Claim Management

Follow the steps below to find or edit an existing claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Optional: Modify the claim information.

5. Click Save. Otherwise, click Close if no changes were made.

Claims may be marked as incomplete for multiple reasons. Incomplete claims will not be sent to the clearinghouse or the payer.    

Follow the steps below to identify why a claim is incomplete:

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Hover your mouse over the  icon.

5. A window will open providing you with additional information as to why the claim is incomplete. 

6. Make edits to your claim accordingly.

    If the patient's record is incomplete and you're unsure why, please open the patient's record and follow the same steps as above. Once the patient record is completed, you must open the claim and save it to mark it as complete

   

   
   

7. Once all required fields are complete the claim will automatically be marked as Completed.

8. Click Save.

Follow the steps below to delete an existing claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Delete button.

5. When the confirmation window opens, select Delete Claim. 

Print Option provide the capability for users to print, copy, or show a preview of how the claim will print. Follow the steps below print your claim, view a preview or print a copy. 

1. Select Claim > Claim.

2. Use the Search field to search for your claim.  

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Print button and choose one of the following actions:

   1. Save and Print Claim: Prints the claim from your desired printer.

      Make sure the appropriate claim form(s) are loaded in the printer before selecting this option and that scale to fit is unchecked and set to 100!

   2. Show Preview: View what the claim will look like once printed on the form. 

   3. Copy: Prints a copy of the claim for your record or to provide to a patient. 

   4. Save and Print With Form: Downloads a pdf copy of the claim on the official CMS-1500 or UB-04 claim form.

       A printed copy of this CMS-1500 form should not be used for the submission of claims. They must be submitted in the official form since the copy will not accurately replicate the scale and OCR (in Flint OCR Red, J6983) color of the form as directed by the CMS and the payers. Each Print will count as a 1/2 claim transaction.

   5. Claim Transaction History: Prints the transaction history of the claim.

   6. EOB: Prints the EOB based on the claims  ERA Report.

   7. Open Negotiations Form: Prints an Open Negotiation Form (OMB 1210-0136) directly from the claim screen so that providers that are out-of-network can enter open negotiations with the insurance company.

5. Click Save. Otherwise, click Close. 

The Claim Transaction History contains a list of all of the claim’s transactions and billing activity. You can quickly print out a detailed list of the claims transaction dates, charges, TCN #s, payments and adjustments, etc.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.  

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Print button.

5. Select Claim Transaction History.

6. Click Save. Otherwise, click Close. 

The Open Negotiations Form allows users to print an Open Negotiation Form (OMB 1210-0136) directly from the claim screen so that providers who are out-of-network can enter open negotiations with the insurance company to determine the amount that the insurance company will pay for emergency services.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.  

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Print button.

5. Select Open Negotiations Form.

6. Enter the Signer's relationship to the office.

7. Enter the out-of-network rate offer to the desired percentage of the total amount and click Set.

8. Optional: You can also Enter/Edit the Offer for Total Out-of-Network Rate column for each individual service line.

9. Click

10. Click Save. Otherwise, click Close. 

Claim Review helps you manage the complex rules and terminology of coding. This feature analyzes the claim(s) before submission to the clearinghouse and identifies any issues with your claim(s), maximizing the potential for you to be paid correctly on the first submission. Claim review is made up of 3 parts.

1. Real Time Claim Submission (RTCS): Real-Time Claim Submission (RTCS) gives you on-demand visibility into your claim. Within seconds, claims are scrubbed for tens of thousands of clearinghouse edits.

   The charge must be in the status of “send to insurance via clearinghouse” to use RTCS.

2. Claim Analysis: Claim Analysis is a built-in clearinghouse edit engine that validates professional and institutional claims for Generic or Payer-Specific Edits. This feature allows you to correct claims before it’s rejected by the Clearinghouse. Analyzing your claim prior to it being sent to the Clearinghouse will save you a significant amount of time on rework.

3. Code Scrubbing (If the service is enabled): Code Scrubbing is a solution that validates your procedure codes, diagnosis codes, CCI, NCD, LCD, HCPCS, Modifiers, and LMRPs to catch any common errors before the claim is sent to a payer.

Follow the steps below to review a claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Review button and select one of the following options:

   1. Review Claim.

      If the claim hasn't been reviewed yet the following message will appear in the drop-down “This claim has not yet been reviewed.”

   2. View Results.

      If the claim has been reviewed, you will see  the date and time it was last reviewed and allow you to click “view results”.

5. A Claim Review Result window will open with a summary of the review.

6. Click Close.

Follow the steps to pull an activity listing for a patient’s claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click  and select one of the following options:

   1. For This Claim Only: Select this option to view activity history for the patient and will include only the claim you currently have open under the claim activity listing.

