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Claim Section

The Claim section allows you to create, edit and send the claims and charges for the patients.

The following help pages are supported by the current version of CollaborateMD. Please follow the curriculum outline to receive the proper training associated with this section.

Claim

Charges

Additional Info

Insurance

Activity

Notes

Alerts

Documents

Review


Button Overview

Below you will find a description of the buttons located within the Claim section:
  • Add Professional Claims: Selecting this button will allow you to add a professional claim.
  • Add Institutional Claims: Selecting this button will allow you to add an institutional claim.
  • Advanced Search: Selecting this button will allow you to perform an advanced search on your claims.
  • Find For <Patient Name>: Selecting this button will allow you to find a claim for your active patient.
  • Search: Selecting this button will allow you to perform a simple claim search.
  • Import: Selecting this button will allow you to import your claims.
  • Claim Status: Selecting this button will allow you to check the status of your claim if it is currently at the payer.
The following options are only visible when a claim is open: 
  • Save: Selecting this button will save your claim.
  • Close: Selecting this button will close your current claim without saving.
  • Save/Print: Selecting this button will print your claim upon saving.
  • Print: Selecting this button will allow you to Save/Show Preview of the claim, Print a Copy of the claim, or print a Superbill.
  • Copy: Selecting this option will copy the claim.
  • Delete Claim: Selecting this option will delete the claim.
  • Track: Selecting this button will open up the claim within Claim Tracking in the Control section.
    • View Charge History: This option allows users to see when and by whom the status of a claim was changed for each CPT code listed on the claim.
  • Convert Claim to: Selecting this button will convert the claim to the opposite claim form. i.e Professional to Institutional.

Professional Claim

Add Blank Claim

Follow the instructions below to add a blank professional (CMS-1500) claim:
  1. Go to the Claim section.
  2. Click Add Professional Claim.
  3. Select Blank Claim.
  4. Claim Frequency: When resubmitting a claim that the payer has already received, you can use any of the following frequency types or just let the claim default. The claim Frequency Type Codes are as follows:
    • Original Claim: This is an original claim
    • Replacement of Prior Claim: This is replacing a prior claim
    • Void/Cancel Prior Claim: This is voiding or canceling a prior claim
  5. Begin adding your basic claim information. NOTE: To open any of the options below, select the middle icon next to each field that matches the section icon associated with that specific field.
    • Patient: Select the patient by selecting the magnifying glass and searching for the patient you would like to add to the claim. Important: It is best practice to add the patient first. 
    • Rendering Provider: Select the rendering provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim. 
    • Billing Provider: Select the billing provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Supervising Provider: Select the supervising provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Ordering Provider: Select the ordering provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Referring/PCP Provider: Select the Referring/PCP provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Facility: Select the facility by clicking on the magnifying glass and selecting the facility you would like to add to the claim.
    • Primary Insurance: Select the Primary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Secondary Insurance: Select the Secondary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Tertiary Insurance: Select the Tertiary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Office Location: Select the Office Location from the dropdown if different from the Office location tied to the provider. 
  6. Select your Claim Options.
    • Select your claim status from the drop down menu: This will change the status of all charges on the Charges tab. 
      • Options include: No Change, Send to Payer, User Print and Mail to Payer, Balance Due Patient, On Hold, Claim at Payer, Incomplete, Pending Payer, Pending Patient, Pending Physician, Collection, Paid, Deleted, Waiting for Review, Appeal at Payer, Denied at Payer, Rejected at Clearinghouse.
    • Always validate codes on save: This option will verify your procedures and diagnosis codes are valid, prior to saving the claim. 
    • Always validate dates on save: This option will check your dates upon saving the claim.
    • Always auto-calculate totals (units * unit price): This option will auto-calculate the price of each line item based on the units x unit price.
  7. Patient's Current Authorization: If authorization has been entered in the Patient section it will display in this section. Select Copy Authorization to Claim to copy the information to the Insurance tab within the Claim section.
    • Important: To store an Authorization Number on the claim level, please manually enter the Authorization Number within the Insurance tab of the Claim section for the applicable payer.
  8. Enter your dates if necessary: 
    • Patient Recall Date: A recall is a reminder for the office staff to schedule a patient for a certain appointment. 
    • Patient Appointment: This date is the date of the patient appointment.
    • Patient Followup Date: This date is when you have a followup appointment with the patient. 
    • Claim Followup Date: This date is when you need to follow up on the claim.
  9. When you are done, begin adding your Charges.

