Payers

The Payer section provides the functionality to select from over 2,000 payers to automate and manage claims and payer demographics. This section allows you to view, add, or modify payer information; such as name, payer types, identification numbers and more.

There are 3 main types of payers you can create within CollaborateMD, Electronic, Paper & Attachment payers. Electronic payers are payers configured to receive claims electronically through our clearinghouse, Change Healthcare. Paper payers are payers who are not able to receive claims electronically and must be mailed the claim. Attachment payers are payers that require additional forms. Attachment payers are most commonly used for Workmans comp forms.

Note: Payers with CPID that contains a 3 in the 2nd digit (ex. 1360) are paper payers.     

Add a New Electronic Payer

Follow the steps below to add a new electronic payer

  1. Select Customer Setup > Payers.

  2. Click the New Payer button. 

  3. Click Yes, when the "Would you like to configure a Clearinghouse connection for this payer?"

  4. Use the Master Payer Search window to locate your payer.

    1. Search for the Payer by using the name, Payer ID or CPID number, then click Search.

    2. Select the Payer.

  5. Optional: Add the Plan Name.

    This information does not appear on the claim.

  6. Use the Payer Type drop-down menu to select the type of payer. 

    The Payer Type is auto-selected based on the payer you choose in the Master Payer Search. Changes should only be made if you've been advised by the payer to do so.

  7. Use the Default Billing Status drop-down menu to select the status.

    The Default Billing Status is auto-selected as "new charges created" for this payer. You can manually change the status of the charges during claim creation.

  8. Use the Server Processing Mode drop-down menu to tell the server how to process the claim after it's been created.  

    1. The clearinghouse will send the claims electronically: Select this option to have the clearinghouse submit the claim to the payer electronically.

      If a payer requires an agreement to be filled out please confirm that you have been authorized to submit the claim electronically prior to doing so. Otherwise, the claim can either be dropped to paper and mailed to the payer (in this event please make sure the Contact Information for the payer is accurate) or the claim will be rejected in the event you are submitting a claim to a payer that does not accept paper claims, i.e. Medicare payers.

    2. The clearinghouse will print and mail the claims: Select this option to have the clearinghouse print and mail the claim to the payer for a fee.

      Not all payers accept paper claims (i.e., Medicare and payers with a South Carolina address). In the event a payer does not accept paper claims the claim will be rejected by the clearinghouse with the following rejection reason, "64 INVALID CARRIER DIRECT CPID 4301". In the event you receive this rejection message please fill out an agreement for this payer and change the processing mode to the clearinghouse will send the claims electronically. If claims need to be printed and mailed to the payer please note it has to be manually printed and mailed by your office (use the processing mode below in this scenario).

    3. Do not send claims to the clearinghouse for processing: Select this option to NOT have the clearinghouse process claims electronically or on paper.  In the event this option is selected please be sure you are properly dis-positioning the necessary claims to their appropriate statuses. 

  9. The Sequence# is auto-populated by CollaborateMD once the payer is saved.

  10. The Reference# can be created to further identify the payer.

  11. Enter the Contact Information used to mail any claim(s) to this payer.

    Reference the Patient's Insurance Card or contact the Payer directly. 

  12. Enter any applicable ID Numbers for the payer.

  13. Optional: You can override the practice info on the claim by placing a check in the "Use alternate practice info" box.

    1. Enter the practice info you would like to have populated on the claim.

      Ensure the Bill Mode set for the provider is set to "Group" under the Provider section or the Provider tab of the Billing Options.  

  14. Click Save.

Add a New Paper Payer

These payers will be saved with a paper CPID. All paper CPID's have a second digit of '3'. Ex. 4300. Payers that have a paper CPID must be printed and mailed by your office or printed and mailed by the clearinghouse as long as the payer accepts paper claims.

Follow the steps below to add a new paper payer.

  1. Select Customer Setup > Payers.

  2. Click the New Payer button. 

  3. Enter the Payer Name.

  4. Optional: Add the Plan Name.

    This information does not appear on the claim.

  5. Use the Payer Type drop-down menu to select the type of payer.

    The Payer Type is auto-selected based on the payer you selected in the Master Payer Search. Changes should only be madeif you've been advised by the payer to do so.

  6. Use the Default Billing Status drop-down menu to select the status.

    The status will auto-select as "new charges created" for this payer. You can manually change the status of the charges during claim creation.

  7. Use the Server Processing Mode drop-down menu to tell the server how to process the claim after its been created.

    1. The clearinghouse will print and mail the claims: Select this option to have the clearinghouse print and mail the claim to the payer for a fee.  