   2. For All Claims: Select this option to view the activity history for the patient and will include all claims created for the patient you currently have open. 

5. An Activity record will open in a new window.

   Reference our Activity Help Article to learn more about the activity record.

Follow the steps below to view a summary of the claim. 

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Claim Summary tab from the side panel.

5. Review the claim information.

   1. Patient: Displays the patient's name,  account number, and reference number (when applicable). 

   2. DOB: Displays the patient's date of birth, age, and gender.

   3. Form Version: Displays the claim version (CMS-1500 or CMS-1450 (UB04)).

   4. Total Amount: Displays the total billed amount for the procedure codes included on this claim.

   5. Ins Payments: Displays any payment(s) a payer has paid towards this claim.

   6. Pat Payments: Displays any payment(s) the patient has paid towards the claim (e.g., a copay).

   7. Adjustments: Displays any adjustments the payer has made towards this claim.

   8. Balance: Displays any open balance remaining after insurance and/or patient payments have been applied towards this claim.

   9. Patient Credits: Displays any credit amount available on the patient’s account.

   10. Patient Follow Up Date: Enter a patient follow-up date.

   11. Patient Recall Date: Enter a patient recall date.

   12. Date of Service: Displays the date of the service(s) based on the claim’s procedure codes.

   13. Date Entered: Displays the date this claim was created.

   14. Last Billed Date: Displays the last date this claim was submitted to a payer.

   15. Last Statement Date: Displays the last date a statement was sent for this claim.

   16. Follow Up Date: Enter a follow up date for this claim. Claims with follow updates can be tracked within the Follow Up Management screen.

       The Follow up date can be automatically populated on a claim based on the payer the claim was billed to. For more information on defaulting follow up dates per payer reference the General Billing Options Help Article.

   17. Copay Remaining: Displays the unpaid copay balance for the claim.

6. Click Save.

The Patient Estimates feature allows you to easily create Good Faith Estimates as required by the No Surprises Act.  Providers and billers can now create estimates of patient responsibility at the time of service for uninsured, self-pay patients, or high deductibles and copays.  Once an estimate is created (from either an appointment or a claim), users can print the estimate, send a statement, collect payments in the patient payment portal, create payment plans for the estimate, and much more.

Follow the instructions below to create a patient estimate from a claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Locate and click  Estimate from the right-hand side panel. 

5. Click New Estimate.

6. Select the type of estimate:  

   The contract amount is required in order to create an accurate estimate unless the patient is Self Pay.  For more information visit our Patient Responsibility Estimates FAQs.

   1. Auto Estimate: Works directly with the payer’s eligibility system to determine the patient’s amount due based on the services and the latest plan information about remaining deductibles and other limitations.

      1. Verify the estimate and click Save.

   2. Quick Estimate: This is the most common option and will quickly create an estimate based on the patient’s copay amount. This option uses the copay that is set on the patient's Insurance policy (check the Patient > Insurance Info tab within the appointment).

      1. Verify the copay estimate and click Save.

   3. Custom Estimate: Works directly with the payer’s eligibility system to determine the patient’s amount due based on the services and the copay and coinsurance. For example, if both a copay and coinsurance are set, then it will use the copay. If you get rid of the copay, then it uses the coinsurance.

      1. Check the box to calculate the amount based on copay, deductible, and coinsurance; or manually enter the copay, remaining deductible, and/or coinsurance amounts.

      2. Click Save.

7. Once finished with the appointment, click Save.

Notes can be used to include any special information regarding a specific patient interaction. Notes can be viewed by all users that have permission to access the Claim screen. Using the notes feature can help your team stay organized and up to date on general claim information or specific actions to come.

Add, edit or remove claim notes.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Locate and click on Patient Notes from the right-hand side panel.

   Categorize your notes by selecting Appointment, Claim, My, Patient, Payment,  or Relative Notes.

5. Select one of the following actions:

   Click the Pop-out  icon to expand your notes to see more details on each note.

   1. To add notes, click Add Note to write your message, then click Done.

   2. To edit or view existing notes, click the Note and make your changes, then click Done.

   3. To sort existing notes, click the Sort Icon and select a sorting option from the dropdown, then click Done.

   4. To remove a note, select the Note and click the Delete  icon.

      1. Undo this action by clicking the Redo  icon

6. Click .

Copy claim notes to other claims.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Locate and click on Patient Notes from the right-hand side panel.

   Categorize your notes by selecting Appointment, Claim, My, Patient, Payment,  or Relative Notes.

