Control Section

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The Control section of the application provides functionality to track claims that have been submitted, control and resubmit claims at a batch level, track patient statements, and control patient accounts receivable (AR). In addition, it provides the functionality for printing claims, statements, superbills and final demand notices (FDN) at a batch level. 

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.


Button Overview

Below you will find a description of the buttons located within the Claim Control tab:
  • Search: This button will search for claims using the filter selections entered.
  • Save: This button allows you to save your changes made.
  • Review: This button allows you to review your claims to ensure they are correct.
  • Print: This button allows you to print your claim control list.
  • Import: This button allows you to import your claims from a third party that are exported in a known format.
    • Use Cases: This feature is currently support by a third party EMR called Cypress.  If you are using Cypress EMR and want to utilize this feature please contact a Client Services Representative for more information on importing claims. 
  • Close: This button allows you to close the list without saving changes.
  • Select Columns: This button will allow you to set your display columns.

Claim Control is used to change the status of multiple claims at once. 

Search for Claims

Follow the instructions below to search for claims:
  1. Go to the Control section. 
  2. Click the Claim Control tab.
  3. Enter your search criteria:
    • Claim Criteria: 
      • Claim Type: Select whether you want to view professional, institutional or all claims.
      • Review Status: Select the claim review status from the menu.
      • Claim Status: Select the claim status for the claims you would like to display.
    • Date Range: 
      • Claim Entered: This date range coincides with the date that the claim was entered. 
      • Claims Submitted: This date coincides with the date that the claim was submitted. 
      • Claim Status Range: This date is the date in which there was a status change on the claim.
      • Claim Follow-Up Range: This date coincides with the follow-up date set on the claim. 
    • Payer Types: Select the payer type specified for the payer. By default (All) payer types will be selected. Uncheck the (All) box and select the payer type(s) you wish to search for.
    • Search Criteria: You can filter your list further by entering in specific search criteria. 
    • Insurance Payment Amount:  Select the filtering results from the drop down.
  4. When you are done setting your filters, click Search.

Right Click Capabilities

These right click capabilities will give you easy access to the information you want when you want it. 

Follow the instructions below to view the right-click capabilities:
  1. Go to the Control section. 
  2. Click the Claim Control tab.
  3. Enter your search criteria then select Search
  4. Once your search results are displayed, right-click on a row. A window will open with the following options:
      • Show Details: 
      • Open <name of section>: Allows you to open and edit any associated sections within the application.

    Submit a Batch of Claims

    Follow the instructions below to resubmit a batch of claims:
    1. Go to the Control section. 
    2. Click the Claim Control tab.
    3. Use the filters to search for the claims. Tip: Select a CPID from the Search Filter pane to drill down on a specific payer.
    4. Click Search.
    5. Once the claims are listed, click on the Control drop down menu. 
    6. Select Default billing status for payer/procedure to use the default billing status you've selected for the procedure code within the Codes section of the application or for the payer within the Payer section of the application. Alternatively, select Send to insurance via clearinghouse to resubmit all charge(s) on the claim(s) to the clearinghouse for processing. 
    7. If you wish to resubmit the entire batch of claims listed, click on the first-row header to have all of the boxes checked or simply individually select the ones you wish to resubmit. 
    8. When you're satisfied, click Save

    Change Claim Status for a Batch of Claims

    Follow the instructions below to change the status of claims:
    1. Go to the Control section. 
    2. Click the Claim Control tab.
    3. Use the filters to search for the claims. 
    4. Once the claims are listed, click on the Control drop down menu and select the appropriate control level. 
    5. If you wish to change the status of the entire batch of claims listed, click on the first-row header to have all of the boxes checked or simply individually select the ones you wish to resubmit. Note: You can only use one control level at a time.
    6. When you're satisfied, click Save
    Note: User must have the Control permission set to Search and Save in order to save results.

    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 Control section
    2. Click on the Claim Control tab and search for the claims you wish to validate.
    3. Once the claims are displayed, select the claims you wish to validate. Or to select all claims, click on the first-row header to have all of the boxes checked.
    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.