      Not all payers accept paper claims (i.e., Medicare and payers with a South Carolina address). In the event a payer does not accept paper claims the claim will be rejected by the clearinghouse with the following rejection reason, "64 INVALID CARRIER DIRECT CPID 4301". In the event you receive this rejection message please fill out an agreement for this payer and change the processing mode to the clearinghouse will send the claims electronically. If claims need to be printed and mailed to the payer please note it has to be manually printed and mailed by your office (use the processing mode below in this scenario).

    2. Do not send claims to the clearinghouse for processing: Select this option to NOT have the clearinghouse process claims electronically or on paper.  In the event this option is selected please be sure you are properly dis-positioning the necessary claims to their appropriate statuses.

  8. The Sequenceis auto populated by CollaborateMD once the payer is saved.

  9. The Reference# can be created by you to further identify the payer.

  10. Enter the Contact Information used to mail any claim(s) for this payer. 

    The Payer's claim address can be found on the patient insurance card, or contact the payer directly. 

  11. Enter any applicable ID Numbers for the payer.

  12. Optional: You can override the practice info on the claim by placing a check in the "Use alternate practice info" box.

    1. Enter the practice info you would like to have populated on the claim.

      Ensure the Bill Mode set for the provider is set to "Group" under the Provider section or the Provider tab of the Billing Options.  

  13. Click Save.

Find or edit a Payer

  1. Select Customer Setup > Payers.

  2. Use the Show All button to view all payers. Or use the Search field to further drill down your search. 

    Check the “Include inactive payers” box to include inactive payers in your search results.

  3. Select the Payer.

  4. If applicable, modify the Payer's information. 

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


Payer Billing Options

Follow the steps below to view and edit the billing options for payers.

  1. Select Customer Setup > Payers.

  2. Use the Show All button to view all payers. Or use the Search field to further drill down your search.

  3. Select the Payer.

  4. Click the Billing Options tab from the side panel. 

  5. Make your selections by referencing the Billing Option Descriptions below. 

  6. Click Save.


Billing Options Field Descriptions


General Options Tab

  1. Use the magnifying glass to the default POS (Place of Service) Code to be used on claims for this payer.

  2. Automatically set Claim Follow-Up dates: Check this box to have the system automatically enter a claim follow up date based on the payer.

    • Important things to know:

      • You can set automatic claim follow up dates from 1 to 365 days after the claim was submitted/printed. 

      • If you specify to have the claim follow-up 0 days after the claim was submitted, no automatic follow-up date will be set. 

    • The date will get populated when any of the following actions are taken:

      • The claim is printed from the Claim section, Payment section, or Batch Printing tab.

      • The claim is sent electronically. 

    • The follow-up date WILL get overridden if the claim is re-submitted or send to a secondary/tertiary payer. 

    • The follow-up date WILL get overridden if you manually enter a date BEFORE the claim is actually submitted/printed.

    • The Claim Follow-Up Report is a report you can run to follow up on your claims.

  3. Use the provider name as the pay-to name: Check this box to only send the provider name vs the practice name as the pay to name.

  4. Only send the pay-to address: Check this box to only send the pay-to address.

  5. Use the office address as the pay-to address: Check this box to print the Office Location/Other Offices address selected within the claim section to print in box 33.

  6. Print CMS-1500 as NY Workers Compensation Form: Check this box to print claims as the Workers Compensation form.

  7. Override billing provider with rendering provider: Check this box if you would like claims to be billed under the Rendering Provider selected on the claim.


Professional 

  1. Do NOT print the payer address on the top of the form: Check this box if you do not want the payer address printed on the top of the CMS-1500 claim form.

  2. Exclude patient payments from Box 29: Check this box if you do not want to include any patients payments on the CMS-1500 claim form in box 29.

  3. Print the license number in Box 31: Check this box if you wish to include the license number in Box 31 (of the CMS-1500 form).

  4. Print the following in Box 31: Use the drop-down menu to select whether to use the Provider Name, Practice Name or the Signature on File for Box 31 (of the CMS-1500 form).

  5. Remove the insured’s ID# from Box1A: Check this box to remove the insured’s ID# from Box 1A (of the CMS-1500 form).

  6. Print the following supplemental info in Box 24: Use the drop-down menu to select to use either the Narrative Notes or the Anesthesia Start/Stop Time in Box 24 (of the CMS 1500 form).

  7. Print ICD codes in Box 24E: Check this box if you would like to print the ICD codes in Box 24E (of the CMS 1500 form_. 

  8. Send minutes instead of units on anesthesia claims: Check this box if you would like to use minutes instead of units for anesthesia procedures.

