Business Office

This menu selection from the Administrative Toolbar contains functions used by business staff.

The user of these functions must be assigned a role that authorizes access to the claim function. Click here for a listing of tables showing page rights for specific roles in CMBHS.

Clients to be accessed must have a profile in CMBHS. They must be admitted to a program and have received documented services.

The Business Office menu items will depend on the location type.

• From a Substance Use location, Recovery Support Services or Prevention/Intervention location: Client Payment, Services Offered, Search Claims (Pending and Submitted), Provider/Location Detail, Medicaid Eligibility Verification List, and Provider Fee Schedule will be displayed.
• From a Mental Health location: Services Offered, Provider/Location Detail, and Medicaid Eligibility Verification List.
• From the Provider location: Client Payment, Services Offered, Search Claims (Pending and Submitted), Contracts, Provider/Location Detail, Medicaid Eligibility Verification List, and Provider Fee Schedule will display.
• From HCBS-AMH Provider location: Client Payment, Services Offered, Search Claims (Pending and Submitted), Contracts, Provider/Location Detail, Medicaid Eligibility Verification List, and Provider Fee Schedule will display.

The following information will explain each sub-menu item. 

Client Payments

The Client Payments function in Clinical Management for Behavioral Health Services (CMBHS) allows the service provider to document payments made by a client toward the cost of his/her services or a deductible.

To document a client payment, you must have a CMBHS role that gives you Read-Write access to the Client Payments page.

Click here to view a list of Read-Only and Read-Write Page Rights according to your role/s in CMBHS.

To document or view a client’s payments, you must be at the Client Workspace.

Have all the information you will need to document the payment, so you can complete the documentation in one session. The Client Payment page does not have a Draft document status, so it must be completed to save the document. If all the information is not available, the Cancel button will close the page without saving the document. 

Key Client Payment Facts

• The Client Payment page does not check for duplicate entries, so you can enter more than one payment for the same amount for the same day. Check the prior entry to prevent unintended duplicates.
• There is no document status (Closed Complete, Draft, Closed Incomplete, or Ready for Review) for this page. When you Save, the document is in Closed Complete status, although the status does not display on the page.
• This page does not display audit information. Your organization may choose to require those who receive a client payment to document information such as who made the payment (e.g., the client, a parent, or spouse) or where the cash was placed, in the optional Note field.
• Client payments are not connected in any way with other payment functionality in CMBHS — for example, pending claims and/or submitted claims.
• Using the client payment functionality is optional.
• Client Payment entries can be edited after they are Saved. With the Client Payment page open, CLICK on the New Payment button to access the Edit button.
• Your organization may choose to develop a procedure that prohibits staff from changing entries after they have been documented, but CMBHS allows changes to be made.

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How to Document a Client Payment in CMBHS

To document or view a client’s payments, you must be at the  Client Workspace .

The CMBHS Client Payment page is accessed from the Administrative Toolbar at the top of each page of CMBHS. Select  Business Office   >  Client Payments .

The first time this page is opened for a client, you will see the Client Payment History box with “No records found” and the New Payment button above it.

1. CLICK on the New Payment button and the data entry fields display.
2. Complete all the required data fields. See  Client Payment Data Fields.
3. The Note field is optional. Because this page does not display audit information, your organization may require that providers who receive a client payment, document their name and additional information, such as where the cash was placed, in the Note field.
4. CLICK on the Add button. CLICKING on the Add button inserts your documentation into the Client Payment History table. DO NOT FORGET THIS STEP.
5. To document another payment, follow the above steps again. All information from the previous payment will populate the data fields. Remember to change the date (unless a second payment is being made on the same day) even if the payment amount and type are the same. CLICK on the Add button after you record each payment.
6. The last step is to CLICK on the Save button. This saves your documentation in the client record. A Successfully Saved message will display.

The client’s payment history in the Client Payment History table will display any entries or changes during the current episode of care. 

How to Edit a Client Payment

To Edit a client payment that has been saved, first open the Client Payments page from the Administrative Toolbar.

1. CLICK on the New Payment button and the Edit button will display.
2. Select a row to be edited and CLICK anywhere in that row. The row will be highlighted. Select the Edit button.
3. The payment data displays in the Client Payment Information section.
4. Select a field to be changed. TYPE in the new text. The Amount field can be changed by deleting the current value and entering a new value. The Method of Payment dropdown can be selected and changed to the appropriate Method of Payment.
5. If a debit or credit card is used, enter the last four digits in the field that displays. If a check is used, enter the check number in the field that displays.
6. CLICK on the Add button and then the Save button.
7. You may also select an entry to be removed from the table by highlighting the row and CLICKING on the Remove button. 

 

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Client Payment Data Fields

 

Payment Date (Required)

• Document the date that the client made the payment in this field. The date can be a past date but not a future date.
• Enter the eight (8) numbers of the date (mmddyyyy) and CMBHS will format them correctly (mm/dd/yyyy). Or you can type the forward slashes yourself.

 

Amount of Payment (Required)

Enter the amount of the payment in dollars and cents.

 

Method of Payment (Required)

• Document the method of payment used by the client.

The choices are:

• Check – If you select Check, an additional field displays to document the Check Number.
• Credit Card – If Credit Card is selected, an additional field will display. Enter the last four (4) digits of the credit card number.
• Cash – No additional information is required.

• Debit Card – If Debit Card is selected, an additional field will display. Enter the last four (4) digits of the debit card number.

 

NOTE: If it is the policy of your organization, or client preference, not to enter this credit card or debit card information, you can enter a placeholder such as 0000 or 9999. You cannot enter letters in this field.

 

Note (Optional)

• You can document any additional information related to the payment, in the Note field.
• Because the Client Payment page does not display audit information, your organization may require that those who received a client payment document their name and additional information, such as where the cash or payment documents were placed, in the Note field.

 

What’s Next?

• You may check your spelling by using the Spell Check button at the top right of the page.
• After completing these fields, CLICK on the Add button and then on Save.
• You may now view a statement of this client’s payments and the balance due, if any. 

 

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Client Statement

This Clinical Management for Behavioral Health Services (CMBHS) function allows the user to view payments made by the client and produce a statement. If the payments are made towards a deductible documented in the client’s CMBHS Financial Eligibility assessment, the Client Statement will track and total the payments, display a balance due, and then subtract the client’s payments from the balance. 

