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Managing claims with multiple payer levels

WebPT only sends CollaborateMD up to 2 payers (primary and secondary) per claim. While the WebPT system allows their users to store more than 3 payers per patient, users can only set which payers from that list will be primary and secondary for the claim. 

Within CollaborateMD, the support of tertiary payers can be problematic due to how CollaborateMD saves the patients relationship to the Insured Party information . For example, if the relationship for the primary and secondary payers are the same (i.e. both SELF, or SPOUSE, etc...) then the primary and secondary payers use the 2 payer slots on the "Insured" tab in the patient section of CollaborateMD and the "Other Insured" tab is available for manually adding a tertiary payer for the patient.

But if the relationships are different, then the primary payer goes on the "Insured" tab and the secondary payer will be on the "Other Insured" tab, because each one needs to have their own Insured Party information stored separately, and leaving no room in CollaborateMD for a tertiary payer.

Here are some example scenarios that we support:


Primary

Secondary

Tertiary

Status

Supported

Self

Self

Self

All 3 are the same relationship

Self

Self

Spouse/Self

First 2 are the same, 3rd same or different

Self

 

 

Only 1

Not Supported

Self

Spouse

Self

 

Self

Spouse

Spouse

 


In the event claims need to be billed to the tertiary for one of the "Not Supported” relationship patterns, customers will have to manually create a paper claim and bill it to the tertiary payer.