Why Does the Wrong Provider Appear on a Claim Sent to CollaborateMD?

Issue

Why does the wrong provider sometimes show up on a claim when sending it to CollaborateMD?

Environment

CollaborateMD, Roles: Account Setup & Providers, Facility permission, User, Features: Claims, Claim Info

Resolution

When CMD decides which provider (doctor or healthcare professional) to link to a claim, it uses a specific matching process:

1. Direct Match by Provider ID

   • CMD first checks if the Provider ID in the claim matches a Provider “Sequence #” in CMD.

   • If it matches, that provider is used.

2. Check for a National Provider Identifier (NPI)

   • If the ID looks like a valid NPI, CMD checks whether exactly one provider in CMD has that NPI.

   • If yes, that provider is used.

3. Match by Facility Reference (if a facility is involved)

   • If the claim includes a facility that CMD recognizes, and the Facility has a “Reference Number,” CMD looks for any providers sharing that same reference number.

   • If matches are found:

     • CMD will only consider those providers.

     • No error is returned, no matter which provider is selected.

4. Narrowing Multiple Matches

   • If multiple providers match, CMD narrows them down in this order:

     • First by First and Last Name

     • Then by Middle Initial

   • If there are still multiple matches after this, CMD will select one.

Additional Information

• Find or edit a facility
• Find or edit a provider