Provider Section

The Provider section contains information regarding the physician(s) providing the service on the claim. Each provider has their own information screen. You will use this section to add new providers or to edit the profile of an existing provider.

Monthly per provider fees are calculated by unique Rendering, Attending, or Organizational provider name. CollaborateMD will consolidate providers whose names are an exact match on a per customer level. For example, if the individual provider last name + individual provider first name = organization provider name, then the providers will be consolidated on your monthly invoice. For more information regarding monthly prices, please review your price plan by following the instructions found here.
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.

Provider Information

Notes

Alerts

Eligibility



Button Overview

Below you will find a description of the buttons located within the Provider section:
  • New Provider: Selecting this option will allow you to add new provider.
  • Print: Selecting this option allows you to print all or current provider open. 
  • NPI Registry: Selecting this option will open a search window, linked to the NPI Registry website where a search can be performed using the NPI number entered in this section. 
  • Show All: Selecting this option will show all providers.
  • Save: Selecting this option will save the changes you've made. 
  • Close: Selecting this option will close the window.

Add Provider

Note: Users with the Account Setup permission can add a new Provider with an existing Tax ID. Users with the Bill Payment permission can add a new Provider with a new Tax ID.

A Provider can be but is not limited to, an M.D., P.A., N.P., D.O. or medical care facility (hospital) who provides health care services. 

Note: In the event new providers are added with a different EIN or SSN than one that already exist in your account, you will be charged a tax-id add on fee. Only Authorized Representatives and Admins with the Bill Payment permission can add a new Provider with a new Tax ID. 

Once a Practice is added, you can associate the Provider to your Practice. Providers can be added to an existing Practice for the following reasons. 

  1. When a provider needs to bill claims under multiple EIN or SSN numbers. 
  2. When claims need to be billed under a different rendering provider compared to the billing provider although they use the same EIN or SSN. 
Note: This is normally a nurse practitioner and physician. These providers normally use the same EIN or SSN number that’s on file for the already added Provider. Once a provider is associated to a practice it cannot be dissociated. You must inactivate the Provider and add it again. 

Follow the instructions below to create a provider: 
  1. Go to the Provider section. 
  2. Click on the New Provider button.
  3. Enter the provider's demographics (see a description of each section below). 
  4. When you're satisfied with your changes, click the Save button.
A. Enter the provider’s demographics: 
  1. Last: Enter the provider last name. 
  2. First: Enter the provider first name. 
  3. MI: Enter the provider middle initial. 
  4. This provider is an
  5. NPI: Enter the provider's NPI number. 
  6. Taxonomy Specialty (required): Select the provider’s taxonomy specialty. 
  7. Reference#: In the event, you have to enter a provider into the system twice, use this field to help distinguish between the two providers. (i.e. TAX ID, EIN, Provider A, Provider B). This field is informational and does not appear on any claims). 
  8. Code: You can use this field to enter a code of up to 3 letters or numbers. This code will then be displayed on certain reports within the Report section of the application to identify which provider performed the service. 
B. Begin entering the providers Billing Information: 
  1. Practice for this provider: Click on the magnifying glass to search for the practice you want to associate the provider too. This will be the provider's default practice. Important Note: Once the provider has been saved, the practice listed in this field cannot be changed. 
  2. Bill claims under: Click on the magnifying glass to choose the provider all future claims will be created under.  
  3. Check eligibility under: Click on the magnifying glass to choose the provided all eligibility checks will be submitted under. Note: We recommend configuring one provider for all eligibility checks to be completed under to prevent having to configure multiple providers.
  4. Bill as: Select whether this provider will bill under their individual provider (Provider section) information or group (Practice section) information. 
  5. Use which ID number? Select whether to bill using the providers SSN or EIN number. 
    1. Social Security# (SSN): Enter the provider’s SSN number. 
    2. Employer Identification# (EIN): Enter the providers EIN number. 
  6. Professional Mode/Institutional ModeAuthorized Reps can move Provider(s) into Production Mode once a Submitter Number is assigned to the Provider(s). In order for a User or Admin to move a Provider into Production Mode,  permission for Account Setup must be set to Allow
    • Production Mode – Claims will be submitted to the payer for processing.
    • Test Mode/Hold – Claims will not be submitted to the payer for processing.
  7. Real – Time Submitter Number: Change Healthcare assigns each new Tax ID number a Submitter Number. This Submitter Number tells Change Healthcare which customer is sending them electronic products such as claims, statements, ERA's, etc. It also allows Change Healthcare to send Clearinghouse reports back into your account. Submitter Number will automatically be generated under the Internal Use field.
    • Important: An message with the Change Healthcare Username and Password will be sent through CMD Messaging to the CollaborateMD User who added the provider. Once the email is received you may begin to complete Payer Agreements within 24-48 hours in the application.
C. Enter the providers Contact Information
D. Enter any applicable ID Numbers for the provider. 
E. Enter any applicable Claim Defaults for the Provider. Note: Claim Defaults for the provider must first be enabled within the System section > Defaults tab.
  • Important: The system will always use the Claim Defaults associated to the provider regardless if the default values are displayed or hidden.