Important Facts

The Client Statement page is Read-Only. Click here for a list of Roles and their Page Rights throughout CMBHS.

Paraprofessional Supervisor is an add-on role in CMBHS. Users with this role should also be given the role of Clinician to ensure that they have access to all the functionality they need in CMBHS. 

How to View and Use the Client Statement

The Client Payment Statement  can only be viewed right after documenting a client payment in CMBHS. You may not otherwise go directly to the Client Payment Statement page.

To view a client’s Payment Statement in CMBHS, you must be on the client’s Client Workspace.

• First, open the Client Payment page from the Administrative Toolbar at the top of the page by hovering over Business Office and then CLICKING on the first menu item, Client Payment .
• Follow the instructions in How to Document a Client Payment above.
• After you Save the payment, the Statements button will display. CLICK on the Statements button. The Client Payment Statements page displays.

At the top of the page is the Services list, showing the services the client has received during this Episode of Care. The column headers for the list include the Service Date, Service Type, Rate, Claim Amount, DSHS Payment, and Client Payment.

• Beneath the Services list is the Client Payments list that includes all payments made by the client and entered into CMBHS. The column headers for the list include the Payment Date, the Payment method, and the Payment Amount.
• In the lower right corner and beneath the Client Payments list, all the client’s payments are totaled and a Balance displays.
• If the client is not making payments on a deductible balance, a negative number will display in the Balance field. 

 

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Services Offered

This function is an important part of the setup process for every CMBHS Substance Use Disorder (SUD) business entity. It allows the provider to limit, within CMBHS, where certain services are provided. If the Services Offered page is not completed correctly, documentation of progress notes and claims will not operate correctly.

This page must be occasionally updated due to changes in contracts with HHSC and other funding sources, as well as when the provider adds new services to a location and/or removes others. 

Before You Start

The user must be assigned a role that allows Read-Write access to the Services Offered page to set up the page initially and to make changes.

For a list of the Page Rights of all CMBHS roles,  click here .

Before you attempt to complete or update this page, make sure that you have a list of all the services provided at each service location and the characteristics of the persons served (gender, age group). 

Facts about Services Offered

The Services Offered page must be set up for each of the provider’s service locations.

You cannot set up or view the Services Offered page from the administrative/parent level of your organization. The page must be set up at each location.

Adult and Youth services can be set up for the same location. Do this by selecting All as the Age Group. 

How to Access and Set up the Services Offered Page

1. Go to the CMBHS Location you need to set up using the Change Location function on the Administrative Toolbar.
2. Select  Business Office  >  Services Offered from the Administrative Toolbar. The Services Offered page displays.
3. Select the Edit button.
4. Add the Services Offered at this location one at a time.
5. Begin by CLICKING on the first service in the list that is provided at this location. The line detail will be displayed at the bottom of the page.
6. Next select the Offered checkbox
7. Select the appropriate Gender. Options are All, Male, and Female.
8. Select the Update button.
9. CLICK on Save when you have completed the process for all the services offered at this location.

Complete this process for each CMBHS location where you provide services. Remember, this process is not completed at the parent/administrative level of your organization.

Services Offered Data Fields

The Services Offered page has the following data fields:

Service Type (Required)

Select the Service offered by your business entity. The list of Service Types are for any service types, current or expired, used by Substance Use Providers. 

Offered (Required)

• Indicate if this service is offered (provided) at this location.
• If the service is offered at this location, select the check box.
• If this service is not offered, leave the box blank.
• If the Services that display on the Services Offered page are not correct, contact the CMBHS Help Line at Help Line: 1-866-806-7806. 

Age Group (Required)

The Age Group displays as:

• All – Includes all ages served by contract with HHSC.
• Youth – Persons 13 to 18 years of age and older; may include some persons who are up to 21 years old based on funding source.
• Adult – 17 years old or older depending on funding source. 

Gender (Required)

The Gender will display as:

• All
• Female
• Male 

What is Next?

CLICK on Save when you have completed the process for all the services offered at this location.

Complete this process for each CMBHS location where you provide services. 

 

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Claims

This section of the Clinical Management for Behavioral Health Services (CMBHS) Online Help addresses the documentation, submission, and payment of claims using CMBHS for services rendered to clients. The payer may be the Health and Human Services Commission (HHSC), or TMHP on behalf of Medicaid for YES Waiver claims.

Click on one of the following four links to go directly to that section of CMBHS Help.

 

Documenting Service Delivery to Create a Claim

This section describes how to document the services delivered to clients so the correct claim can be created and is ready for review and submission to the payer. CMBHS has four documentation types which can create a Claim:

 

• Progress Note
• Medication Service Note
• Day Rate Attendance
• YES Waiver Services Note .

 

Search Pending Claims

The CMBHS Pending Claims page allows you to search for claims that have been documented but not yet submitted to the payer. After using the Pending Claims Search function, the Pending Claims page displays a list of billable claims that can be submitted to HHSC. Your search can be conducted while you are logged into your service delivery location.

 

Submit Claims

After using the Pending Claims Search function, the Pending Claims page displays a list of billable claims that can be submitted to HHSC. When a claim has been submitted, it no longer appears on the Pending Claims page.  For service providers required to have approvals for claims, the claims will appear on the pending claims page until the final approver has submitted the claim.

 

Search Submitted Claims

The CMBHS Submitted Claims page and function allows the user to view and search claims that have been submitted to HHSC for payment. The Submitted Claims page displays a list of claims that have been submitted by the provider to HHSC and from this page, the status of the claim can be monitored as it moves through the payment process.

 

Before You Start

• Your organization’s contract with HHSC specifies the type of claims you can submit using CMBHS. You can view authorized services on the Contract Activity screen . This screen is only available to entities with a direct contract with HHSC. Service Providers or lower-level service approvers in a multilevel approver set up must reference the highest-level service approver’s contract details.
• You must be assigned a CMBHS role that allows you to create source documents for claims and/or direct access to the claim submission function.  Click here for a list of Page Rights according to CMBHS Roles.
• To submit a claim to HHSC for services provided to a client, the client must have a profile in CMBHS, must be admitted to the provider organization, must have a Service Begin with a billable service type, and must have received services that are documented in Progress Notes, Medication Services, or Day Rate Attendance Records in the client’s CMBHS record.
  • YES Waiver Services Notes require an Individual Plan of Care (IPC) that has been authorized by TMHP in the client’s CMBHS record. 
  • HCBS-AMH Progress Note require an Individual Recovery Plan that has been authorized by TMHP in the client’s CMBHS record for Medicaid claims. Where as Non-Medicaid clients does not need an authorization from TMHP.
  • If your location has “Yes” selected for the “Does this Location Require Approvals?” flag, the client must have an unexpired service authorization in place.
• Before you use CMBHS to document the services received by a client or to submit a claim for payment, you should always verify that you have the correct client by checking the client’s name at the top of the CMBHS page, and at least one other identifier.

