Payer Section

The Payer section provides the functionality to select from over 2000 payers to automate and manage claims and payer demographics. This section allows you to view, add, export, print or modify payer information; such as name, payer types, identification numbers and more.

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. 

Payer Information

Provider ID Numbers

Contracts

Options

Notes

Alerts

Agreements


Button Overview

Below you will find a description of the buttons located within the Payer section:
  • ConnectCenter: 
    • Payer Agreements: Selecting this option will take you to the ConnectCenter website where you will be prompted to enter your username and password in order to fill out electronic payer agreements. Visit the Agreements Help Page for more information on how to fill out payer agreements on the ConnectCenter website.
    • Payer Notifications: Selecting this option will take you to the ConnectCenter website where you will be prompted to enter your username and password in order to find Payer Notifications received by the Clearinghouse.
  • CMS Form Version: Selecting this option will allow you to choose which CMS form you want to default for all Professional and Institutional payers.
  • New Payer: Selecting this option will allow you to add a new payer to your payer list.
  • Show All: Selecting this option will display all payers within your payer list.
  • Print: This option will allow you to print your current payer, all payers or a label.
  • Export: Selecting this option will allow you to export your payer list.

New Electronic Payer

Follow the instructions below to add a new electronic payer:
  1. Go to the Payer section. 
  2. Click on the Payer tab.
  3. Select New Payer.
  4. Click on the magnifying glass displayed besides the Electronic Link field. 
  5. When the Master Payer Search window is displayed enter your search criteria. See legend below. 
  6. Click on the Search button when you're satisfied.
  7. When the Master Payer Search window opens, select the payer from the list. Note: If the payer requires an agreement to be filled out you will be notified with the following message: 
    • "This payer requires an agreement to be filled out and approved before you can submit claims electronically. Please either use the Agreements tab in the Payer section of CollaborateMD or go to www.collaborationcompass.com and fill out the payer agreement for this payer. Note: You can ignore this message if you have already been approved or submitted the agreement."
  8. Click I Understand
  9. Enter the payers Contact Information
  10. Continue to enter the payer details (see below).
  11. Click on the Save button when you're satisfied with your changes. 
Master Payer Search Window
    1. Name: Enter the name of the payer.Tip: Less is more. For example: type in Blue instead of Blue Cross Blue Shield.
      • From the start of the name: Enter the start name of the payer.
      • From anywhere in the name:  Enter a partial name of the payer.
    2. Envoy#: If you have the electronic Payer ID enter it into this field. This will ensure that you have the correct payer.
      • Tip: You can usually get the payer ID# off of the back of the patient's insurance card or by calling the payer.
    3. CPID: Enter the CPID associated to the payer. Tip: Avoid selecting payers that have a second digit of a 3 in the CPID ID field. Claims for payers that have second digit of a three will be printed and mailed by the Clearinghouse if submitted electronically.
      • Professional/Institutional: Select what payer type you're searching for. 
    4. Electronic Remittance Advice Support: Click on this drop down menu to search for payers that participate in Electronic Remittance Advice.
    5. Include all payers: Select this option to search for all payers including claim attachment payers.
    6. Limit search to attachment payers*: Select this option to only search for claim attachment payers.
    7. Exclude attachment payers*: Select this option to exclude claim attachment payers from your search. 
    8. Search inactive payers: Check this box to search for inactive payers in our Master Payer list.
    9. Search/Cancel: Click on the Search button to search for payers or click on the Cancel button to cancel your search results.
*Only visible if enabled see Services help page for more information

