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.


New Contract

For a contract to populate, all of the following must be true:
  • A contract is set on the payer which includes the current procedures.
  • The claim status must be currently AT INSURANCE for the specific payer sending the payment.
  • The payment is from the Primary Payer (or a Secondary/Tertiary Payer, but all prior payers have entered "exclusions": $0.00 payments and adjustment).

Blank Contract

Step 1:

Follow the instructions below to create a new blank contract:

  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. Click on the Contracts tab and select New Contract.
  5. When the New Contract Wizard window opens, enter your Contract Name.
  6. Select Create a new blank contract and then click on the Next button.
  7. Please click on the Finish button to create your new fee schedule. 
Step 2:

Once saved, the Payer Contract Editor window will open where you can select your contract settings. 
  1. Enter an Effective/Termination Dates (if applicable). 
  2. Select an Entity type. By Default, Use this contract for any billing entity is selected. 
  3. Select a Place of Service. By Default, Use this contract for any Place of Service is selected. 
  4. When you're satisfied, click on the Apply button. 
  5. Click on the Save button to save the contract to the payer. 
Step 3:

Once the fee schedule is created please note you must configure your contract prices. Please see the Add New Contract Help Page for more information.  Once you've completed steps 1-3 you may now begin adding payments for claims associated to this payer. 

From an Existing Contract

Step 1:

Follow the instructions below to create a new contract from an existing contract:

  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. Click on the Contracts tab and select New Contract.
  5. When the New Contract Wizard window opens, enter your Contract Name.
  6. Select Create a new contract from an existing contract and click on the Next button. 
  7. Click on the magnifying glass to search for an existing contract. When the All Contracts window opens, select the contract. 
  8. If necessary you may adjust the pricing of the contract by entering a value into the Adjust the pricing of the new contract by a multiple of __ field. 
  9. When you're satisfied, click on the Next button. 
  10. Please click on the Finish button to create your new fee schedule.  
Step 2:

Once saved, the Payer Contract Editor window will open where you can select your contract settings. 
  1. Enter an Effective/Termination Dates (if applicable). 
  2. Select an Entity type. By Default, Use this contract for any billing entity is selected. 
  3. Select a Place of Service. By Default, Use this contract for any Place of Service is selected. 
  4. When you're satisfied, click on the Apply button. 
  5. Click on the Save button to save the contract to the payer. 

From Medicare Fee Schedule

Step 1:

Follow the instructions below to create a contract from the Medicare Fee Schedule:

  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. Click on the Contracts tab and select New Contract.
  5. When the New Contract Wizard window opens, enter your Contract Name.
  6. Select Create a new contract from the Medicare Fee Schedule and then click on the Next button.
  7. Select the Fee Schedule Year you would like to base your pricing off of.
  8. Choose the option to Use your zipcode or the option to Manually enter your Carrier or Locality.
  9. Select the Pricing Method
  10. If applicable, choose to Adjust the allowed pricing by a multiple of _. 
  11. When you're satisfied, click on the Next button. 
  12. Please click on the Finish button to create your new fee schedule. 

Step 2:

Once saved the Payer Contract Editor window will open where you can select your contract settings. 
  1. Enter an Effective/Termination Dates (if applicable). 
  2. Select an Entity type. By Default, Use this contract for any billing entity is selected. 
  3. Select a Place of Service. By Default, Use this contract for any Place of Service is selected. 
  4. When you're satisfied, click on the Apply button. 
  5. Click on the Save button to save the contract to the payer. 

Existing Allowables

Follow the instructions below to create a new contract from your existing allowables:

Step 1:

  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. Click on the Contracts tab and select New Contract.
  5. Enter your Estimate prices for each payer based on allowables entered in the lastdays
  6. When you're satisfied, click on the Next button. 
  7. Please click on the Finish button to create your new fee schedule. 
Step 2:

Once saved the Payer Contract Editor window will open where you can select your contract settings. 
  1. Enter an Effective/Termination Dates (if applicable). 
  2. Select an Entity type. By Default, Use this contract for any billing entity is selected. 
  3. Select a Place of Service. By Default, Use this contract for any Place of Service is selected. 
  4. When you're satisfied, click on the Apply button. 
  5. Click on the Save button to save the contract to the payer. 

Add Existing

Follow the instructions below to add an existing contract:
  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. Click on the Contracts tab and select Add Existing.
  5. When the Payer Contract Editor window opens click on the magnifying glass displayed besides the Contract field.
  6. Enter an Effective/Termination Dates (if applicable). 
  7. Select an Entity type. By Default, Use this contract for any billing entity is selected. 
  8. Select a Place of Service. By Default, Use this contract for any Place of Service is selected. 
  9. When you're satisfied, click on the Apply button. 
  10. Click on the Save button to save the contract to the payer. 

Edit Contract

Follow the instructions below to edit an existing contract that's associated to 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. Click on the Contracts tab and select the contract you wish to edit.
  5. Double click on the contract you wish to edit or select the contract and click on the Edit button.
  6. Make the necessary change and when you're satisfied, click on the Apply button. 
  7. Click on the Save button to save the contract to the payer. 

Inactivate Contract

Follow the instructions below to inactivate a contract associated to 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. Click on the Contracts tab. 
  5. Select the contract you wish to inactivate and check the Inactive box displayed in the Inactive column in the associated row.
  6. Click on the Save button when you're satisfied with your changes.