Add Claim for Active Patient

Follow the instructions below to add a professional (CMS-1500) claim for an active patient: 
  1. Go to the Claim section.
  2. Click Add Professional Claim.
  3. Select Add for <Patient Name>.
  4. Claim Frequency: When resubmitting a claim that the payer has already received, you can use any of the following frequency types or just let the claim default. The claim Frequency Type Codes are as follows:
    • Original Claim: This is an original claim
    • Replacement of Prior Claim: This is replacing a prior claim
    • Void/Cancel Prior Claim: This is voiding or canceling a prior claim
  5. Begin adding your basic claim information. Some fields will be auto-populated based on the patient's information. NOTE: To open any of the options below, select the middle icon next to each field that matches the section icon associated with that specific field.
    • Patient: Select the patient by selecting the magnifying glass and searching for the patient you would like to add to the claim. Important: It is best practice to add the patient first. 
    • Rendering Provider: Select the rendering provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim. 
    • Billing Provider: Select the billing provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Supervising Provider: Select the supervising provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Ordering Provider: Select the ordering provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Referring/PCP Provider: Select the Referring/PCP provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Facility: Select the facility by clicking on the magnifying glass and selecting the facility you would like to add to the claim.
    • Primary Insurance: Select the Primary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Secondary Insurance: Select the Secondary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Tertiary Insurance: Select the Tertiary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Office Location: Select the Office Location from the dropdown if different from the Office location tied to the provider. 
  6. Select your Claim Options.
    • Select your claim status from the drop down menu: This will change the status of all charges on the Charges tab. 
      • Options include: No Change, Send to Payer, User Print and Mail to Payer, Balance Due Patient, On Hold, Claim at Payer, Incomplete, Pending Payer, Pending Patient, Pending Physician, Collection, Paid, Deleted, Waiting for Review, Appeal at Payer, Denied at Payer, Rejected at Clearinghouse.
    • Always validate codes on save: This option will verify your procedures and diagnosis codes are valid, prior to saving the claim. 
    • Always validate dates on save: This option will check your dates upon saving the claim.
    • Always auto-calculate totals (units * unit price): This option will auto-calculate the price of each line item based on the units x unit price.
  7. Patient's Current Authorization: If authorization has been entered in the Patient section it will display in this section. Select Copy Authorization to Claim to copy the information to the Insurance tab within the Claim section. 
    • Important: To store the authorization on the claim level please manually enter the Authorization Number within the Claim section > Insurance tab > Authorization field.
  8. Enter your dates if necessary: 
    • Patient Recall Date: A recall is a reminder for the office staff to schedule a patient for a certain appointment. 
    • Patient Appointment: The date of the patient appointment.
    • Patient Followup Date: This date is when you have a followup appointment with the patient. 
    • Claim Followup Date: This date is when you need to follow up on the claim.
  9. When you are done, begin adding your Charges.