Search Claims

This section of the Clinical Management for Behavioral Health Services (CMBHS) Help addresses CMBHS documentation of claims to the Health and Human Services Commission (HHSC).

When you hover your mouse pointer over Search Claims under the Business Office tab, you see the choices of Pending Claims and Submitted Claims.  

 

Pending Claims

The CMBHS Pending Claims page allows the user to Search for claims that have not yet been submitted to HHSC or TMHP. The Search can be conducted from the service delivery Location. After using the Pending Claims Search function, the Pending Claims page displays a list of billable claims that can be submitted to HHSC. When a claim has been submitted, it no longer appears on the Pending Claims page.

For service providers required to have approvals for claims, the claims will appear on the pending claims page until the first approver has submitted the claim. If there are more levels of approval required, it will follow a process like the two-level approval scenario illustrated below:

No	Process Steps	Where the pending/submitted claim is displayed
1	Service Provider completes a progress note.	The claim appears on the pending claim page for the level 1 approver. Level 2 approver does not see it at this point.
2	Level 1 submits the claim to the next level, it will go to level 2	Pending claim will now appear for the level 2 approver on the pending claims page. The level 1 approver will see the claim on the submitted claims page as “Submitted 1 / 2”
3	Level 2 approver submits the claim. Since they are the final level of approval, it goes to HHSC for processing.	The level 1 approver, and level 2 approver will see the claim on the submitted claims page as “Submitted 2 / 2”

 

Submitted Claims

The CMBHS Submitted Claims page allows the user to view and search claims which have been submitted to HHSC for payment. The Submitted Claims page displays a list of claims that have been submitted by the provider to HHSC. From this page, the status of the claim can be monitored as it moves through the payment process. 

 

Searching Pending Claims

• To search for a  Pending Claim , complete the search criteria data fields described below and then CLICK on the Search button. Fields preceded by a red asterisk * are required.
• The maximum date range for searching Pending Claims is 92 days, to ensure that all claims for a 3-month period can be retrieved at one time.
• For HCBS-AMH program, the maximum date range for searching Pending Claims is 90 days, to ensure that all claims for a 3- month can be retrieved at one time. 
• The greater the number of criteria you type in, the fewer the results that will be returned and the more likely you are to find the claim for which you are searching.
• If one or more matches exist, the Pending Claims page will display the claims matching your search criteria. The page can display up to 50 matches at a time. If there are greater than 50 matches, additional pages will be created.
• If no matches are found for the search criteria, the page will display No Records Found .
• If you cannot locate a Pending Claim, you may need to check the Submitted Claims page, as once a claim has been submitted, it no longer appears on the Pending Claims page.

 

Search Criteria

To locate a Pending Claim, search using the following data fields:

Funding Source

• CLICK the arrow on the dropdown list and select a funding source. This is a required field.
• For HCBS-AMH Program, the system would display DSHS Program Funding and Medicaid Claims.

Business Location

• This search criterion displays the business entity service locations and is a required field.
• Select a location from the dropdown list to use as the Location of your search.
• This field will default to the location that is displayed in the upper left banner, which indicates the location where the user is logged in.

Supporting Document Type (SD Type)

• Select the appropriate radio button for the type of claim that will be submitted for payment. The choices are Day Rate Attendance Record, Medication Service, or Progress Note.  YES Waiver is displayed but can only be searched at a YES Waiver Service Provider Location.
• For HCBS-AMH Program, the choices are HCBS-AMH DRA and HCBS-AMH Progress Note
• This is a required field. 

Supporting Document Number (SD #) (Optional)

• This is the unique number given by CMBHS to each document created in CMBHS. This number can be obtained from the Client Workspace   in the   Document List . If you have it, this is one of the quickest ways to determine if a claim is in the Pending Claims List.
• Enter the Supporting Document Number into the text box and select Search. 

Service Begin Date

• TYPE the eight numbers of the service begin date and CMBHS will format them as mm/dd/yyyy. Or, you may type it this way yourself. This field is required.

Service End Date

• TYPE the eight numbers of the service end date and the program will format them as mm/dd/yyyy. Or, you may type it this way yourself. This field is required. 

Service Types

• Although this is not a required field, a number of service types are available to choose from in the dropdown list. The more search criteria you provide, the more accurate your search results will be.
• Select a service type from the list.
• For HCBS-AMH Program, the selection made in the “Funding Source” drop-down will decide the drop-down values of Service Types. 

Procedure Codes

• Select a Procedure Code from the dropdown list to set it as a search criterion. This is not a required field, but it can help narrow your search.
• For HCBS-AMH program, value in the Service Type drop-down will decide the value in the Procedure Code drop-down. 

CMBHS Client Number

• If you know the client’s CMBHS number, TYPE it in this text box. The number contains only numerals, no letters. The use of a Client’s CMBHS Number in a search will display the pending claims for that client.

 

What’s Next?

• Now you may click on the Search button in the upper right corner of the screen to conduct a search for Pending Claims.
• Your results will display on a new view of the page without the Search Criteria fields — either the claims that match your criteria will display, or a message will display saying No Records Found.
• If results display, you can use the View link to see the claim source associated with a claim.
• You can select one or more claims from this page and submit them for payment.

 

 

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Submitting Claims

This section of the Clinical Management for Behavioral Health Services (CMBHS) Online Help provides information on submitting claims to HHSC for services provided to eligible clients. This function in CMBHS is currently available only to HHSC funded substance use disorder services provided through an active contract with HHSC and for Youth Empowerment Services (YES) Medicaid Waiver Services paid by TMHP.

