CMD v10 Professional Claims Overview

In this video we will see how to create and submit a

professional

claim from CMD. The CMS 1500 Professional Claim Form is typically used by providers who see patients in their office or facility and perform outpatient procedures. Any user with

professional

claim permission can create and submit professional

claims

to their payers. Let us begin! Professional

claims

can be created from the patient section, from the scheduler and from the claims section. Feel free to create a claim from any of these sections depending on your workflow. Regardless of which section you create your claims in, the process is the same.

To create a professional claim from the claim screen, click the Add Professional Claim button. We recommend starting by adding a patient. Click on the magnifying glass next to the patient field to locate the patient you want to add to the claim. Depending on default values ​​and patient settings, additional fields will be automatically populated. However, you can add or edit any field by clicking the magnifying glass next to the field you want to change. Once you are happy with your selections, navigate to the charges tab. Add diagnostic codes by clicking the magnifying glass and searching for the code in your local list.

You can do the same with procedure codes. First, use the "from and to" dates to select your service dates and then click the magnifying glass in the code field to add your code. The other fields will be automatically populated based on the default values ​​of the selected code. Adding DX pointers tells payers which diagnosis codes relate to which procedure codes. Click the magnifying glass and then select up to four diagnostic codes. If your payers require additional information about the claim, you can enter it in the additional information table. To make it even simpler, you can see which fields are completed in the ANSI or in which box on the CMS 1500 claim to ensure you are completing the claim correctly.

The last tab on this screen is the ambulance information tab. If the claim is an ambulance claim, set this option to yes and enter the ambulance trip information following your payers' requirements. Now that your claim has been created, the next step is to submit the claim to your payer so you can receive payment. There are two ways to submit a claim from CMD electronically to the Clearinghouse or by printing and mailing the claim yourself to the payer. If the payer supports electronic claims, we recommend that you submit claims electronically. Under the charges tab you will find a status column for your procedure codes.

This status defines what will be done with the position. Should it be sent to the payer electronically? Will you print and mail the claim to the payer or is the balance owed to the patient? If submitting claims electronically, update the status of charges individually or all at once using the "set all charges to" option, save the claim and CMD will take care of the rest. If you are printing and mailing the claim, update the status, click print, and then select "save and print." It is important to note that the application does not print the claim forms.

You will need to purchase and upload your own forms to your printer. Regardless of which option you select, our system will run the claim through thousands of edits to increase the likelihood that the payer will approve the claim. With our 100% real-time claims submission, if our system detects an error, you will be notified immediately so you can go back and resolve the issue before sending it to the payer. That's all it takes to create and submit a professional claim at CMD. We recommend partnering with your payers to obtain any additional information or requirements they need to include in your claims.

For step-by-step instructions, FAQs, and other how-to videos on the claims section, visit our Knowledge Center at help.collaboratemd.com. Thanks for watching!