5. Select the note you want to copy.

6. Click the copy icon and select the unpaid claim(s) for this patient to copy the note to (by checking the corresponding box(es).

7. Click Select.

8. Click Done.

9. Click

Follow Up Activity can be used to add follow up notes related to a patient’s claim or expected payment information. For more information, please reference our Follow Up Management Help Article

Add, edit or remove Follow Up notes.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Locate and click on Follow Up Activity from the right-hand side panel.

5. Select Follow Up Notes

6. Select one of the following actions:

   1. To add notes, click Add Note and add your message.

   2. Edit, or delete notes: use the icons associated with the note.

      1. The copy icon  copies the note to other unpaid claims for this patient.

      2. The gear icon  is used to configure which users can view this note.

      3. The remove icon  removes this note from the claim.

      4. The Undo icon  undoes removing the follow-up note.

7. Click .

Expected Payment Info

After speaking to the payer, enter any expected payment info into this section, making it easier to locate this information for future reference.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Locate and click on Follow Up Activity from the right-hand side panel.

5. Select Expected Payment Info.

6. Add or edit payment information within the corresponding fields ( Check , Check Date, Paid Amount, Allowed Amount, Reference).
   

7. Click 

CollaborateMD allows you to add specific alerts to a patient record. These alerts will appear as a pop-up whenever the patient is opened in any sections of the CollaborateMD applications. 

Follow the steps below to add alerts to a claim. 

1. Select Claim > Claim.

2. Use the Search field to search for your claim.

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Alerts tab from the side panel.

5. Click the Add Alert Button.

6. Write the message you would like appear in the alert.

7. Use the Display Options boxes to determine when you would like the alert to appear.

   For more information on  the Display Options, please visit the Alert Control Help Article.

8. The Effective date Range allows you to set how long the alert should remain active.

9. Once satisfied with the alert, click Done. 

10. Click Save. 

By default you are only allowed to edit or delete alerts you created. Users with the “Create and Edit All” Alert permission is able to edit and delete any report. Please reference our User Management Help Article for more information. 

Follow the steps below to find, edit or delete an existing claim alert. 

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Alerts tab from the side panel.

5. Click the alert you want to edit.

6. Make the desired changes.

7. Click Done. Otherwise, click Close to exit or Delete to remove the alert. 

8. Click Save.

CollaborateMD allows you to create specific tasks associated with your claims. Tasks will help you keep track of items that need to be completed. Tasks can have due dates, links, descriptions, statuses, and priorities. You can assign tasks to yourself or to specific users within your business.  

Follow the steps below to add tasks to a claim. 

1. Select Claim > Claim.

2. Use the Search field to search for your claim.

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Tasks tab from the side panel.

5. Click Create Task.

6. Enter the task name in the Task Title field.

7. Add the task’s Due Date, Status, and Priority.

   • Low: blue down arrow.
   • Normal: Yellow side arrow.
   • High: Red upwards arrow.

8. Write in the Description of the task.

9. Optional: Click the Add Link to link the task to an action. Tasks can be linked to a patient, claim, practice, provider, facility, payer, report, message, or customer.

10. Enter the username you would like to assign this task to. Or click  and select the user from the list.

    Only users with the Administer All permission under administer tasks can edit tasks for other users.

8. Click Done.

9. Click Save.

   For more information on Tasks, please visit the Tasks Help Article.  

Follow the steps below to find, edit or delete an existing claim task. 

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Tasks tab from the side panel.

5. Click the Task you want to edit.

6. Make the desired changes.

7. Click Done. Otherwise, click Cancel to exit or click the icon to the right of the task to delete it.

8. Click Save.

Add a document to a claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Documents tab from the side panel.

5. Select whether the document is Patient Document or Claim Document.

6. Click the Add button and choose how you want to associate a document:

   1. Select Associate Existing to choose a document that’s already been uploaded.

      1. Drill down into the appropriate folder.

      2. Click the document you want to associate.

      3. Click Save.

   2. Select Upload New to open a new window.

      1. Click the Add Files button.

      2. Select the file from your local drive.

      3. Add any applicable note.

      4. Choose the Folder Location to add the file.

      5. Click Select.

      6. Click Upload Files.

7. Click Save.

Delete claim documents.

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click on the Documents tab from the side panel.

5. Click the Delete  icon next to the claim document file you want to delete.

6. Click Save.

Follow the steps below to apply a credit. 

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click on the Payment tab from the side panel.

5. Fill in the button for Apply Account Credit to Claim.

   1. The Credit Available will display.

   2. Populate the Applied Amount field with the amount of credit to apply. 

   3. Select the Received Date.

   4. The Memo field is defaulted to Apply Account Credit. If necessary, update the memo per your business needs.

6. Click Save.

Follow the steps below to apply an unapplied copay credit to a claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click on the Payment tab from the side panel.

