Generally, remittance codes received from the payer require some type of required action or step to be performed. To help you work less, CollaborateMD can be configured to perform those actions automatically based on the received remittance code.
Best Practice Tips:
Only have one (1) action per payer type (e.g., Commercial, Medicare). If more than one action exists for multiple payer types the system will first use the specific payer type assigned action (e.g., Medicare), followed by the "All Types" action.
If an action is created on multiple codes and each code is on the ERA response, the system will use the action in the order the code is received within the ANSI (835) file itself.
Actions based on Group Code will take priority over actions based on Payer Type in the event that multiple options are applicable.
Follow the steps below to add actions to your remittance codes.
Select Customer Setup > Codes... > Remittance Codes.
Use the Search field to find the remittance code by the code, description, or memo line. Or use the Show All button to view all codes.
Select the remittance code.
Typically, adding actions to the following remittance codes is not recommended and can result in incorrect balance allocation or charge workflow after applying the ERA:
- 1: Deductible Amount
- 2: Co-insurance Amount
- 3: Co-payment Amount
- 45: Charges exceed your contracted/legislated free arrangement
- 253: Sequestration: reduction in federal payment
Locate and click on the Actions tab from the right-hand side panel.
Click the Add button to add a new action.
Use the Action Category drop-down menu to select if this action should be applied to Payer Types or Adjustment Group Codes.
Use the Action Type drop-down menu to further define which group this action should effect.
Use the Action drop-down menu to select the action to perform upon receiving this remittance code.
Optional: If you find yourself wanting to remove an action, click the icon to remove the action.
Actions do not affect how the payments and adjustments are applied and will not affect the status of a claim if the balance is $0.00 after payments, as the status is then Paid, including full payer adjustments resulting in $0.00 balances.