    Find/Edit Provider

    Follow the instructions below to find and edit a Provider:

    1. Go to the Provider section.
    2. Click the Show All button.
    3. Select the Provider (if multiple providers exist).
    4. Edit the provider's information.
    5. When you're satisfied with your changes, click Save

    Edit Provider Mode

    Note: Only Authorized Representatives and Admins with Account Setup permissions can change a Provider's Mode to one of the following modes: 

    Production

    In Production Mode, claims will be sent to the Clearinghouse electronically then forwarded to the payer. 

    Important: If required Claim agreements have not been completed or Authorized by your payers, moving into PROD mode can incur additional fees if your claims are dropped to paper. 

    Follow the instructions below to move the provider in PRODUCTION mode: 
    1. Go to the Provider section.
    2. Click on the Show All button. 
    3. Select the Provider (If multiple providers exist) 
    4. Change Professional/Institutional Mode to PROD
    5. Click Save

      Test

      In Test Mode, the claims will be sent to the Clearinghouse for testing purposes only.

      Follow the instructions below to place the provider in TEST mode: 
      1. Go to the Provider section.
      2. Click on the Show All button.
      3. Select the Provider (If multiple providers exist)
      4. Change Professional/Institutional Mode to TEST
      5. Click Save.

      Hold

      Providers whose modes are set to HOLD will prevent claims from leaving the system as long as the provider is set as the Billing Provider on claims.

      Follow the instructions below to place the provider on a HOLD status: 
      1. Go to the Provider section. 
      2. Click on the Show All button.
      3. Select the Provider( if multiple providers exist).
      4. Change Professional/Institutional Mode to HOLD
      5. Click Save.

      Update/Change Tax ID

      A request to update or change a provider’s Tax ID should only be made if:


      • A typo was made when adding the provider initially

      • If the Tax ID used initially was the wrong Tax ID and all claims are being rejected due to an incorrect Tax ID

      • If the Tax ID has been legally changed


      Note: If the above three scenarios are not met, this request should not be made. Instead, a new provider record should be added with a different Tax ID. A one-time charge for a Tax ID Add-on may apply, unless the change request was one of the following:

      1. Claims were never submitted with the Tax ID (prior to the change)
      2. Claims were submitted but claim rejections were received and can be found/seen within CollaborateMD
      3. The provider is currently transitioning from SSN to EIN or vice versa
      If the new Tax ID provided does not meet the three (3) criteria above, a Tax ID Add-on fee will be applied and processed using the Default Payment Profile.

      In order to request a Tax ID change, users of any type will need the following permissions:

      Section

      Permission

      Access Level

      Provider

      Provider

      Access and Modify

      Admin

      Bill Payment

      Allow

      Admin

      Account Setup

      Allow


      If permissions need to be granted, an Admin or Authorized Rep on the account will need to complete these changes in the Admin section.


      Follow the instructions below to request a Tax ID change/update:


      1. Go to the Provider section.

      2. Click on the Show All button.

      3. Select the Provider(if multiple providers exist).

      4. Select the Request Tax ID Change link.

      5. When the pop-up window appears, enter the required information

        • Keep claims/ERA separate?

