Practice Section

The Practice section contains information regarding the entity creating the claims. This could be a physician's practice, laboratory, clinic, etc. This is the first set of data that you must enter and or verify was correctly entered for you when you begin using CollaborateMD. The first time you log on to CollaborateMD, you will find that we have completed the Main Information section for your practice. Information entered into the Practice section will populate in box 33 of the CMS-1500 form and box 56 of the UB-04.

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 Defaults

Claim Defaults contain fields that are automatically carried over to your newly created claims. They can be changed at any time to a new default setting, or can be changed on a claim itself for a one-time change. 

Follow the instructions below to set your claim defaults: 

  1. Go to the Practice section. 
  2. Click on Show All.
  3. Select the Practice (if multiple exist)
  4. Click on the Defaults tab and then select Claim Defaults.
  5. Make your selections (see below). 
  6. Click on the Save button when you're done. 
NoteThe following defaults when edited will only affect newly created claims going forward.


General Defaults

    • Default Type of Service: Click on the magnifying glass to select a default type of service. 
    • Default Place of Service: Click on the magnifying glass to select a default place of service. 
    • Print Payer address on claim: Click on the drop down menu to select what side on the claim form you want to print the payers address. Options include right or left. Note: By default Right is selected. Changes can be made based on your business needs. 
    • Print Anesthesia  start/stop time on CMS-1500 box 24: Check this box to print the anesthesia start and stop time on the claim form on box 24. 
    • Auto decrement authorized visits on claim entry: Check this box to auto decrement the visits authorized on claim entry. This will automatically decrease the visits left once the claim is saved. 
    • Include accident and illness information on claims for all patients: Check this box to automatically populate the Injury/Accident date shown in the Patient section under the Claim Defaults tab on all future claims created once checked.  If user un-checks the box in the Patient section under Claim Defaults a warning message will pop up inactivating "The practice for this patient is set up to include accident and illness information on claims for all patients" and "You may not turn off for this patient". 

Institutional Claim Defaults

    • Set a default bill type for institutional claims: Check this box to set a default three-digit bill type for institutional (UB-04) claims using the options below.
      • Type of Facility: The type of facility represents the first digit of the bill type.
      • Type of Care: The type of care represents the second digit of the bill type and is dependent on the type of facility. 
      • Frequency: The frequency represents the third digit of the bill type.
    • Admission Type: Select the drop down to set a default Admission Type for institutional claims. 
    • Admission Source: Select the drop down to set a default Admission Source for institutional claims. 
    • Patient Status: Select the drop down to set a default Patient Status for institutional claims. 

Real-Time Claim Submission

Real-Time Claim Submission (RTCS) gives you on-demand visibility into your claim. You can rest assured your accepted claims are on their way to the Payer, and rejected claims can quickly be corrected, within seconds of submission. There’s no need to wait until the next morning to see which claims were accepted or rejected.

Within seconds, claims are scrubbed for tens of thousands of clearinghouse edits on an individual claim level or batch level. Accepted claims will automatically be passed onto the Clearinghouse (based on this option being selected). Rejected claims will show the real-time results followed by their rejected reasons, so corrections can be made in real-time! Validating claims using RTCS means less claim rework to perform and accelerated reimbursements so you get paid faster.

Claims can be validated using RTCS anywhere within the application, where you can update a claim status. This includes the Claim, Payment, and Control sections.

The following default selections for RTCS affect ALL claims for ALL practices under the customer you're currently logged into, meaning, this feature cannot be configured for each individual practice. 

Note: Only user types of Admin or Authorized Rep can enable or disable this feature. 


Real-Time Claim Submission Descriptions:
  • Automatically validate and submit the claim: Choosing this option will give you real-time claim results along with real-time claim status. Claims “Rejected” will be set to “Rejected at Clearinghouse”. Claims “Accepted” will be set to “Claim at Insurance”. Results and statuses will be visible within Claim Tracking, as long as the Claims Submitted date matches the date the claims were validated and submitted. Clearinghouse Reports will not be available until the next business day. 
  • Automatically validate, but do not submit the claims: Choosing this option will allow you to obtain real-time claim results, however, claim statuses will not be updated in real time. Claim statuses will remain at “Send to Insurance via Clearinghouse” until we automatically batch process claims at 11:00 PM Eastern Standard Time. Claim results along with claim status updates, will not be available until the next day within Claim Tracking
  • Do not validate or submit the claim automatically: Choosing this option will disable RTCS. Claim statuses will remain at “Send to Insurance via Clearinghouse” until we automatically batch process claims at 11:00 PM Eastern Standard Time. Claim results along with claim status updates, will not be available until the next day within Claim Tracking
  • Copy this option to all customers: Choose this option to copy the default configuration to all customers, using a single click. This mainly applies to accounts with multiple customers, such as Medical Billing Companies.

Patient Defaults

These defaults will apply to all new patients added into the system. Patient defaults can be changed individually in the patient section.