How to Access the Submit Claims Function

• The process for submitting claims to HHSC begins with the Search Pending Claims page.
• The Search Pending Claims page can be accessed by hovering over the Business Office Tab on the Administrative Toolbar at the top of any page of CMBHS.
• When the menu drops down, hover your mouse pointer over Search Claims and CLICK on the  Pending Claims menu item when it appears to the right.

 

Submit Claims

After you have completed the data fields for your search, CLICK on the Search button in the upper right corner of the page.

If there are no matches for your search, No Records Found will display in  the table.

If CMBHS finds matches for your search criteria, your results will display on the same page; however, the Submit Claims table will be displayed , with the following data fields:

• Claim Type – the Claim Type is either Professional (individual practitioner) or Institutional (group practice, facilities  and institutions).  Claim Type column is not applicable to HCBS-AMH Program.
• Client Number – The client’s CMBHS number contains only numbers, no letters.
• Client Name – The client’s first and last name.
• Begin Date – the Begin Date for the claim.
• End Date – the End Date for the claim.
• Claim Status
• Submission Level Column to Display Submitted level for Original/Cancel/Corrected Status

• Service Provider – The name of the person who created the Progress Note. And for DRA records, it would be blank.

• Service Units – The units by which the service is measured.
• Service Type – the Service Type that was provided to the client.
• Plan ID – Use the Contract dropdown list to select the HHSC contract that corresponds to the claim. The list will be blank until a Contract/Plan ID is selected for  the claim.
• Billing Procedure Code – the Healthcare Common Procedure Coding System (HCPCS) billing code used by the HHSC billing system.
• Rate – After the contract is selected, the rate will display in the table. This field will be blank until a contract/plan ID is selected for the claim.
• Claim Amt – After the contract is selected, the claim amt (amount) will display in the table. Will be blank until a contract/plan ID is selected for the claim.
• CP Amt – After the HHSC Contract is selected, the amt (amount) of the claim to be paid for the client, if any, will display in the table. This field will be blank until a contract/plan ID is selected for the claim.
• FE # – Document # (number) for the Financial Eligibility currently in effect for the client. FE column is not applicable for HCBS-AMH program.
• SD # – Source Document # (number) for the claim.
• SD Type – Source Document type (progress note, day-rate-attendance record, or medication service).
• SD Status – Source Document status (original, cancel).

 

How to Submit a Claim

After searching for pending claims and receiving your search results, you may now perform the following functions.

 

• To View the claim source document for a selected claim: CLICK on the words View Claim Source . A pop-up box will appear and display the requested claim source document.

To Submit one or more claims to HHSC:

1. Select those to be submitted to HHSC for payment by either CLICKING in the checkbox (after SD Status column) at the top of the column to check the entire page of claims to be submitted, or select the claims one at a time. A check mark appears for the record/s that will be submitted.
2. The maximum number of Claims that can be submitted to HHSC at one time is one hundred (100).
3. Next, select the Contract from the dropdown list in the top right corner of the table, for the claims you have selected. After you select the Contract , the page will refresh. Depending on the number of claims you selected, this refresh may take  some time.
4. When the processing is finished, the claims will display with the Plan ID , Rate , Claim Amt , and CP Amt , and all the claims will have a check mark in the select field.
5. If, after processing, all or some of the claims disappear from the list, then you have not selected the correct Contract from the list or the contract is not set up for that service type, population, or clinic. Go back to the top of the page and select another Contract. If the correct contract was selected and there is a problem with your contract, contact your contract manager.

• To Export the data to your computer: CLICK on the Export button.
• To Print the results: CLICK on the Print button.
• To Search again: CLICK on the Search Again button in the upper right corner of the page.

Once the desired claims have been selected, click on Submit Claims.

A report of the submitted claims will display.

 

 

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Searching for Submitted Claims

This section of the Clinical Management for Behavioral Health Services (CMBHS) Online Help provides information on finding claims in CMBHS that have already been submitted to HHSC for payment. This function in CMBHS is currently available only to HHSC funded substance use services provided through an active contract with HHSC, and for Youth Empowerment Services (YES) Medicaid Waiver Services paid by TMHP.

 

How to Search for Submitted Claims

1. To search for a Submitted Claim, hover your mouse pointer over Business Office on the Administrative Toolbar, then hover over Search Claims and click on Submitted Claims.
2. Complete one or more of the Search Criteria data fields described below and then CLICK on the Search button.
3. The greater the number of criteria entered, the fewer the results that will be returned and the more likely you are to find the claim for which you are searching.
4. If one or more matches exist, the Submitted Claims page will display the claims matching your search criteria. The page can display up to 50 matches at a time.
5. If no matches are found for the search criteria, the page will display No Records Found.
6. If you cannot locate a Submitted Claim, you may need to check the Pending Claims page to verify that the claim was submitted. After a claim has been submitted, it no longer appears on the Pending Claims page.

Once the Search Claims screen has been completed, select Search.

 

Search Criteria Data Fields

• Complete the following search criteria to search for submitted claims. The more fields you complete, the more accurate your results. Fields marked with a red asterisk * are required.

 

Funding Source

• Currently, only HHSC funded claims for Substance Use services can be submitted for payment. Medicaid claims will be displayed on the dropdown list, but that functionality is not available yet. This field is required.
• From a YES Waiver Service location, only YES Waiver will be displayed in the Funding Source dropdown list.
• For HCBS-AMH Program, the Funding Source values will be DSHS Program Funding and Medicaid Claim.

 

Claims Type  (This is not applicable to HCBS-AMH Program)

Select one of the following claim types (not required):

• Professional – This claim type is used by an individual practitioner.
• Institutional – This claim type is used for services provided in group practice, facilities, and institutional settings.

 

Business Location

• This search criterion displays a business entity's service locations.
• Select a location from the dropdown list to use Location as search criteria. This field is required for search.
• This field will default to the location listed on the top left banner and indicates the location where the user is logged in.

 

Service Begin Date

• TYPE in the eight numbers of the Service Begin Date mmddyyyy and CMBHS will format them into the correct CMBHS date format, mm/dd/yyyy. Or you may enter the date this way yourself. Required field.

 

Service End Date

• TYPE in the eight numbers of the Service End Date mmddyyyy and CMBHS will format them into the correct CMBHS date format, mm/dd/yyyy. Or you may enter the date this way yourself. Required field.