Institutional Claim

Add Blank Claim

Follow the instructions below to add a blank institutional (CMS-1450) claim: 
  1. Go to the Claim section.
  2. Click Add Institutional Claim.
  3. If prompted, select Blank Claim.
  4. Type of Bill: You can edit the Bill Type by selecting the magnifying glass.
    • Select the Facility Type: Select the Facility type from the drop down. 
    • Select the Type of Care: Select the Type of Care from the drop down. 
    • Select the Frequency: Select the Frequency from the drop down. 
  5. Begin adding your basic claim information. Some fields will be auto-populated based on the patient's information. NOTE: To open any of the options below, select the middle icon next to each field that matches the section icon associated with that specific field.
    • Patient: Select the patient by selecting the magnifying glass and searching for the patient you would like to add to the claim. Important: It is best practice to add the patient first. 
    • Attending Provider: Select the attending provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim. 
    • Billing Provider: Select the billing provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Operating Provider: Select the operating provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Other Provider: Select the other provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Referring/PCP Provider: Select the Referring/PCP provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Facility: Select the facility by clicking on the magnifying glass and selecting the facility you would like to add to the claim.
    • Primary Insurance: Select the Primary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Secondary Insurance: Select the Secondary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Tertiary Insurance: Select the Tertiary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Office Location: Select the Office Location from the dropdown if different from the Office location tied to the provider. 
  6. Select your Claim Options.
    • Select your claim status from the drop down menu: This will change the status of all charges on the Charges tab. 
      • Options include: No Change, Send to Payer, User Print and Mail to Payer, Balance Due Patient, On Hold, Claim at Payer, Incomplete, Pending Payer, Pending Patient, Pending Physician, Collection, Paid, Deleted, Waiting for Review, Appeal at Payer, Denied at Payer, Rejected at Clearinghouse.
    • Always validate codes on save: This option will check your codes upon saving the claim.
    • Always auto-calculate totals (units * unit price): This option will auto-calculate the price of each line item based on the units x unit price.
  7. Copy Authorization: If authorization has been entered in the Patient section it will display in this section. Select Copy Authorization to Claim to copy the information to the Insurance tab within the Claim section.
  8. Enter your dates if necessary:
    • Patient Recall Date: A recall is a reminder for the office staff to schedule a future appointment for the patient. 
    • Patient Appointment: This date is the date of the patient appointment.
    • Patient Followup Date: This date is when you need to follow up with the patient.
    • Claim Followup Date: This date is when you need to follow up on the claim.
  9. When you are done, begin adding your Charges.

Add Claim for Active Patient

Follow the instructions below to add an institutional (CMS-1450) claim for an active patient:
  1. Go to the Claim section.
  2. Click Add Institutional Claim.
  3. Select Add for <Patient Name>.
  4. Type of Bill: You can edit the Bill Type by selecting the magnifying glass.
    • Select the Facility Type: Select the Facility type from the drop down. 
    • Select the Type of Care: Select the Type of Care from the drop down. 
    • Select the Frequency: Select the Frequency from the drop down. 
  5. Begin adding your basic claim information. NOTE: To open any of the options below, select the middle icon next to each field that matches the section icon associated with that specific field.
    • Patient: Select the patient by selecting the magnifying glass and searching for the patient you would like to add to the claim. Important: It is best practice to add the patient first. 
    • Attending Provider: Select the attending provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim. 
    • Billing Provider: Select the billing provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Operating Provider: Select the operating provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Other Provider: Select the other provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Referring/PCP Provider: Select the Referring/PCP provider by clicking on the magnifying glass and selecting the provider you would like to add to the claim.
    • Facility: Select the facility by clicking on the magnifying glass and selecting the facility you would like to add to the claim.
    • Primary Insurance: Select the Primary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Secondary Insurance: Select the Secondary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Tertiary Insurance: Select the Tertiary Insurance by clicking on the magnifying glass and selecting the payer you would like to add to the claim.
    • Office Location: Select the Office Location from the dropdown if different from the Office location tied to the provider. 
  6. Select your Claim Options.
    • Select your claim status from the drop down menu: This will change the status of all charges on the Charges tab. 
      • Options include: No Change, Send to Payer, User Print and Mail to Payer, Balance Due Patient, On Hold, Claim at Payer, Incomplete, Pending Payer, Pending Patient, Pending Physician, Collection, Paid, Deleted, Waiting for Review, Appeal at Payer, Denied at Payer, Rejected at Clearinghouse.
    • Always validate codes on save: This option will verify your procedures and diagnosis codes are valid, prior to saving the claim. 
    • Always auto-calculate totals (units * unit price): This option will auto-calculate the price of each line item based on the units x unit price.
  7. Copy Authorization: If authorization has been entered in the Patient section it will display in this section. Select Copy Authorization to Claim to copy the information to the Insurance tab within the Claim section.
  8. Enter your dates if necessary: 
    • Patient Recall Date: A recall is a reminder for the office staff to schedule a patient for a certain appointment. 
    • Patient Appointment: The date of the patient appointment.
    • Patient Followup Date: This date is when you have a followup appointment with the patient. 
    • Claim Followup Date: This date is when you need to follow up on the claim.
  9. When you are done, begin adding your Charges.