Follow the instructions below to set your patient defaults: 
  1. Go to the Practice section. 
  2. Click on Show All.
  3. Select the Practice (if multiple exist)
  4. Click on the Defaults tab and then select Patient Defaults
  5. Make your selections. 
  6. Click on the Save button when you're done. 

Patient Defaults Descriptions:
    • Marital Status: Click on the drop down menu to select new patients martial status. 
    • Employment status: Click on the drop down menu to select new patients employment status. 
    • Student status: Click on the drop down menu to select new patients student status. 
    • Residence status: Click on the drop down menu to select new patients residence status. 
    • Statement typeClick on the drop down menu to select new patients statement type.
      • When "Single" is selected, statements will print charges and credits for this patient only. 
      • When "Family" is selected, statements will print charges and credits for this patient as well as all linked dependents. This will combine all charges and balances due on one statement and list the patient and all dependents at the header of the statement.
    • Notification type: By default paper statements are selected. This option cannot be changed.
    • Mail statement to: Click on the drop down menu to select whom statements are mailed to. By default, this field is set to "Insured." You can change this selection to "Patient" or one of the other choices at any time on the patients record and.
    • E-mail statement to: Currently, this feature is not enabled and this option cannot be changed. 
    • Send statement: Click on the drop down menu to select if statements should be sent to new patients. 
    • Language: Click on the drop down menu to select new patients preferred language. 
    • Accept Assignment: Click on the drop down menu to select the default accept assignment. This information will populate on the CMS 1500 form (box 27) and/or on the electronic ANSI file
    • Gender: Upon creating a new patient the Gender field will default to blank. Click on this drop-down menu to default a Gender for all new patients.

Payment Defaults

Follow the instructions below to set your ERA Defaults: 
  1. Go to the Practice section. 
  2. Click on Show All.
  3. Select the Practice (if multiple exist)
  4. Click on the Defaults tab and then select Payment Defaults
  5. Make your selections. 
  6. Click on the Save button when you're done. 
NoteUsers must log out and log back in for the changes to take effect

Payment Defaults Descriptions:


ERA Defaults:

1. Allow automatic patient payment redistributionThis option is selected by default and is used to set whether the patient or the payer gets an account credit due to the overpayment of a charge, regardless of the source of the overpayment. For example: 
  1. The patient makes a payment on a $100 charge at the time of service (this could be a patient payment or a patient co-pay).
  2. The claim is submitted to the payer for processing.
  3. When we receive the ERA check from the payer they include an $80 payment and a $20 adjustment.
  4. User auto-applies the check and the following actions take place:
    • The non-insurance payments are removed from the charge (ie. patient payment/patient co-pay). 
    • The insurance payments and adjustments are applied to each charge. 
    • The system will verify if there are any outstanding balances on the claim. 
    • If so, the system will apply the payment amount (patient payment) that was removed; to bring the charge to $0 or until all money is used.  
  5. If there’s any money left, the system will set this money as an account credit due to the patient (in this case $20).

Note: When "Allow automatic patient payment redistribution" is not checked, all the steps remain the same, except for #5 which will then be the following:

    • If there’s any money left, the system will set this money as an account credit due to the payer (in this case $20). 
2. Include the sequestration amount (adj code 253) in the allowed amount: Selecting this option will include the sequestration amount (shown under adjustment reason code 253) within the Allowed amount on ERAs received by Medicare. 
 
New Payment Defaults:

3. Make the Check # field optional for posting insurance payments: Selecting this option will prevent users from not having to enter the Check/EFT number when posting an Insurance Payment.

4. Automatically create an information line when entering a deductible: Selecting this option will populate any deductible information entered while posting an insurance payment within the patient's activity.

5. Set the Received date for applied account credits to be the same as the original payment’s received date: Selecting this option will automatically set the received date to the same as the original date the payment was made when applying an account credit to a charge.

6. Enable auto-calculation of insurance adjustments for non-primary payments: Select this option to have the system automatically calculate adjustments on EOB payments based on the allowed amount and the charge balance for non-primary payers (i.e. secondary and tertiary payers). This is not usually the correct adjustment amount for secondary payers, and may result in undesired account credits. Important: Please ensure that all users verify the correct adjustment amounts if you decide to enable this option. 

7. Account credits created from overpayments default to: Select the drop down to change the option for whom overpayments should be assigned to. 

8. Show Payer alerts in the payment section

  • When entering insurance payments from the payer: Select this option to enable alerts added to a specific payer to pop up when entering insurance payments from that payer. 
  • Within Manage Account (based on the patient's insurance policies): Select this option to enable alerts added to a specific payer to pop up within the Manage Account tab when the payer is listed as one of the patient's insurance policies. 
  • When entering patient payments (based on the patient's insurance policies): Select this option to enable alerts added to a specific payer to pop up when entering patient payments when the payer is listed as one of the patient's insurance policies.