 

Service Types

• Choose a Service Type from the dropdown list.
• For HCBS-AMH program, the selection made in the Funding Source drop-down will decide the values in the Service Types drop-down.

 

Procedure Codes

• Select the appropriate Procedure Code from the dropdown list.

 

CMBHS Client Number

• The client's CMBHS number contains only numbers, no letters.
• TYPE the client’s CMBHS number into the text box.

 

Plan ID

• TYPE the client’s Plan ID in the text box.

 

Supporting Document Type (SD Type)

• Select the type of documentation that was used to document the claim from the dropdown list. You may choose from Day Rate Attendance Record, Medication Service, or Progress Note. YES Waiver will display but is only functional at a YES Waiver Service Provider location.

 

Supporting Document Number (SD #)

• TYPE the Document Number in the text box.

 

Claim Status

• Choose the status of this claim from the dropdown list.

 

Claim Identification Number (CID)

• Type the Claim ID Number into the text box.

 

Voucher ID (VID)

• This is the Voucher Identification number assigned by the HHSC contract management and payment system.
• If you know the Voucher ID number, enter it here to use it as a search criterion.

 

What's Next?

After you have completed the search data fields, CLICK on the Search button to the right. If your search nets results, they will display.

 

Your Search Results

After you search CMBHS for Submitted Claims, your results, if any, will display with the following information:

 

• Begin Date – Source Document begin date
• End Date – Source Document end date
• Units – Units of service
• Service Type – Service client is receiving
• Client Name – in Last Name, First Name format.
• Service Provider – The name of the person who created the Progress Note. And for DRA record, it would be blank.
• Billing Procedure Code – the Healthcare Common Procedure Coding System (HCPCS) billing code used by the HHSC billing system
• Claim Amt – Amount of claim
• SD # – Source Document number. Hyperlink that when selected will display the source document in a separate window
• SD Type – Progress Note, Day-Rate Attendance Record or Medication Service Note
• Claim Status – Status available from the dropdown list
• Submission Level - Display level of Submission for Multilevel Approvers
• Payment Amt – Claim payment amount
• Payment Date – Date the claim was processed for payment
• View Claim – Claim detail hyperlink will display

The submitted claims list can be printed or exported to an Excel spreadsheet.

Claim Submission Process

After submission, the claim is processed through other HHSC systems. Typically, a claim is processed within a week of submission, although this is subject to change and dependent on system updates and the voucher processing system. The main claim status options include:

• Original
• Pending
• Approved
• Vouchered / Partially Vouchered
• Recouped
• Rejected

 

Some additional claim status include:

• Void
• Reversed
• Deleted before sent to source
• TMHP Accepted (Medicaid claims only)
• TMHP Denied (Medicaid claims only)
• TMHP Processed (Medicaid claims only)
• TMHP Rejected (Medicaid claims only)
• TMHP Reversal (Medicaid claims only)
• Deleted before sent to TMHP (Medicaid claims only)

View Claim Detail

The sections of the Claim Detail are:

Claim Information and Claim Information Source

This section contains the:

• Claim number – system generated claim number
• Dates of Service – service begin and service end date
• Claim Status – the current status of the claim
• Submission Level- Multilevel Submission will be displayed
• Claim Status Date – date the claim was set to the current status
• Billed Amount – Claim Billed amount
• Paid Amount – Claim paid amount

Voucher Information

This section contains the:

• Voucher ID – system generated number
• Voucher Status - current status of the voucher
  • Completed = Paid
  • Cancelled = Voucher was cancelled because of an internal HHSC issue.  Claim will be repaid on a subsequent voucher.
  • Replaced = Voucher was cancelled and repaid on a voucher processed within the HHSC Account system.
• Voucher Date - date the voucher was generated
• Voucher Comments - Comments related to cancelled or replaced vouchers

 

Patient Information

This section contains the:

• Client name – in Last name, First name format
• Medicaid number – Client's Medicaid number. This field will be blank if the client does not have Medicaid.
• Date of Birth – Client date of birth in mm/dd/yyyy format
• CMBHS Client # – CMBHS generated client number

Provider Information

This section contains the:

• Provider NPI – Provider’s National Provider Identifier
• Provider Name – Provider name as it appears in CMBHS

Claims Details

This section contains the:

• SD# – Source Document number
• Begin Date – Client's service begin date
• End Date – Client's service end date
• Procedure Code
• Modifiers
• Units
• Billed Amount
• Paid Amount
• Provider NPI

EOB/EOPS Codes & Messages – this section will only populate for Medicaid claims. EOB means Explanation of Benefits and EOPS means Explanation of Pending Status.

 

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Contracts

This function in the Clinical Management for Behavioral Health Services (CMBHS) application allows a user to view his/her business entity’s contracts with the Texas Health and Human Resources Commission (HHSC) and, after selecting a contract, to perform functions related to payment and reporting requirements.

 

Before You Start

Your business entity must have a contract with HHSC (or with an entity that contracts with HHSC) that allows you to view contracts.

The user must have a CMBHS user role that allows access to this CMBHS function. For a listing of Page Rights — read-only or read-write — according to Roles in CMBHS, click here.

 

Contract Facts

• The HHSC Contracts displayed on the contracts page include past inactive contracts, as well as current active contracts.
• CMBHS displays contracts on the basis of Vendor ID . Your business entity’s Vendor ID was entered into CMBHS during the initial setup process.
• Some business entities may have several pages of contracts. If the user’s list has more than one page of contracts, the page numbers are displayed in blue font at the bottom left corner of the Contract List.
• If there are several pages of contracts, use the column headers to sort the contracts. This will help you find the contract you are looking for more quickly and allow you to be sure that a contract is not listed before contacting HHSC.
• All contract functions are not available to all contracts nor are they available at all times. Some contract function buttons will be grayed–out when this function is not available to the user because of the contract type, the user’s role, or the status of a current or previous submission.

NOTE: CMBHS does not have a function to allow the user to directly view the text of his/her HHSC contract in CMBHS.

 

Contracts Page Data Fields

All of the following data fields are Read Only for CMBHS users. They are made available on the Contracts page, so users have enough information to select the correct contract for other functions. To access the Contracts page, hover your mouse pointer over the Business Office tab of the Administrative Toolbar, and CLICK on Contracts.

The Contracts Page displays. The following are the column headers:

Contract ID

• This is an HHSC assigned contract identification number.