Find/Edit Claim

Follow the instructions below to find/edit a claim: 
  1. Go to the Claim section.
  2. You can search for claims in one of four ways:
    1. Use the Search field provided to search by patient name, phone#, and more. Click on the (?) for all search capabilities.
    2. Click on Find for <Patient Name> button to find claims for the active patient.
    3. In the Recently Opened pane, select the claim you wish to open. 
    4. Click on the Advanced Search button. 
  3. Open the claim you would like to make edits to. 
  4. Once you are satisfied with your edits, click Save.

Claim Utilities

Delete Claim

Follow the instructions below to delete a claim:
  1. Go to the Claim section.
  2. You can search for claims in one of four ways:
    1. Use the Search field provided to search by patient name, phone#, and more. Click on the (?) for all search capabilities.
    2. Click on Find for <Patient Name> button to find claims for the active patient.
    3. In the Recently Opened pane, select the claim you wish to open. 
    4. Click on the Advanced Search button. 
  3. Once opened, select Delete Claim.
  4. When the confirmation window opens, select Yes to delete the claim.

Print Claim

Follow the instructions below to show a preview of the claim, print a copy of the claim, or print a superbill.
  1. Go to the Claim section.
  2. You can search for claims in one of four ways:
    1. Use the Search field provided to search by patient name, phone#, and more. Click on the (?) for all search capabilities.
    2. Click on Find for <Patient Name> button to find claims for the active patient.
    3. In the Recently Opened pane, select the claim you wish to open. 
    4. Click on the Advanced Search button. 
  3. Once opened, click Print and then select the action you would like to proceed with.

Save/Print Claim

Charges that are set to User Print and Mail will be the only charges printed. If charges are not set to this status you will receive an error. 

Follow the instructions below to save and print a claim:
  1. Go to the Claim section.
  2. Add a new claim.
  3. When you are done with the claim, select Save/Print Claim.

Copy Claim

Follow the instructions below to copy a claim:
  1. Go to the Claim section.
  2. You can search for claims in one of four ways:
    1. Use the Search field provided to search by patient name, phone#, and more. Click on the (?) for all search capabilities.
    2. Click on Find for <Patient Name> button to find claims for the active patient.
    3. In the Recently Opened pane, select the claim you wish to open. 
    4. Click on the Advanced Search button. 
  3. Once the claim is opened, select Copy.

Track Claim

Follow the instructions below to track a claim:
  1. Go to the Claim section.
  2. You can search for claims in one of four ways:
    1. Use the Search field provided to search by patient name, phone#, and more. Click on the (?) for all search capabilities.
    2. Click on Find for <Patient Name> button to find claims for the active patient.
    3. In the Recently Opened pane, select the claim you wish to open. 
    4. Click on the Advanced Search button. 
  3. Once the claim is opened, select Track and then Claim. The claim will then open in Claim Tracking within the Control section.
  4. It is recommended to select Expand All in the search filters to see all tracking results for the claim. 

Convert Claim to Institutional

Follow the instructions below to convert a professional (CMS-1500) claim to institutional (CMS-1450):
  1. Go to the Claim section.
  2. When adding or editing a professional claim, select Convert Claim to Institutional.

Convert Claim to Professional

Follow the instructions below to convert an institutional (CMS-1450) claim to professional (CMS-1500):
  1. Go to the Claim section.
  2. When adding or editing an institutional claim, select Convert Claim to Professional.