Payer Details Window
  1. Name: Displays the name of the Payer.
  2. Electronic Link: Click on the magnifying glass to search for an electronic payer. Select the payer you would like to add to your personal payer list. If the payer requires an electronic agreement for claims submission, you will receive a pop up notification. Select I Understand.
  3. Plan Name: Enter a plan name if applicable. Note: This information does not appear on the claim. 
  4. Payer Type: The Payer Type is automatically selected based on the payer you selected. Changes should only be made to the Payer Type only if you've been advised by the payer to do so
  5. Default Billing Status: Select the charge default billing status for this payer. The selected status will automatically be selected for new charges created for this payer. Note: You can manually change the status of the charges during claim creation. 
  6. Server Processing Mode: Select the server processing mode for this payer. The selected processing mode tells the server how to process the claim after it's been created. 
    • The clearinghouse will send the claims electronically: Select this option to have the clearinghouse submit the claim to the payer electronically. Important: If a payer requires an agreement to be filled out please confirm that you have been authorized to submit the claim electronically prior to doing so. Otherwise the claim can either be dropped to paper and mailed to the payer (in this event please make sure the Contact Information for the payer is accurate) or the claim will be rejected in the event you are submitting a claim to a payer that does not accept paper claims, i.e. Medicare payers. 
    • The clearinghouse will print and mail the claims: Select this option to have the clearinghouse print and mail the claim to the payer. Important: Not all payers accept paper claims (i.e. Medicare). In the event a payer does not accept paper claims the claim will be rejected by the clearinghouse with the following rejection reason, "64 INVALID CARRIER DIRECT CPID 4301 ". In the event you receive this rejection message please fill out an agreement for this payer and change the processing mode to the clearinghouse will send the claims electronically. If claims need to be printed and mailed to the payer please note it has to be manually printed and mailed by your office (use the processing mode below in this scenario).
    • Do not send claims to the clearinghouse for processing: Select this option to NOT have the clearinghouse process claims electronically or on paper.  In the event this option is selected please be sure you are properly dis-positioning the necessary claims to their appropriate statuses. 
  7. Sequence#: This number is auto-populated by CollaborateMD once the payer is saved.  
  8. Reference#: If applicable, enter a reference number to further identify the payer.
  9. Contact Information: Enter the contact information for the payer. If claims are being submitted to an electronic payer please note the CPID associated to the payer will act as the "address". It's important make sure the address is accurate in the event claims need to be printed and mailed to the payer. 
  10. ID Numbers: Enter any applicable id numbers associated to the payer. 
  11. Use alternate practice info (This overrides the practice info on the claim): Check this box to use alternate practice information. Once selected a window will open where you can populate the Alternate Practice InfoNote: This information overrides the Primary Office information, which is located in the Practice section.
  12. Professional Claims CPID: This field represents the Common Processor Identifier (CPID) for Professional claims. 
  13. Institutional Claims CPID: This field represents the Common Processor Identifier (CPID) for Institutional claims.
  14. Envoy ID: This field represents the electronic payer identification number. The 5-character code is unique to each payer and increases accuracy of claims processing; reduces payer rejections and increases speed of claims payment.
  15. Eligibility CPID: This field represents the Common Processor Identifier for Eligibility (CPID).
  16. Claim Status: This field represents the Common Processor Identifier for Real-time Claim Status (CPID).
  17. Electronic Remittance Advice: This field represents if the payer participates in Electronic Remittance Advice.
  18. Accepts Secondary Electronic Claims: This field represents if the payer accepts secondary claims electronically. For more information about submitting secondary claims electronic, please reference the Claim Help Page.
  19. Accepts ICD-9/ICD-10 Only: This field represents if the payer accepts ICD-9, ICD-10 or both. 
https://sites.google.com/a/collaboratemd.com/training/helppages/payer

New Paper Payer

Follow the instructions below to add a new paper payer. Please note these payers will be saved with a paper CPID. All paper CPID's have a second digit of '3'. Ex. 4300. Note: Payers that have a paper CPID must be printed and mailed by your office or printed and mailed by the clearinghouse as long as the payer accepts paper claims.

Follow the instructions below to create a paper payer:
  1. Go to the Payer section. 
  2. Click on the New Payer button. 
  3. Under the Payer Information tab, enter the Payer Name in the first field provided. 
  4. Select a Payer Type
  5. Select a Default Billing Status and a Server Processing Mode
  6. Under Contact Information enter the claim mailing address associated to the Payer. Important: Please ensure the address is accurate in order to ensure the delivery of claims to the payer.
  7. Enter any other information you would like to associate to the payer. Note: Please see the call out descriptions above for more information about the different fields and options presented under the Payer Information tab.
  8. When you're satisfied with your changes, click on the Save button. 