 

Begin Date

• This is the date the contract starts.

 

End Date

• This field displays the date the contract ends.

 

Funding Source

• The source of funding for each contract is displayed in this field.

 

Contract Type

One of the following contract types will display.

• Fee for Service/Unit Rate
• Quarterly Allocation
• Cost Reimbursement
• Deliverable
• Lump Sum

 

Distribution Method

One of the following methods of payment/distribution of funds will display.

• Contract % based
• Activity based
• PO % based

 

Contract Status

• This field displays the current status of the contract.
• The Contract Status is either  Active  or  Inactive .

 

Contract Amount

• This is the total amount of the contact for the specified time period.

 

Payment Previously Requested

• This field reflects the amount of the previous payments requested by the provider.

 

How to Find and Select a Contract

To find and select a contract in CMBHS, log in to CMBHS and then h over your mouse pointer  over the Business Office tab on the Administrative Toolbar at the top of the page.

• CLICK on Contracts and the contracts page will display with a list of all the contracts the business entity currently has with HHSC. Contracts from previous years also display.
• CMBHS displays Contracts for a provider based on USAS Vendor ID.
• To select a Contract, CLICK anywhere in the row for the desired Contract. When the row is highlighted, you are ready to select one of the Action buttons.

 

What’s Next?

After selecting a Contract, you may CLICK on one of the following buttons located at the bottom of the list:

• Invoices
• Advances
• Financial Status Reports
• Contract Activity
• Measures
• Curriculum Measures

 

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Invoices

This section of the Clinical Management for Behavioral Health Services (CMBHS) Help provides information to assist users in managing invoices to be submitted to the Health and Human Services Commission (HHSC). The HHSC MH/SUD contracts and claims payment system provides the information needed by CMBHS to support the correct operation of this function.

The invoice types included in this function are Cost Reimbursement Quarterly Allocations, Lump-sum Payouts, and .

 

Before You Start

• The CMBHS business entity must have an executed contract with HHSC that requires billing by invoice.
• The user must be assigned a role that permits him/her to select the contract for which an invoice will be submitted. Click here for a listing of Roles according to Page Rights.
• The Oversight role has Read-Only access to the CMBHS Invoice function.
• The Billing Specialist, Business Manager, and Security Administrator have Read-Write access to these pages.
• In CMBHS, invoices can only be submitted from the business entity's Provider location. The CMBHS user cannot submit invoices from service or clinic locations. To determine if the Provider location is selected, look to the upper left banner and confirm the Provider level is displayed.

 

Business Rules for Invoices

• Invoices can only be edited or deleted while in Draft and Submitted status.
• When a user deletes an Invoice, the record is removed from the CMBHS system and cannot be retrieved, even by HHSC.

 

Invoice Page Data Fields

At the top of the Invoice page, the following information about the Contract displays:

Contract ID (Read-Only) – This is an HHSC assigned contract identification number.

 

Contract Type (Read-Only) – The type of HHSC contract.

One of the following contract types will display.

• Fee for Service/Unit Rate
• Quarterly Allocation
• Cost Reimbursement
• Deliverable

 

Begin Date (Read-Only) –  This is the HHSC contract begin date.

 

End Date (Read-Only) –  This field displays the date the contract terminates or ends.

 

 

List of Invoices

If invoices have been submitted for this contract or if there are invoices in Draft status, they will display in the List of Invoices.

The List of Invoices includes the following information about each Invoice:

Invoice Number – Initially will be blank. CMBHS will assign a number after the invoice is submitted to HHSC.

Invoice Date – The Date the Invoice was submitted by the provider to HHSC.

Invoice Type – One of the following Invoice Types will display:

• Cost Reimbursement –  Contact % based, PO % based
• Deliverable – Lump sum, Contact % based, PO % based
• Cost Reimbursement –  Activity Based
• Deliverable – Lump sum, Activity Based

Invoice (Begin Date - End Date)

Invoice Amount – The total dollar amount of the Invoice.

Invoice Status – One of the following statuses will display:

• Draft
• Submitted
• In-process
• Vouchered
• Rejected

 

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How to Create and Submit a New Invoice

1. From the Contracts page, select the contract for which the invoice will be submitted by CLICKING anywhere in that row. The row will be highlighted.
2. Then CLICK on the Invoice button at the bottom of the table. The Invoices page will open.
3. When the Invoices page opens, CLICK on the New button on the right side of the table to create a new invoice. The New button will open the Invoice page.
4. At the top of the page, information about the selected Contract will display. The information is generated by CMBHS and is view only.
5. On the Invoices page, you can either pick an existing invoice by CLICKING anywhere in the row or you can CLICK on the New button on the right side of the Invoices List table.
6. Complete the Invoice data fields, and ensure that the information in the Invoice data fields is correct, and then CLICK the Submit button.

 

Data Fields for a New Invoice

Request Type (Read-only)

• The Request Type is assigned by CMBHS.
• The first time an Invoice is submitted for any given month, its type is Initial .
• Any subsequent Invoices submitted for the same month are Supplemental .
• If the Request Type is Supplemental , the user must TYPE justification information in the Comments box.

 

Invoice Begin Date/End Date (Required)

The rules for the Begin Date and End Date are:

• The Begin Date and End Date must fall within the Contract Begin Date and End Date.
• The Begin Date and End Date must be within the same month.
• The Begin Date cannot be in future. It can be the current date.
• The End Date cannot be in the future. It can be current date.
• The Begin Date must be on or before the End Date.

 

As of Date (Required)

• The As of Date cannot be a date in the future and it must be within the Begin and End dates of the Contracted program.
• The rules for the As of Date are:
• The As of Date must be greater than or equal to the End Date.
• The As of Date must be greater than or equal to the As of Date in the last Invoice for that contract.

 

Total Expenditures (Required)

• Total expenditures must be greater than zero. This amount is the amount to be requested plus any previously requested payments.

 

Payments Previously Requested (Required)

• This is a read-only field.
• The values are derived from the HHSC con tract payment system.

 

Total Requested Amount (Required)

• This is a read-only field.
• The system generates the Total Requested Amount based on the following formula:

Total Requested Amount = Total Expenditures (–) Payments Previously Requested

• When submitting an invoice, the total requested amount must be greater than zero.