Send Claim to Secondary Insurance

We maintain a marker in the payer database that states whether a payer accepts secondary claims electronically.  When an insurance payment is entered manually or automatically via EOB Auto Apply, and the claim has a secondary payer and there is a remaining balance, the software knows when to set the charge status to “Send to Secondary via Clearinghouse”.  As long as the payer is willing to accept the electronic secondary claim, please note you can submit it via CollaborateMD. 

Important: If the secondary payer does not accept secondary insurance claims electronically, the software will set the charge status to “User Print and Mail” OR you can manually modify the charge statuses. Secondary claims can be billed the same day the primary payment is applied, accelerating reimbursement. Remember, these claims must be printed and mailed to the payer and the EOB must be attached to the claim.

Once you have verified that the payer is willing to accept the secondary claim electronically and you're approved, follow the instructions below to send a claim to the secondary insurance:
  1. Post the payment received from the primary insurance. Please see the Payment Help Page for instructions on how to post payments. Note: In the event the primary payer paid $0.00, it's important to post the payment as you received it.
  2. Once the payment is posted change the Line Item Status of the Charges on the claim to bill to the secondary payer via Clearinghouse. Please see the Claim Help Page for instructions on how to Find/Edit a claim.
  3. Once the status is changed and the claim is submitted, we will automatically send the primary insurance's 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. 

Tips for Sending Secondary Claims

  • If the insurance company paid $0.00 please be sure to post the payment according to the EOB, if not your claims will be rejected.
  • Prior to sending claims to the secondary payer, please verify that you have been approved to submit claims to the secondary payer in the event they require an agreement to be filled out.

Resubmit Claim

Follow the instructions below to resubmit a claim:
  1. Go to the Claim section.
  2. You can search for claims in one of four ways:
    1. Use the Search field provided to search by patient name, phone#, and more. Click on the (?) for all search capabilities.
    2. Click on Find for <Patient Name> button to find claims for the active patient.
    3. In the Recently Opened pane, select the claim you wish to open. 
    4. Click on the Advanced Search button. 
  3. Once opened, in the Claim tab, under Claim Options, select the option that best applies. You can also send by individual line item within the Charges tab by changing the Status next to the line item.
  4. Click Save

Tips for Resubmitting Claims

Prior to submission, it may be required to perform the following actions, depending on the specific payer's requirements. If you are unsure what the payer requires, contact them directly to ensure the correct actions are being taken. 
  1. Change the claim frequency
    • Professional Claim (CMS-1500): The Frequency drop-down can be found on the Claim tab of the opened claim. 
    • Institutional Claim (UB-04): The Frequency drop-down can be found within the Type of Bill options on the Claim tab of the opened claim. 
  2. Populate the original claim number 
    • The original claim number can be found within the claim's Activity and will be the earliest dated TCN number received by the payer. 
    • Once copied, paste this number under the Insurance tab in the Orig Claim # field for the insurance you are resubmitting to.
  3. Enter a Resubmit Reason Code (Professional Claims ONLY)
    • This field can be found under the Additional Info tab of the opened claim. 

Real-Time Claim Status (RTCS)

Once enabled, claims can be validated using RTCS anywhere within the application, where you can update a claim status. This includes the ClaimPayment, and Control sections. 

Follow the instructions below to validate a claim using RTCS:

