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. 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 all price plans and transaction based pricing 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.

This section is used to activate Eligibility for the selected provider and payers. 

Important: In order to use the eligibility feature it must first be enabled in the Admin section. Click here to view the instructions to enable eligibility for Medical Practice accounts or here to view the instructions to enable eligibility for Billing Service accounts. 

Activate Eligibility

Follow the instructions below to begin configuring eligibility.
  1. Go to the Provider section. 
  2. Click on Show All.
  3. Select the provider you wish to set eligibility under (if multiple providers exist)
  4. Click the Eligibility tab.
Begin entering the eligibility information:
  • Payer #: This number is provided by CollaborateMD and cannot be changed.
  • Payer Name: This pulls from your local list of payers that participate in the eligibility verification service. 
  • CPID: This is the payer's eligibility Clearinghouse Payer ID (CPID). 
  • Provider ID: Enter the provider ID. This can be the Tax ID, NPI, or payer assigned. If you are unsure which ID to place here, please contact your payer(s) to verify how the provider is identified. 
  • Alternate NPI: Enter the provider's alternate NPI. This can be the billing or rendering/attending NPI. If you are unsure which NPI to place here, please contact your payer(s) to verify how the provider is identified. 
  • Login Required: This checkbox will automatically be checked if the payer requires the provider's login information to check patient eligibility verification. This box cannot be manually checked or unchecked.
  • Payer Login: If the payer requires a login, enter the Payer Login username here.
  • Payer Password: If the payer requires a login, enter the Payer Login password here.
  • Status: Use the status column to make payer connections active or inactive for the provider. If the status is set to inactive for a particular payer, eligibility cannot be checked for that payer. 
  • Agreement: This field will identify whether or not the payer requires an agreement to check eligibility electronically.
    • No: Agreement is not required.
    • Yes, Payer: An agreement is required to be completed prior to verifying eligibility. 
  • Approved: If an agreement is required, this field will display whether or not the agreement has been approved by the payer. If an agreement is not required, this field will display "N/A". 
  • Default Service Type: Select the type of service you would like to be verified when running eligibility checks. This default service type may also be selected prior to checking eligibility.
Once you have your eligibility configured, press Save.

See Also: Once Eligibility has been configured please see the Eligibility Help Page under the Patient for instructions on how to view, check and print eligibility results for patients.

Inactivate Eligibility

Follow the instructions below to disable real-time eligibility checking for a provider or a specific payer.
  1. Go to the Provider section. 
  2. Click on Show All.
  3. Select the provider eligibility is configured under (if your unsure please open each provider). 
  4. Click the Eligibility tab.
  5. In the Status column click on the drop down menu for each payer that is set to Active and change it Inactive
  6. When you're satisfied with your changes click on the Save button.