    Scrub a Batch of Claims

    Follow the instructions below to review/scrub a batch of claims using Claim Scrubbing. Please note this feature must be enabled within the Admin section prior to being able to perform this action. Please review your Price Plan prior to enabling in order to understand any additional fees that may incur.
    1. Go to the Control section. 
    2. Click the Claim Control tab.
    3. Search for the claims you would like to view. 
    4. Select the claims you wish to review then click on the Review button. 
    5. After claims are reviewed, the severity of the scrub will be displayed besides the claim number (Informational & Error). 
    6. To view the details of the scrub right click on the claim and select Open Claim
    7. Once in the Claim section click on Review > Claim Scrubbing > View Current Report. The errors (if applicable) will be listed here. 
    8. Based on the error received please be sure to correct the error then review the claim again to ensure there are no more issues with the claim.  

    Delete a Batch of Claims

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    Note: In order to delete a batch of claims, you will need “Search and Save” permissions for Control and Access, Modify and Delete permissions in Claim.


    Once claims are deleted, they will no longer be accessible within the Claim section or within Claim Control. Click here to learn how to undelete a claim.


    Follow the instructions below to delete a batch of claims:

    1. Go to the Control section.

    2. Click the Claim Control tab.

    3. Use the filters to search for the claims.

    4. Click Search.

    5. Do one of the following:

      • Option 1: Once the claims are listed, if you wish to delete the entire batch of claims listed, click the first-row header to check all boxes.

      • Option 2: Individually select the claims you wish to delete.

    6. Click the Control drop down menu and select Delete.

    7. When you're satisfied, click Save.

    8. When the confirmation window appears, select Delete Claims.

    Retrieve Interface Claims

    Follow the instructions below to retrieve claims that are transferred to CollaborateMD from an interface: 
    1. Go to the Control section. 
    2. Click the Claim Control tab.
    3. Select the following search filters:
      • Claim Type: All
      • Review Status: All 
      • Claim Status: Waiting for Review 
      • Claims Entered: Select the appropriate date. 
      • Claims Submitted: All
      • Charge Status Range: All
    4. When you're satisfied with your selections, click the Search button. 
    5. The claims that match your search results will be displayed. 
    6. Select the claims you wish to update by placing a check mark in the check box displayed beside the Claim# column or select the check box header to select all claims displayed. 
    7. By default, the Control status selected should reflect Default billing status for payer/procedure. This will use the default billing status you've selected for the procedure code within the Codes section of the application or for the payer within the Payer section of the application. Alternatively, select Send to insurance via clearinghouse to resubmit all charge(s) on the claim(s) to the clearinghouse for processing. 
      • Important: Changing the Control status to anything other than Default billing status for payer/procedure will override the Default Billing Status selected in the Payer section of the application. 
    8. Click on the Save button to update the selected claims. 

    Note:

    1. Claims that have a payer Default Billing Status of User Print and Mail will need to be printed and mailed. Please see the Batch Printing Help Page for more information on how to print claims that have a charge status of User Print and Mail
    2. Claims that have a payer Default Billing Status of On Hold will remain on hold until the status is updated. To find a list of claims that are set to On Hold run the Claims On Hold Report located in the Report section of the application. Alternatively, you can Batch Submit Claims.

    Retrieve Incomplete Interface Claims

    Follow the instructions below to retrieve incomplete claims that are transferred to CollaborateMD from an interface: 
    1. Go to the Control section. 
    2. Click the Claim Control tab.
    3. Select the following search filters:
      • Claim Type: All
      • Review Status: All 
      • Claim Status: Incomplete 
      • Claims Entered: Select the appropriate date. 
      • Claims Submitted: All
      • Charge Status Range: All 
    4. When you're satisfied with your selections, click on the Search button. 
    5. The claims that match your search results will be displayed. NOTE: You will be required to open each claim in order to save the claim as complete.
    6. Select a claim and right click. 
    7. Select Open Claim
    8. Once the claim opens, click on the box "Claim is complete". 
    9. Click Save. NOTE: The system will advise what is wrong with the claim. Please correct then repeat steps 8 and 9. 

    Note:

    For more information regarding incomplete claims, please see the Managing Incomplete Claims Help Page