  1. Go to the Claim section
  2. Add or Find an existing claim. 
  3. After the charge details are entered, do one of the following:
    1. Click on the Claim tab, under Claim Options, click on the Status drop down menu and select “Send to Insurance via Clearinghouse”. 
    2. Click on the Charges tab, in the Status column, click on each charge status you wish to validate and select “Send to Insurance via Clearinghouse”.
  4. After your selections are made, click Save.
  5. The software will perform begin validating claims based on the Real-Time Claim Submission (RTCS) option enabled.
  6. Once the claim is validated, a window will appear with a list of claims that were accepted or rejected. Click on each claim for more details.
    1.  If the claim was accepted, it may be sent to the Clearinghouse immediately for processing (based on this option being selected) and charge statuses will reflect “Claim at Insurance”. Otherwise, charge statuses will remain at “Send to Insurance via Clearinghouse”, and claims won’t be submitted until 11:00 PM Eastern Standard Time. Click Close once you’re satisfied.
    2.  If the claim was rejected, it will not be sent to the Clearinghouse for processing and charge statuses will reflect “Rejected at Clearinghouse” (based on this option being selected). A description of the rejection will be denoted within the result window. 
  7. If the claim was rejected, review the description of the rejection and choose from one of the following options:
    1. Close & Fix Now: Choose this option to close the window so you can correct the issue in real-time.
    2.  Close & Fix Later:  Choose this option to close the window so you can correct the issue at a later time. 
Important:
  •  If “Automatically validate and submit the claim” is enabled, results for validated claims can be found in Claim Tracking or in the Report Viewer by running the Claims Rejected at Clearinghouse Report.
  • If “Automatically validate, but do not submit the claims” is enabled, results for validated claims are not saved. You must validate the claim again in order to view the rejection message (as long as the claim hasn’t been fixed). 

Tips for Troubleshooting Rejections

  1. Carefully read the description of the rejection. Once you’ve fully read the message and understand what needs to be corrected, correct the claim, verify the status is still set to “Send to Insurance via Clearinghouse”, if not, update the status and then click Save.
  2. If you’re unable to identify what corrections need to be made, visit the Self-Service Portal for a list of common claim rejections and their resolution. If you don’t have a username and password for this website, please contact Support for additional assistance.
  3. After exhausting all of your resources, contact Support for additional assistance.

Claim Status

Claim Status provides the capability for users to submit Claim Status requests and receive responses in real time.  The claim status response will provide information about your claim within the payer’s adjudication process, including how much is being paid on the claim once approved. Users can retrieve this information via the Claim or Control sections of the application without having to contact the payer or search on the payer’s website. There are no additional fees for this service.

Claim Status can be verified for any claim that meets the following criteria: 

  1. The payer supports electronic Real-Time Claim Status
  2. The claim was submitted electronically to the payer.  
  3. The claim status must be set to "Claim At Insurance".

At this time please note that there is limited payer availability. We will be working diligently with our clearinghouse, RelayHealth, to add more participating payers. For more information on participating payers please run the Electronic Payer Listing report located within the Report section of the application.


Check Claim Status

Follow the instructions below to check the status of your claim: 
  1. Go to the Claim section.
  2. You can search for claims in one of four ways:
    1. Use the Search field provided to search by patient name, phone#, and more. Click on the (?) for all search capabilities.
    2. Click on Find for <Patient Name> button to find claims for the active patient.
    3. In the Recently Opened pane, select the claim you wish to open. 
    4. Click on the Advanced Search button. 
  3. Once opened, click on the Claim Status button.
    • Note: If the selected payer does not participate in real-time claim status you will not be able to select this button. 
    • Tip: Please see the New Payor Connection Request Help Page to request a connection to a non participating payer. 
  4.  If a claim’s status has already been checked for the day when clicking on the “Claim Status” button, you will receive the following notification:
    • Selecting “Check Status” will send a new status request to the payer.
    •  Selecting  “View Status in Claim Tracking” will automatically take you to the Claim Tracking tab of the Control section, and a search will be automatically performed to show you the previous real-time claim status checks and their results.
    • Selecting the “Cancel” button will cancel the request.

Find/View Results

Your claim status report will be shown in the Claim Status Result window.

Please note that depending on the information received from the payer, less information may be available, and therefore less information may be shown in your result window.