 

Invoice Status

The default status for the Invoice is Draft. It will remain in this status until the user CLICKS on the Submit button.

The user has only one option for changing the status of the Invoice. The user can change the status from Draft to Submitted. This is done when all data entry is complete and the user CLICKS on the Submit button to send the Invoice to HHSC. The status will change to Submitted.

After the user has submitted the Invoice, one of these five statuses will display:

• Submitted – Displays after the user has submitted the Invoice to HHSC .
• In Process – The transmission of information to HHSC has failed.
• Pending – The Invoice has been received by HHSC.
• Rejected – HHSC has rejected the Invoice.
• Vouchered – The Invoice has been accepted by HHSC and is being processed.

CMBHS will not allow the submission of another Invoice when the previous submission is in Draft or Submitted status.

 

How to Find an Existing Invoice

1. Log in to CMBHS.
2. On the Administrative Toolbar at the top of the page, select Business Office > Contracts.
3. The Contracts page will open and display a list of your business entity's HHSC contracts.
4. Select the Contract for which you want view an existing invoice by CLICKING anywhere in that row. The row will highlight with a darker color to indicate it is selected.
5. Then CLICK on the Invoices button at the bottom of the table. After the Invoices page displays, select the Invoice you wish to view by CLICKING anywhere in its row. The row will highlight. Then CLICK on the VIEW button.
6. The Invoice page will display depending on your contract type.
7. When you have finished viewing the Invoice, CLICK on the Close button and you will return to the List of Invoices.

 

How to Edit an Existing Invoice

1. Users can edit an Invoice while it is in Draft or Submitted Status.
2. From the Contracts page, select the Contract for the Invoice you wish to Edit by CLICKING anywhere in the Contract's row.
3. Then CLICK on the Invoices button at the bottom of the table. The Invoices page will open.
4. When the Invoices page opens, you will see the Contract Information for the Invoices displayed at the top of the page. This information is generated by CMBHS and is view only.
5. Select an existing invoice by CLICKING anywhere in its row. Then CLICK the View button. When the Invoice opens, check the Invoice Status field. If the Status is anything other than Draft or Submitted, you will not be able to make a change to the Invoice.
6. If the Status is Draft or Submitted, make the needed changes to the data fields. Ensure that the information is correct and then CLICK on the Submit button.

 

 

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Provider Location Detail

This section of the Clinical Management for Behavioral Health Services (CMBHS) Online Help provides information on the Provider Detail and Location Detail for an entity in CMBHS.

The initial setup for the Provider Location Detail happens when an entity is granted access to CMBHS. HHSC Contracts will provide the CMBHS Business Team the necessary information to set up the organization in CMBHS.

Provider Detail

The Provider Detail menu, when accessed from the Provider Location, will display six tabs:

Provider Information – the following are the fields on this tab:

— Provider Business Type – the following are the options in this field. This is a required field:

• Other Business Type – Optional field if needed.
• Other Business Type – Mandatory if selected “Other (specify) in the Provider Business Type field above.
• Provider Legal Name – Provider's name as it appears on their contract.
• Provider Common Name – The name the provider typically uses. May or may not be the same as the Provider Legal Name. Optional field.
• Effective Date – Date the provider is entered into CMBHS or the contract begin date. Optional field.
• Expiration Date – Date the provider's access is terminated or the end date of the contract. Optional field.
• Business Phone Number/Ext: – Provider's primary phone number. This field is required. You can add an extension in the Ext field.
• Toll Free Number/Ext: – Optional field if needed.
• Fax Number – Optional field if needed.
• Webpage URL – Optional field if needed.
• Email – Optional field if needed.

— Addresses – The mailing, billing, and physical address are required for every provider location. This tab has the following fields:

• Address Type – This is a required field. It is a dropdown list with the following options:

        - Mailing     

        - Physical     

        - Billing     

        - Other

• Address Line 1 – Address line one is a required field.
• Address Line 2 – Optional field for additional address information.
• Zip Code – Required field is a five-digit field with an optional zip code extension having a four-digit field.
• City
• State
• County

— Identifiers – A required identifier is needed depending on the location type and contract type. The following are the identifier types:

• API – Atypical Provider Identifier
• BHIPS Organization Number – The previous EHR system
• Benefit Code – Used for TMHP claims and authorizations
• Component Code – Required field for MH locations
• Default MH Location – Used to designate the location for Batching purposes
• Federal Employer ID Number
• Guid – CMBHS system-generated unique number
• License Number – Clinic license number
• NPI – National Provider ID
• Other Vendor ID – Optional field if needed
• Provider Sub Group – used for MH locations
• Site Number – Required field for SUD location — usually the location's clinic number
• TPI – Texas Provider Identifier issued by TMHP
• Taxonomy – a hierarchical code set that consists of codes, descriptions, and definitions. For more information or to obtain a taxonomy, go to https://nppes.cms.hhs.gov/NPPES/Help.do?topic=Taxonomy
• USAS Vendor ID – Comptroller contract and payment system number used for processing payments
• Identifier Text – Required field used to enter the description of the Identifier type
• Begin Date – The begin date of the Identifier
• End Date – The end date of the Identifier

— Contacts – Required contact(s) are needed depending on the location type and contract type. The following fields are found on the contacts tab.

- Contact Type

• CEO
• Contractor Risk Manager
• Crisis Counseling Staff
• MHSA Disaster Staff
• Primary
• Safety Officer
• Secondary

    - Prefix

   - Suffix

- First Name

- Middle Name

- Last Name

- Office Phone

- Cell Phone

- Email

— Provider Flags – Used to activate or deactivate a provider location

— Locations – All locations associated with the provider location

You must have the appropriate role to view this page and only the Security Administrator can make changes or request changes.  Click here for a list of Page Rights according to Roles in CMBHS.