        • Select YES, if you will need the provider’s current Tax ID for reporting or claim re-billing purposes.

        • Select NO, if you will NOT need to use the provider's current Tax ID for reporting or claim re-billing purposes.

      1. Check the box confirming your understanding that a one-time charge for a Tax ID Add-on may apply.

      2. Click Submit.


      Once submitted, the request will be processed within 2-3 business days unless otherwise specified.   


      Print Provider

       Providers can be printed one of two ways, follow the instructions below to print a Provider:
      1. Go to the Provider section. 
      2. Click on Show All.
      3. Select the Provider (if multiple providers exist).
      4. Click Print.
      5. Select Current Referring, All Providers.
      6. Click on the Print button continue printing.  
      Or
      1. Go to the Provider section. 
      2. Select All Providers
      3. Click on the Print button continue printing.  

      Inactivate Provider

      Please note that inactivating a provider will only prevent new claims from being created using that provider. It will not prohibit existing claims with that provider from leaving the system. To prevent claims for the provider from being billed out, it is recommended that you place your provider on HOLD. Click here for instructions on how to place your provider on HOLD. 


      Follow the instructions below to inactivate a Provider:
      1. Go to the Provider section. 
      2. Click on Show All.
      3. Select the Provider (if multiple providers exist).
      4. Click the Make this provider inactive box.
      5. When prompted, select one of the following options:
        1. Place on HOLD: Select this option to place the provider on HOLD and mark the provider as Inactive. Note: Switching the provider’s mode to HOLD will prevent existing and future claims from being sent to the clearinghouse electronically for this provider. 
        2. Continue to Bill Claims: Select this option to inactivate the provider and still allow claims to be billed, when applicable. Note: If selected, CollaborateMD is not liable for any fees incurred after inactivating the provider.
      6. Click Save.

      Find Inactive Provider

      Follow the instructions below to add a find an inactive Providers:
      1. Go to the Provider section. 
      2. Click on the Search Inactive Providers box.
      3. Select Show All.
      4. Select the Provider you would like to open.

      Reactivate Provider

      Follow the instructions below to reactivate a Provider:
      1. Go to the Provider section. 
      2. Click on the Search Inactive Providers box.
      3. Click on Show All.
      4. Select the Provider (if multiple providers exist).
      5. A pop-up will appear indicating “This provider is currently inactive”. Click OK.

      6. Click the Make this provider inactive box so there is no check present.

      7. Click Save.
      https://sites.google.com/a/collaboratemd.com/training/helppages/provider

      NPI Registry

      Selecting this option enables users to search for all active providers using the NPPES information. All information provided is produced by the NPI Registry in accordance with the NPPES Data Dissemination Notice and is updated daily. Using this functionality not only allows users to search for Individuals or Organizations but it also automates the process of adding Providers and Practices into the application.

      Important: All of the information displayed is directly from the NPPES website. CollaborateMD does not accept responsibility, or liability, for the consequential actions of adding Individuals or Organizations to the application using the NPI Registry. Users are responsible for validating the information returned prior to saving the record. 

      Follow the instructions below to search or add a provider using the NPPES (National Plan and Provider Enumeration System) information:

      1. Go the Provider section.
      2. Click on the NPI Registry button, or click on the New Provider button or click on the Show All button to search for all providers and click on the NPI Registry button once the provider is selected.
      3. When the NPI Registry window opens, populate the fields you would like to search by.
      4. Once you’re satisfied, click on the Search button. Note: Only the first 200 results are returned).
      5. When the NPI Registry results are returned, select the record you wish to Add or view More Details
        1. Add: Select this option to add the record within CollaborateMD. 
          • If you’ve selected to Add the record and you have an existing provider open you will be prompted to save the record you have open and open a new record or you can overwrite the existing provider information for the provider that you currently have open. Remember to review the changes that will be made prior to saving your changes. When you’re satisfied click on the Save button.
        2. More Details: Select this option to view more details regarding the selected option. 
          • If you’ve selected to view the detailed results for the selected record, click on the Add button to add the record (See Add above for details). 
      6. Once you’re satisfied with your changes click on the Save button.
      https://sites.google.com/a/collaboratemd.com/training/helppages/provider