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Claim FAQs

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Contents

  1. 1 How do I submit a corrected, voided, or replacement claim?
  2. 2 How do I bill claims under my Group NPI?
  3. 3 Why are claims not crossing over to the secondary?
  4. 4 Where does the CLIA Number from the Codes Defaults populate on the Professional (CMS-1500) claim form?
  5. 5 What is the purpose of Box 29 on the CMS-1500 Professional claim?
  6. 6 Why is the unit price not populating in the Charges tab when creating an Institutional Claim?
  7. 7 How can I send the HCPC description, instead of the Rev Code description, on an Institutional UB-04 claim that I've already created?
  8. 8 How do I populate the P4 indicator in Loop 2300 REF01?
  9. 9 Why is a G2 quailifer populating in Box 24I instead of the ZZ qualifier?
  10. 10 Why aren't claims leaving the system?
  11. 11 Why is the alert on a specific code not popping up within the claim?
  12. 12 How do I edit or delete a charge that has a patient or insurance payment applied towards it?
  13. 13 How do I track paper claims billed from CollaborateMD?
  14. 14 Why is the claim status feature not available if the payer does offer claim status?
  15. 15 When I look at my claims in Claim Tracking, I see a TSH ID. What does that mean?
  16. 16 How do I set a default Place of Service (POS) and Type of Service (TOS) to they automatically populate when creating a new claim?
  17. 17 I have a payer that is Primary for some patients and Secondary for others. Is there a way to default the charge Status to be "On Hold" when this payer is secondary?
  18. 18 What goes in Box 66 of the UB-04 claim form?
  19. 19 Why is the secondary payer stating the payment information is missing in the AMT segment? They're rejecting my claims.
  20. 20 How can I enter a Sales Rep on a claim?
  21. 21 What does "AUTO-CLAIM" mean in the View Charge History window? 
  22. 22 Why is the default Referring Provider not populating on my claims? 

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

Tips for submitting claims can be found on our Claim Help Page. 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.
Once the Frequency or Type of Bill is updated click here for instructions on how to resubmit a claim.

How do I bill claims under my Group NPI?

If this applies to ALL payers:
  1. Go to the Provider section
  2. Search and open your provider(s)
  3. Click on the Bill Mode drop-down and select Group.
  4. Click Save.
If this only applies to a specific payer:
  1. Go to the Payer section
  2. Search and open the payer
  3. Go to the Provider ID Numbers tab
  4. Under the Bill Mode column, click on the drop-down and select Group for each provider this applies to.
  5. Click Save.
Your claims will now be billed under the Group NPI located in the Practice section.

Why are claims not crossing over to the secondary?

A crossover claim is a transfer of processed claim data from Medicare to Medicaid (or state) agencies and private insurance companies that sell supplemental insurance benefits to Medicare. Forwarding the claim from the primary payer to the secondary payer is at the primary payer's discretion. CollaborateMD has no control over the primary payer forwarding the claim to the secondary payer. 

Where does the CLIA Number from the Codes Defaults populate on the Professional (CMS-1500) claim form?

This code default will populate the CLIA Number on the Charges tab, within the claim. Follow the steps below to view the field which will be updated:

  1. Go to the Claim section
  2. Open an existing Professional (CMS-1500) claim
  3. Go to the Charges tab
  4. On the line with the appropriate CPT code, select the Other button
Please visit the Code Defaults Help Page for more information related to the available default options. 

What is the purpose of Box 29 on the CMS-1500 Professional claim?

Box 29 reflects the amount paid or the amount of payment received from both the patient and any payers. In order to populate Box 29 on the claim, a payment must be entered to one or more charges on the claim. Use the links below to find step-by-step instructions for posting payments in CollaborateMD:

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. 

To add a Rev Code to your claim:
    1. Go to the Claim section > open the claim
    2. Click on the Charges tab 
    3. Enter your revenue code under the Rev Code column. 
    4. Click Save
To control which Default Price gets populated on the claim (HCPCS or Revenue Code price):
    1. Go to the Codes section > Fee Schedules tab
    2. Click on the Options button
    3. Under "On institutional claims, apply prices based on the" > select your preference (HCPCS Code or Revenue Code)
    4. Click Save

How can I send the HCPC description, instead of the Rev Code description, on an Institutional UB-04 claim that I've already created?