  9. Send anesthesia start/stop times in a line note: Check this box if you would like to include the anesthesia start and stop times as a line note on the CMS-1500 form.


Institutional 

  1. Print the following in Box 38: Use the drop-down menu to select whether to use the Insured's address, Payer's address or to leave Box 38 blank on the UB-04 claim form. 

  2. Print the following in Box 80: Use the drop-down menu to select whether to use the Insured's address, Payer’s address or the remarks for Box 80 blank on the UB-04 claim form.

  3. Print referring physician in Box 76: Check this box if you would like to include the referring provider in Box 79 (of the UB-04 form).


Provider Tab

The provider billing options allow you to customize certain configuration settings for one or more providers specific to this payer. Providers not listed below will bill claims based on their general settings/configuration in the provider screen.

  1. Click on the Customize for Providers link.

    1. Use the Provider(s) drop-down menu find the provider you would like to find.

    2. Use the Status drop-down menu to select whether or not this provider is active with this particular payer.

    3. Use the Bill Mode drop-down menu to select whether this provider should bill to this payer as an individual or as a group. 

    4. Enter the ID to use if the Bill Mode is set as Individual in the Individual ID field. 

    5. Enter the ID to use if the Bill Mode is set as Group in the Group ID field. 

    6. Use the Accept this Insurance checkbox to select whether or not this provider accepts this insurance. This indicates if the Provider accepts assignment.

    7. Click Add once you are satisfied with your changes. These settings can be edited after saving by clicking on the field you wish to edit.

  2. Click the icon to copy these settings to all providers added to this payer.

  3. Check the Show separate configurations for each office location if you would like to configure these settings differently for each office associated to your account.   

    Note: Updating the settings for that provider to no longer be customized essentially removes the provider from the list.

View Payer Contracts

Follow the steps below to view contracts associated to the Payer.

  1. Select Customer Setup > Payers.

  2. Use the Show All button to view all payers. Or use the Search Bar to further drill down your search. 

  3. Select the payer.

  4. Click the Show Contracts link found on the top of the page to open the contracts window.

  5. A Contracts window will display all contacts associated with this payer. 

  6. Click the Add button to create a new contract.

    For more information on how to create a contact, please view our Contacts Help Article.

  7. Click on the icon to view the contract.

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

Inactivate Payers

In the event a Payer is no longer in use, you can inactivate the payer to prevent staff members in your office from using it. Please note that there is no way to permanently delete a payer.

Follow the steps below to inactivate a Payer.

  1. Select Customer Setup > Payers.

  2. Use the Show All button to view all payers. Or use the Search fields to further drill down your search. 

  3. Select the Payer to inactivate.

  4. Place a check in the Make this payer inactive box.

  5. Click Save

Reactivate Payers

Follow the steps below to reactivate a Payer. 

  1. Select Customer Setup > Payers.

  2. Place a check in the Include inactive payers box.

  3. Use the Show All button to view all payers. Or use the Search field to further drill down your search.

  4. Select the Payer to reactivate. 

  5. Click OK when the “This payer is currently inactive.” pop-up displays.

  6. Uncheck the Make this payer inactive checkbox.

  7. Click Save.  

Add Payer Alerts

CollaborateMD allows you to add specific alerts to your payers. Alerts will appear as a pop-up whenever the payer is opened in any section of the CollaborateMD application. Using alerts helps ensure your team is made aware of any important information associated with your payers. 

Follow the steps below to add alerts to payers. 

  1. Select Customer Setup > Payers.

  2. Use the Show All button to view all payers. Or use the Search field to further drill down your search. 

  3. Select the Payer.

  4. Locate and click on Alerts from the right-side panel.

  5. Click the Add Alert button.

  6. Type the message you would like to have appear in the pop-up.

  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 Display Help Article.  

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

  9. Click Done.

  10. Click Save to save your alert to this payer.

Add / Find Payer Notes

Notes can be used to include any special information regarding a payer and can be viewed by all users that have permission to view this screen. Using the notes feature can help your team stay organized and up to date on changes and updates regarding any payers

Follow the steps below to add, view or edit notes for a Payer..

  1. Select Customer Setup > Payers.
  2. Use the Show All button to view all payers. Or use the Search field to further drill down your search. 

  3. Select the Payer.

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

  5. Add, edit, or view any notes for this Payer. 

  6. Click Save.

Remove Payer Notes

Follow the steps below to remove notes from a Payer.  

  1. Select Customer Setup > Payers.

  2. Use the Show All button to view all payers. Or use the Search field to further drill down your search.

  3. Select the Payer.

  4. Click the Notes tab from the side panel. 

  5. Delete any notes for this Payer.

  6. Click Save.