5. Fill in the button for Apply Account Credit to Claim.

   1. The Credit Available will display.

   2. Populate the Applied Amount field with the amount of credit to apply. 

   3. Select the Received Date.

   4. The Memo field is defaulted to Apply Account Credit. If necessary, update the memo per your business needs.

6. Click Save.

   Save yourself some time and automate this process by enabling the Automatically apply unapplied copays when claims are entered: option found within the Claim Settings Help Article. If the Unapplied Copay and Claim DOS match and the claim has an available copay balance the system will enable this option.

Follow the steps below to add patient payments to a claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click on the Payment tab from the side panel.

5. Fill in the button for Post New Payment to Claim.

6. Enter the Payment Amount.

7. Populate the Payment Received Date.

8. If applicable, enter the Check #.

9. Select the payment Type.

10. Select the Source of the payment.

    If the In-app Credit Card Processing feature is enabled, after saving the payment, you will needed to enter the card information into the Enter Payment Window pop-up. For a detailed step by step guide, please reference the Processing a Credit Card Payment & Printing Receipts Help Articles

11. Update the Memo field as needed.

12. Click Save.

CollaborateMD maintains a marker in the payer database that identifies whether a payer accepts secondary claims electronically. When an insurance payment is entered via EOB Auto Apply, the application will look for a remaining balance and whether the claim has a secondary payer. If there is a balance and a secondary payer, the application will change the charge status to “Send to Secondary via Clearinghouse” (as long as the payer is willing to accept electronic secondary claim(s)). If needed, please reference our Payer Agreements Help Article to learn how to submit and review payer agreements. 

Once verified that the payer will accept secondary claims electronically and the agreement has been approved, follow the steps below:

1. Post the payment received from the primary insurance Please reference our Post Payments Help Article for more information on how to post insurance payments..

   Sometimes a payer will send an EOB where the check amount is $0.00. In these instances, a payer acknowledges the charge but will not reimburse you for the service, such as when a client has a deductible. If the patient(s) listed on the EOB have a secondary insurance and the claims can be submitted electronically to the second payer, you must post the $0.00 payment. Otherwise, the claim(s) will be rejected.

2. Once the payment is posted, change the line item Status under the Charges tab of the Claim to bill the “Secondary Payer via Clearinghouse.”

3. CMD will automatically send the primary insurance payment details as long as there’s a payment and adjustment made to each line item, even if the payer paid $0.00. The payment information that is transmitted electronically acts as the paper EOB the payer would normally receive.

Follow the steps below to re-submit a claim.

1. Select Claim > Claim.

2. Use the Search field to search for your claim. 

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Change the claim Frequency field.

   1. 7 - Replacement of Prior Claim: This is replacing a prior claim.

   2. 8 - Void/Cancel Prior Claim: This is voiding or canceling a prior claim.

5. Provide an Original Claim #, under the Insurance information.

   The original claim# can be either the TCN (Transaction Control Number) or ICN (Insurance Control Number). Typically, the number to use is dependent on whether you’re re-submitting the claim before (TCN) or after (ICN) the EOB has been received.

6. For Professional Claims ONLY: Click the Additional Info tab and enter a Resubmit Reason Code.

7. Click the Charges tab.

8. Under Charge Options, use the drop-down menu to select the status to Set all charges to. Or send by individual line item by updating the Status.  

9. Click Save.

Roster Billing is a way for you to submit multiple claims to Medicare for flu or pneumococcal (PPV) shots and bill them using a simplified method using only one CMS-1500 form and a "Roster" listing the patients. Roster billing is used for Medicare-enrolled “Mass Inmunizers” when billing multiple patients at once. If you have other services to bill, use normal claims filing procedures and forms.

1. Select Claim > Claim.

2. Click the  icon to the right of the Add Professional Claim button and select Print Roster Billing.

3. Begin adding Claim information.

   1. Claim#: will default to Roster.

   2. Patient: Will default to “SEE ATTACHED ROSTER.”

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

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

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

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

   7. Payer: Click the  icon and select the payer.

4. Select the Charges tab.

   1. ICD A will default to Z23 (ENCOUNTER FOR IMMUNIZATION)

   2. Add the (From) date of service based on the payer requirements.

   3. Add the charges (procedure codes).  

      The POS code will default to 60 (Mass Immunization)

5. Click the Print button and choose one of the following actions:

   1. Show Preview: The preview option gives you a quick view of what the claim will look like once printed off.

   2. Roster: Prints a copy of the claim.

6. Once printed click Cancel.