reimbursement. Please Reference our Re-submit a Claim Help Article for more instructions.

Why is the unit price not populating in the Charges tab when creating an Institutional claim?

This is because Revenue codes are required on Institutional Claims. If a HCPCS code is added to a line item without a Rev Code, the Unit Price will not populate until a Rev Code is added to the line item. 

Please reference our Create an Institutional Claim Help Article to learn how to add a Rev Code to your claim. Then, reference our Fee Schedule Help Article to learn how to set the default price for HCPCS or Revenue Codes.

Why is the alert on a specific code not showing within the claim?

There are some limitations when using Code Alerts. When a code is set as a default within the patient's account, under the Claim Defaults tab, the system will not generate the alert pop-up for the code(s) when adding a new claim. 

If you'd like to remove a default code(s)from a patient's account, please reference the Claim Defaults Help Article.

How do I edit/delete a charge that has a patient or insurance payment applied towards it?

Charges that have payments applied towards it cannot be deleted unless the posted payment(s) are deleted. This is not recommended, especially if the payment is associated with a payer. 

If the payment was posted accidentally, please move forward with deleting the payment. If you are attempting record a refund or a recoupment, more than likely the payer will either automatically recoup the payment or notify you in writing. Once you receive the notification of the recoupment, please reference the following Help Pages for instructions on how to post the takeback. 

Why aren't claims leaving the system?

There are many reasons why a claim may not be leaving the system. Use the below options to troubleshoot and understand what may be preventing your claims from being submitted electronically. 

Was the claim set to be sent today?

  1. Open the claim in the Claim section

  2. Select the More button and choose to View Charge History

  3. Under the Bill To column, locate the last submission of Send to insurance via clearinghouse and verify the date on this line.

Note: If the date is today's date, the claim will be submitted at 11 PM (EDT), unless you are using Real-Time Claim Submission.

Is the claim complete?

  1. From the open claim, ensure the Claim is marked as complete.

Is the provider set appropriately?

  1. From the open claim, locate the Billing Provider line

  2. On the right-hand side of this line, click the provider icon to open the provider on the claim

  3. On the Provider Information tab, verify that the claim mode drop down(s) have PROD selected. 

  4. In the Internal Use box, verify that a Submitter # is populated. If a submitter number is not populated, please contact the Support department.

Is the payer set appropriately?

  1. From the open claim, locate the Primary Insurance line for the payer the claim is being billed to.

  2. On the right-hand side of this line, click the payer icon to open the payer.

  3. Verify the Clearinghouse Processing Mode drop down does not say Do not send claims to the clearinghouse for processing. This option will prevent claims from being sent electronically to the clearinghouse.

  4. If necessary, use this drop down to update the selection for how the clearinghouse should process the claims, either electronically or paper to the payer.

If the Server Processing Mode is set appropriately?

  1. From the open payer, open the Billing Options from the side panel.

  2. Open the Provider tab

  3. Ensure the Active drop down has Active selected for your provider.

Is the claim agreement authorized?

If the payer requires an agreement for the type of claim being billed, follow the steps found here to verify the agreement has been authorized by the payer. If the agreement is authorized use the Review Form button to verify the NPI and Tax ID authorized by the payer are the same ones being used on the claim.

After confirming the above are not affecting submission, please contact the Support department for further assistance.