New Attachment Payer

      Follow the instructions below to add a new attachment payer:
      1. Go to the Payer section. 
      2. Click on the Payer tab. 
      3. Select New Payer
      4. Click on the magnifying glass displayed besides the Electronic Link field. 
      5. When the Master Payer Search window is displayed enter your search criteria. 
        • Include All Payers: Select this option if you want your search to include both attachment and nonattachment payers. This is selected by default. 
        • Limit search to attachment payers: Select this option if you want to limit your search to attachment payers only.
      6. Click on the Search button when you're satisfied.
        1. Note: All attachment payers have Professional CPID 5861 and Institutional CPID 3657 with a unique Attachment ID. The Attachment ID is what will differentiate the payers from their CPID’s when billed electronically.
      7. When the Master Payer Search window opens, select the payer from the list. Note: If the payer requires an agreement to be filled out, you will be notified with the following message:
        • "This payer requires an agreement to be filled out and approved before you can submit claims electronically. Please either use the Agreements tab in the Payer section of CollaborateMD or go to www.collaborationcompass.com and fill out the payer agreement for this payer. Note: You can ignore this message if you have already been approved or submitted the agreement."
      8. Click I Understand.
      9. Enter the payers Contact Information
      10. Click on the Save button when you're satisfied with your changes.

      Important: Review the Claims Attachment Help Page for more information on how to begin using this feature.

      New Payer Connection

      Within CollaborateMD, if you are unable to locate a connection with a specific payer this means that RelayHealth does not have an electronic connection with that payer. Reference the New Payer Connection page for instructions on how to make this request. 

      Edit/Find Payer

      Follow the instructions below to edit or find payers:
      1. Go to the Payer section.
      2. Click on the Show All button to search for all payers or use the Search field to search for the payer.
      3. When the All Payers window opens, select the payer. 
      4. Make the necessary changes and then click on the Save button when you're done. 

      Note: You can search by typing the Payer’s name, CPID or Envoy ID#


      Editing Payers After Data Conversion

      For more information about Data Conversions click here

      Follow the instructions to select the proper electronic links for your payers after your data has been converted. 
      1. Go to the Payer section.
      2. Click on the Show All button. When the results are displayed, you will see a list of payers that has been imported into your customer account.
      3. Select the payer you wish to update. 
      4. Once the payer is opened, click on the magnifying glass displayed besides the Electronic Link field  to search for an electronic payer.
      5. When the Master Payer Search window is displayed enter your search criteria. See legend above. 
      6. Click on the Search button when you're satisfied.
      7. When the Master Payer Search window opens, select the payer from the list. Note: If the payer requires an agreement to be filled out you will be notified with the following message: 
        • "This payer requires an agreement to be filled out and approved before you can submit claims electronically. Please either use the Agreements tab in the Payer section of CollaborateMD or go to www.collaborationcompass.com and fill out the payer agreement for this payer. Note: You can ignore this message if you have already been approved or submitted the agreement."
      8. Click I Understand
      9. Enter the payers Contact Information
      10. Continue to enter the payer details (see below).
      11. Click on the Save button when you're satisfied with your changes. 

      Delete Payer

      Follow the instructions below to delete a payer:
      1. Go to the Payer section.
      2. Click on the Show All button to search for all payers or use the Search field to search for the payer.
      3. When the All Payers window opens, select the payer. 
      4. Check the Make this provider inactive check box
      5. Click on the Save button when you're satisfied.

      Export Payer List

      Follow the instructions below to export your payer list:
      1. Go to the Payer section.
      2. Click on the Export button. 
      3. When the dialog window opens click on the File Name folder and choose the location you wish to save the file (I.e Desktop, My Documents etc). Note: If you don't select a specific location to save the file it will automatically be saved to your C:/Drive. 
      4. Once the location is chosen, under Export Options select "Export my data in a tab delimited file" (recommendation), choose any other Export Option if applicable. 
      5. Click on the Next button.
      6. Select the field(s) you want to export. Click on the Add button once you've selected the applicable field. Click on the Remove button to remove any fields you no longer wish to export. Note: You can select more than one item by hold down the Ctrl key.
      7. Check the Remember Field Configuration check box always use the same fields you've selected to export. 
      8. When you're satisfied, click on the Next button.
      9. Click on the Finish button to begin the batch export.
      10. Locate the file in the location you saved it.Choose to open the file in any third party software such as Microsoft Excel.