Claim Section

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The Claim section allows you to 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:
  • Advanced Search: This option opens a dialog that allows you to search by more specific criteria than what is accepted by the main search box, such as account type or reference number.
  • 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 print the claim.
  • 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.
  • Convert Claim to: Selecting this button will convert the claim to the opposite claim form. i.e Professional to Institutional.

Reorder Columns

Columns can be reordered to match your desired claim entry workflow. The changes made will be saved once you log out of CollaborateMD. 

Note: Changes made within this tab are per user and per customer. 

Follow the instructions below to reorder the columns:

  1. Go to the Claim section. 
  2. Add a new claim or Search for an existing claim.
  3. Once the claim is opened, click on the Charges tab. 
  4. Select the column you wish to move, then hold down your mouse and drag it to your desired location.
  5. Repeat until you are satisfied.
  6. Click on the Save button to save your changes. 
Note: Users must manually re-arrange the order of the columns in order to bring it back to its original state. Once a column is moved, all existing and future claims will be displayed in this order. 

Professional Claim

Step 1 - Add Diagnosis Codes

Follow the instructions below to add ICD codes to a claim:
  1. Go to the Claim section. 
  2. Add or open a claim.
  3. Click the Charges tab.
  4. You can enter up to 12 ICD codes on a claim. You can enter them manually or click on the magnifying glass to choose your ICD codes from your list you created within the Codes section. 

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When attempting to save a Professional claim that has a duplicate diagnosis code, users will be warned that the code is on the claim more than once. When prompted can you choose to fix the error or save the claim as incomplete.

Step 2 - Add Charges

Follow the instructions below to add a charge to your professional claim: 
  1. Go to the Claim section. 
  2. Add or Find an existing claim.
  3. Click the Charges tab.
  4. Set your number of line items to display on the claim by setting the number in Set Rows. You can manually enter the number or you can choose the up and down arrows.
  5. Begin adding information to your line item. 
    • Note: If using the auto-decrement feature for Inventory Codes, these codes must be entered on a new row. Do not override a line item already populated with information. 
  6. You can apply a patient copay or patient payment directly from the claim. 
  7. Repeat the steps above until all of your line items have been added to your claim.
  8. Once you're satisfied click on the Save button or continue creating the claim.
  • Dual Code: See the Dual Code section of the Help Page for additional information.
  • Dates of Service: Enter your Dates of Service by adding the dates in the From and To fields. You can manually enter the dates or select from the interactive calendar. 
  • CPT: Enter your CPT code manually or select the magnifying glass to search through your list of CPT codes. 
  • POS/TOSSelect the Place of Service and Type of Service manually or click the magnifying glass to choose from a list. 
  • Modifiers: Enter any modifiers in the M fields manually or click the magnifying glass to choose from a list. Note: Modifiers will automatically populate when default modifiers have been set for the CPT/HCPCS code and/or when other items on the claim match rules set for default modifiers on the CPT/HCPCS code.
  • Diagnosis: The 'D' fields corresponds to the ICD codes at the top of the charges tab. You can change the order of importance of the ICD code by placing the number of importance in the corresponding 'D' column.
  • Unit Price/Units: The unit price will automatically populate when the CPT code is added to the line item. Note: Prices will only auto populate if you have the code in your local list AND you have set a default price or created a Fee Schedule for the code. You can determine where the price is pulling from by hovering your mouse over the Unit Price column. You can change the price or the number of units if necessary. 
  • Total Charges: The Total Charges is based upon your Units * Unit Price. If you have the option selected in the Claim tab, this field will automatically be calculated.
  • Status: Select your status for this line item if different from the status of the overall claim. These options include: 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, and Rejected at Clearinghouse. 
  • Other: Select this button to enter other claim information, such as (Example):
  • Form: Selecting this button will allow you to select claim forms from the a drop down menu.
  • Delete: Check this box to delete the line item. 
  • Copay Due: This pulls from the Patient section. If this information is entered in the patient account it will populate here: 
  • Available Account Credits: This information pulls from the patient account as well. If the patient has any available account credits they will populate in this field.
  • Payment Type: Select whether the payment is a patient copay or a patient payment. 
  • Copay: Enter the copay amount. 
  • Check#: If the patient pays with a check, enter the check number in this field. 
  • Payment Method: Select the payment method.
  • Memo: Enter a memo for this payment. 
  • Update patient CPT defaults on save: Selecting this option will update the patient's default codes within the Patient section. 
  • Print receipt on claim creation: Selecting this option will print a receipt for the payment when the claim is saved.