By default, CollaborateMD will use the Revenue code description for institutional, UB-04 claims whether printing or sending the claim electronically. In order to use the HCPC description instead, follow these steps:
  1. Go to the Claim section and open the claim for which descriptions need to be changed.
  2. Once opened, go to the Charges tab. 
  3. In the top left-hand corner, select the "Use Description From:" drop down and choose HCPC.
  4. Remove the codes populated in the HCPC column and click tab until all HCPC fields are blank.
  5. Either manually type or use the magnifying glass to select the HCPC codes again in the HCPC column. Note: You should see the descriptions change to the HCPC description as you make your selections. 
  6. Make any other changes necessary before clicking Save

How do I populate the P4 indicator in Loop 2300 REF01?

This loop and segment is needed to communicate with the payer the "Demonstration Project Identifier". In order to populate the P4 indicator, follow these steps:
  1. Go to the Claim section and open the claim.
  2. Once opened, go to the Additional Info tab. 
  3. Locate the Demonstration Project field and enter the identifier needed.
  4. Once your satisfied, click on Save

Why is a G2 quailifer populating in Box 24I instead of the ZZ qualifier?

Box 24I will populate the ZZ qualifier when the value being printed matches the provider's taxonomy specialty code. To verify the taxonomy codes:

Provider:
  1. Go to the Provider section and open the provider. 
  2. Under the Provider Information tab, verify the code populated in the Taxonomy Specialty field. 
Payer:
  1. Go to the Payer section and open the payer.
  2. Click on the Provider ID Numbers tab and enter the provider taxonomy code within the Individual column (Note: Ensure this code matches the one listed in the Provider section)
  3. Once your satisfied, click on Save

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 verify what is preventing your claims for being submitted electronically.

 

Was the claim set to be sent today?

To validate if the claim was set to be sent today, follow these steps:

  1. Open the claim in the Claim section

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

  3. 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. If you would like to submit the claim in real-time, click here to enable this feature.

 

Is the claim complete?

To validate that the claim is complete, follow these steps:

  1. From the open claim, go to the Claim tab

  2. Above the patient’s name, ensure the Claim is complete checkbox is checked.

 

Note: If the box is not checked, check the box in order to save the claim as complete for submission.

 

Is the provider set appropriately?

To validate if the billing provider is set appropriately, follow these steps:

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

  2. On the right-hand side of this line, click the middle 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. If not, click here to read more about changing the provider’s mode.

  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?

To validate if the payer defaults are affecting submission, follow these steps:

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

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

  3. On the Payer Information tab, verify the Server 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, follow these steps to ensure the provider is active for this payer:

  1. From the open payer, go to the Provider ID Numbers tab

  2. Locate the line with the billing provider’s name

  3. Ensure the Active column drop down has Active selected. If necessary, use the drop down to update the selection.

 

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.

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

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

Please reference the steps on how to remove the default code from the patient's account:
  1. Go to the Patients section > open the patient
  2. Go to Claim Defaults tab 
  3. Removed the necessary code(s) and click on the Save button. 

How do I edit or 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. 

How do I track paper claims billed from CollaborateMD?

CollaborateMD can only track electronic claims using the TCN. Claims dropped to paper do not have a tracking system, therefore, we recommend calling the payer directly to obtain a status. Please consider the standard mailing and claim processing time.


Why is the claim status feature not available if the payer does offer claim status?

There should be at least one charge that is set to "At Insurance" in order for the claim status feature to work. 
  1. Proceed to the Claim Section
  2. Open the Claim > Select the Charges tab
  3. Edit service line to "At Insurance"
  4. Click Save

When I look at my claims in Claim Tracking, I see a TSH ID. What does that mean?

The TSH ID is the Change Healthcare (formally Relay Health) claim ID that is assigned after the claim passes through Change Healthcare's first level edits. TSH stands for Transaction Solutions Hub.


The payer address is printing on the top left side of my claim. How can I get this to print on the right side?

To change this setting, please follow the steps below:
  1. Go to the Practice section
  2. Open the practice > select the Defaults tab > Claim Defaults tab.
  3. Click on the drop-down menu next to "Print payer address on claim" and select "Right Side". 
  4. Click Save.
All claims for that practice will now print the payer name and address on the top right side of the claim. 


Is there a way to default CPT/ICDs to a patient's record upon claim completion?

Yes, there are two ways to default CPT/ICDs to a patient's record. Upon creating a new claim in the Claim section > Charges tab, you have the option to update the patient's CPT and/or ICD defaults on save (depending on the type of claim you're creating). Note: The application automatically places a checkmark in the box. 