Follow the instructions below to view your real-time claim status history, or to review a previously completed real-time claim status check:

  1. Go to the Control section.
  2. Click on the Claim Tracking tab.
  3. Enter your search criteria.
  4. If you would like to exclude non-real-time claim information, check the “Only include real-time claim status reports” checkbox.
  5. Click on the Search button.
  6. Your Real-Time claim status results will be marked with icons with a small clock in the bottom right-hand corner of the icon.
  7. You can also right-click on any of these rows and select “Show Details”. There will be a tab called “Status Details” which will show you the same data as the Claim Status Result window.

Please note that depending on the information received from the payer, less information may be available, and therefore, less information may be shown in your result window.

Save/Print Results

Follow the instructions below to save or print your claim status results:

  1. From the Above “Claim Status Results” screen. Click on the “View Printable Version” button.
  2. A new window will appear containing a printable version of the same information found on the Claim Status Results window.
  3. Press the “Save” or “Print” button to save or print the report.

Claim Attachments

Click here for more information on how to process and submit Workers Compensation (Workers Comp) claims electronically. 

Workers Comp Claims

Workers Comp Claims are NOT transmitted electronically. These claims must be printed and mailed to the insurance company for processing. Fields that are not carried over from the claim will have to be filled out manually. These forms are printed in a PDF format. The Workers Compensation Board recommends using the latest version of Adobe Reader  which is available as a free download from Adobe's web site. If you require assistance with completing these forms, please contact your local WCB District Office.

Follow the instructions below to create a Workers Comp Claim.

Step 1
  1. Prior to printing a Workers Comp Claim, please ensure that the Payer on the claim is set to "Print CMS-1500 as NY Workers Compensation Form". See General Options for more information. 
  2. Once this option is selected proceed with Step 2.
Step 2
  1. Go to the Claim section.
  2. Create or Search for the claim you wish to print. 
  3. Once the charges and claim details are entered, click on the Claim tab and change the Claim Options to "User Print and Mail". Optionally you can click on the Charges tab and manually change each charge Status.
  4. Click on the "Save/Print Claim" button to print the claim now. Otherwise selecting the Save button will only save the claim with the current selections until your ready to print it at a later time. Note: To learn how to print claims in a batch please see the Batch Printing Help Page. 
  5. When the Select New Workers Comp Form Type window opens, select the form you wish to print. 
  6. Click on the OK button once you're satisfied with your selection.
  7. After the form opens, you may complete the form by typing information on the form before you print it.
  8. Save the form in a secure location for tracking purposes. 
  9. Once you're done filling out the form click on the Print button to mail it to the insurance company.
Listed below is an explanation of each form available within the application. Please note this information was obtained from the Workers Compensation Board website. 

Form Number /Version Date

Form Title

Who Files

Where to File

When to File

C-4 – Doctors Initial Report

Doctor's Initial Report

Health Provider

Workers' Compensation Board, insurance carrier, injured employee or his/her representative

This form is filed within 48 hours of first treatment.

To report continued treatment, use Form C-4.2.

To report permanent impairment use Form C-4.3.

C-4.2 Doctor’s Progress Report

Doctor's Progress Report

Health Care Provider

Workers' Compensation Board, insurance carrier, injured employee or his/her representative

This form is used for the 15 day report after first treatment, and for each follow-up visit scheduled when medically necessary while treatment continues but not more   than 90 days apart.

To report the first time you treated claimant use Form C-4. To report permanent impairment use Form C-4.3.

C-4.3 – Doctor’s Report of MM/Permanent Impairment

Doctor's Report of MMI/Permanent Impairment

Health Care Provider

Workers' Compensation Board, insurance carrier, injured employee or his/her representative

Use this form (1) When rendering an opinion on MMI and/or permanent impairment; or (2) In response to a request by the Workers' Compensation Board to render a decision on MMI and/or permanent impairment.

OT/PT-4 Occupational/Physical Therapist’s Report

Occupational/ Physical Therapist's Report

Occupational/ Physical Therapist

Workers' Compensation Board, insurance carrier, referring doctor, injured employee or his/her representative.

48 hour initial report, within 48 hours of first treatment.

15 day report, after treatment is first rendered.

90 day progress report, at 90 day intervals while continuing treatment.