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Users attempting to save a claim with CPT Codes that aren't in their local list will receive a warning message stating:



Selecting Yes will automatically copy the entered code from the CPT-Master List that corresponds to the user's latest AMA License.


Important: If the user saving the claim does not have access to the latest AMA License that includes the code they're saving, the code will not be added to their personal list.

Institutional Claim

Step 1 - Add Charges

Follow the instructions below to add a charge to your institutional claim: 
  1. Go to the Claim section. 
  2. Add or Find an existing claim.
  3. Click the Charges tab.
  4. Select whether you want to Use Description From Rev Code or HCPC.
  5. Set your number of line items to display on the claim by setting the number in Set Rows. You can manually enter the number or you can choose the up and down arrows.
  6. Begin adding information to your line item. 
  7. You can apply a patient copay or patient payment directly from the claim.
  8. Once you're satisfied click on the Save button or continue creating the claim.
  • Dual Code: See the Dual Code section of the Help Page for additional information.
  • Service Date: Enter your Dates of Service by adding the dates in the Service Date field. You can manually enter the dates or select from the interactive calendar. 
  • HCPCS: Enter your HCPCS code either manually or by selecting the magnifying glass and choosing from the list of codes. 
  • Modifiers: Enter any modifiers in the M fields manually or click the magnifying glass to choose from a list. Note: Modifiers will automatically populate when default modifiers have been set for the CPT/HCPCS code and/or when other items on the claim match rules set for default modifiers on the CPT/HCPCS code.
  • Rev Code: Enter your Rev Code either manually or by selecting the magnifying glass and choosing from the list of codes. This affects the value sent on the ANSI in the SV2 segment, and the value printed in box 43 of the UB-04 claim form. 
  • Description: The description you have set to display will populate this column.
  • Unit Price/Units: The unit price will automatically populate when the Rev Code is added to the line item. Note: Prices will only auto populate if you have the code in your local list AND you have set a default price or created a Fee Schedule for the code. You can determine where the price is pulling from by hovering your mouse over the Unit Price column. You can change the price or the number of units if necessary. 
  • Total Charges: The Total Charges is based upon your Units * Unit Price. If you have the option selected in the Claim tab, this field will automatically be calculated.
  • Status: Select your status for this line item if different from the status of the overall claim. 
    • Options include: 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, and Rejected at Clearinghouse. 
  • Drug Info: Click on this button to enter the Drug Information related to the HCPC code. Note: You can default the Drug Info within the Codes section of the application under the Defaults tab.
  • Delete: Check this box to delete the line item. 
  • Copay Due: This pulls from the Patient section. If this information is entered in the patient account it will populate here.
  • Available Account Credits: This information pulls from the patient account as well. If the patient has any available account credits they will populate in this field.
  • Payment Type: Select whether the payment is a patient copay or a patient payment. 
  • Copay: Enter the copay amount. 
  • Check#: If the patient pays with a check, enter the check number in this field. 
  • Payment Method: Select the payment method.
  • Memo: Enter a memo for this payment. 
  • Update patient CPT defaults on save: Selecting this option will update the patient's default codes within the Patient section. 
  • Print receipt on claim creation: Selecting this option will print a receipt for the payment when the claim is saved.

Step 2 - Add Additional Info

Once the Charges are entered, click on the Additional Info tab to begin entering additional information related to the claim.

Dual Code

Dual coding, as part of ICD-10 education and training will provide coders with valuable practice prior to go live. Coding real patient records with both code sets provides coders with valuable ICD-10 coding practice, allowing them to critically think through and apply the principles learned in training to the types of cases they will regularly encounter after October 1, 2015. Equally important, it provides Practice Managers with an opportunity to better identify staffing needs leading up to and following the go-live date. 

Follow the instructions below to begin dual coding: 
  1. Go to the Claim section. 
  2. Add or Find an existing claim (Professional/Institutional).
  3. Click the Charges tab.
  4. Check the Dual Code w/ICD-9 and ICD-10 check box. Note: Users can dual code their claims with both ICD-9 and ICD-10 codes. Depending on what the payer is currently accepting, the ICD-9 or ICD-10 codes will be sent to the payer. However, the claim will be saved with both sets of codes so you will be able to reference them at any time and practice using the new ICD-10 codes. 
  5. Click on the ICD-9 or ICD-10 tab to begin entering your codes. You can enter up to 12 ICD codes on a claim. You can enter them manually or click on the magnifying glass to choose your ICD codes from your list you created within the Codes section. 
  6. Begin adding the additional claim details. 
  7. Once you're satisfied click on the Save button or continue creating the claim.