To save codes for all patient records, follow the steps below to set your defaults:
  1. Proceed to the System section
  2. Click the Defaults tab
  3. Click the Retrieve Defaults button
  4. Find the Claim Section
  5. Place a checkmark next to your desired default option:
    • Automatically use CPT codes from patient defaults
    • Automatically use ICD codes from patient defaults
    • Update patient CPT/ICD defaults on save
  6. Click Save

Where can I find a list of claim Payer Edits?

You are able to find Payer Edits on the Connect Center website. After logging in, please follow the steps below to search for payer edits:
  1. Hover your mouse over Payer Tools > select Edit Search
  2. Enter your search criteria and click on Search


How do I set a default Place of Service (POS) and Type of Service (TOS) to they automatically populate when creating a new claim?

To set a default for the POS and TOS, please follow the steps below:
  1. Go to the Practice section > open the practice
  2. Go to the Defaults tab > Claim Defaults tab
  3. Select your desired Type of Service and Place of Service default
  4. Click Save.

I have a payer that is Primary for some patients and Secondary for others. Is there a way to default the charge Status to be "On Hold" when this payer is secondary?

  1. Create a duplicate payer so it generates a different sequence #. (Note: You can use the Plan Name field to identify the payer as primary or secondary).
  2. Once the duplicate payer is created, change the Default Processing Mode to "Charges on Hold" for the new sequence #.
  3. Use the original payer for all claims when the payer is the primary insurance.
  4. Use the duplicate payer with the new sequence # for all claims when the payer is the secondary insurance.

What goes in Box 66 of the UB-04 claim form?

Box 66 indicates the ICD version used on the claim. For ICD-9 codes, '9' should be used. For ICD-10 codes, '0' should be used. This is required for every claim in order for the Payer to know the type of ICD codes being billed. More information can be found on the CMS UB-04 billing guide. 


Why is the secondary payer stating the payment information is missing in the AMT segment? They're rejecting my claims.

Below are the troubleshooting steps we recommend for this occurrence and a scenario:
  1. Verify that the claim was submitted to the secondary payer via CollaborateMD.
    • If the claim was crossed-over by the primary payer, they are responsible for providing the secondary payer with this information. 
  2. Verify that the payment is entered.
    • This can be verified by reviewing the activity of the submitted claim. All of the charges that were submitted to the payer must have a payment and adjustment entered.
  3. Verify when the payment was entered.
    • This can be verified by reviewing the activity of the submitted claim. Underneath the CPT code, verify the DATE ENTERED for the payment and adjustment. Compare this to the date to when the claim was submitted to the secondary payer.
  4. Verify what insurance company the payment was posted under. 
    • Changing the primary payer on the claim that the payment was posted under will cause the system not to send the payment information. The payment is no longer attached to the claim because the insurance was changed. 
i.e., Primary payer is Aetna (Seq#123), payment and adjustment is entered. Before the claim was submitted to the secondary payer, the primary payer on the claim is switched to Aetna (Seq#456). The original payment will not be associated to Aetna (Seq#456) since this was not the payer that the payment was originally associated to. 
  • Per the steps above, this scenario can be verified by reviewing the payer name that appears in the Patients Activity and comparing this to the Payer Name/Sequence# that is currently selected on the Claim. You can also compare the payer selected on the Claim to the payer displayed in the Control section. 


How can I enter a Sales Rep on a claim?

By showing Durable Medical Equipment (DME) fields, a Sales Rep and an Initial Delivery Date field will be added to a claim for reporting and tracking purposes on charges and payments related to the Sales Rep. These fields do not transmit on the claim.

To display DME fields, follow the steps below.

1. Go the System section.
2. Click on the Defaults tab.
3. Click Retrieve Defaults.
4. Click Yes next to Show DME fields.
5. Click Save.

See more defaults on our System Defaults page.

What does "AUTO-CLAIM" mean in the View Charge History window? 

"AUTO-CLAIM" indicates that the charge status was changed by our nightly auto-claim generation process. This would appear in the Username column after a claim status went from "Send to Clearinghouse" to "At Insurance".


Why is the default Referring Provider not populating on my claims? 

If you have a default Referring Provider set up in the Claim Defaults tab of the Patient section, but it's not populating on your claims, you might have the "Do not send on claims for this patient" option checked. Follow the steps HERE to edit and remove this option.

After making these changes, new claims created will populate with the referring provider.