 

Location Detail

The Location Detail menu, when accessed from a location, will display five tabs:

— Location Information – The following are the fields on this tab:

• Location Type – Depends on the Provider Organization. The following are the possible location types:
• SU – Substance Use Location
• MH – Mental Health Location
• OSAR – Outreach/Screening/Assessment/Referral Location
• UM-MH – Utilization Management (MH) Location
• HCC – Healthy Communities Collaborative Location
• BMO – Behavioral Management Organization
• Prevention/Intervention
• Recovery Support Services – Peer support program

— Addresses – The components of the address are:

– Address Type – When editing or entering an address, this is a dropdown field with the following options :

• Mailing
• Physical
• Billing
• Clinic
• Other

– Address 1 – Address line is a required field

– Address 2 – Optional field for additional address information

– Zip Code – Required field for a five-digit zip code, and a four-digit, optional zip code extension field

– City

– State

– County 

— Identifiers – An identifier is required depending on the location type and contract type. The following are the identifier types:

• API – Atypical Provider Identifier
• BHIPS Organization Number – The previous EHR system
• Benefit Code – Used for TMHP claims and authorizations
• Component Code – Required field for MH locations
• Default MH Location – used to designate the location for Batching purposes
• Federal Employer ID Number
• Guid – CMBHS system-generated unique number
• License Number – Clinic license number
• NPI – National Provider ID
• Other Vendor ID – Optional field if needed
• Provider Sub Group – used for MH locations
• Site Number – Required field for SUD locations – Usually the location's clinic number
• TPI – Texas Provider Identifier issued by TMHP
• Taxonomy – a hierarchical code set that consists of codes, descriptions, and definitions. For more information or to obtain a taxonomy, go to https://nppes.cms.hhs.gov/NPPES/Help.do?topic=Taxonomy
• USAS Vendor ID – Comptroller contract and payment system number used for processing payments

— Contacts – Required contact(s) are needed depending on the location type and contract type. The following fields are found on the contacts tab.

- Contact Type

• CEO
• Contractor Risk Manager
• Crisis Counseling Staff
• MHSA Disaster Staff
• Primary
• Safety Officer
• Secondary

- Prefix

- Suffix

- First Name

- Middle Name

- Last Name

- Office Phone

- Cell Phone

- Email

— Location Flags – Used to make the location active, inactive, or in a pending status. Also to indicate whether the location is an external provider, internal provider (from the dropdown), or LBHA (indicated with a checkbox).

For more information, also see the Managing Locations section.

You must have the appropriate role to view this page, and only the Security Administrator can make changes or request changes. For more assistance with Provider Location Detail, contact your contract manager or the CMBHS Help Line.

 

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HCBS Provider Setup

The navigation path to enter the Provider/Location Type in CMBHS is Business Office > Provider/Location Detail > Provider | Location > Provider | Location Information.

The Home and Community Based Services–Adult Mental Health (HCBS-AMH) program added two additional flags on the Provider/Location detail page, which will help in setting up the Providers of the HCBS-AMH program. HCBS-AMH program has Provider Agencies (PA’s) and Recovery Management Entities (RME’s).

Flags which will be displayed under Provider Details page > Provider flags are:

• Is HCBS-AMH? Yes/No radio Buttons (Entered by HHSC and required).
• HCBS-AMH type – PA/RME radio buttons (Entered by HHSC and required).
• If the HCBS – AMH flag is Yes, then hide all the other flags on the screen: LBHA, TTOR service Location, IS Yes waiver, ER&S Submitted, Non LMHA MH Provider, MCO Contract Location.
• IF the HCBS-AMH flag is NO, then display all above-mentioned flags.
• HCBS-AMH type – PA/RME radio buttons (Entered by HHSC and required.)

Provider/Location Detail

The “Title” field has been added under the Last Name field on the contact tab of the Provider/Location Detail page.

• Title field – This is an optional field.

HCBS Summary

Home and Community Based Services–Adult Mental Health will serve the Mental Health locations. All the Providers for this program will be under Location Type–MH.

 

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Provider Fee Schedule

The Provider Fee Schedule is accessed from the Client Services Toolbar > Business Office > Provider Fee Schedule. This page can only be edited from your organization's administrative, or parent, level.

To enter a new fee, access the Provider Fee Schedule page and select a Service Type from the dropdown list. Click the New Provider Fee button in the Service Code List area of the page.

Select a Service Code from the dropdown list. In the Provider Fee text box (required), TYPE in the amount of the provider fee for that service code.

Select the service Begin Date (required) and End Date by clicking the calendar icons and clicking on the correct dates. Or you can type the dates into the text boxes.

Click the Add button, and then click Save. When you select the same Service Type again from the dropdown list, the details of the Provider Fee you entered will display in the Service Code List area.

Audit Information at the bottom of the page will detail who created the Provider Fee, when it was created, who it was last saved by, and the date of the last save.

Service Approvers

Service Approver Screen – SVC037

• Access for external (non-HHSC) users will be displayed under Business Office Menu

Overview

Service Approver Page will allow Provider Locations and Approvers to see their Sub contractors according to relationship set up by the HHSC Administrator. This page only applies to providers who have an approval set up. Service providers with a direct contract with HHSC for services will not see their information displayed on this page.

Before You Start

• User must have CMBHS Login User id and Password
• User must have Service Approver Page Access. Click here for a listing of tables showing page rights for specific roles in CMBHS. 

How to Access

• Login to CMBHS using User name and Password
• Go to Business Office Menu
• Click on Service Approver from the Dropdown
• Service Approver Page SVC037 will be displayed

Filter By

Approver: User can choose Approver from the Filter option and system will list all Service Provider Locations under that Approver.

Service Provider: User can choose Service Provider from the Filter option and system will display all locations and approvers attached to that Service Provider.

Service Provider Location: When a Service Provider has been selected, User can choose a Service Provider Location from the Filter option and system will display Service Provider and Approvers for that location.

Columns

• Service Provider: The name of the ‘parent’ location of the entity providing services.
• Service Provider Location: The name of the ‘child’ location of the entity providing services.
• Approver: The name of the ‘parent’ location of the entity providing approvals.
• Approver Location: The name of the ‘child’ location of the entity providing approvals.
• Approver Level: The level of the entity providing approvals. If multiple entities must provide approvals for services or claims. A lower number approver indicates the entity who provides approvals first.
• Effective Date: The date when subcontractor relationship has started as per contract.
• End Date: The date when subcontractor relationship will end as per contract, if available.
• Feature Type: SAR, Claims, MH
  • SAR: Service Authorization Request: The service authorization function in CMBHS provides the method by which the provider, through his/her Authorization Requester, documents a request for approval for a client’s services using an automated process.
  • Claims: The claims approval function in CMBHS provides the method by which the provider through their approvers, submits the request for payment for a client’s services.
  • MH: 
• View Hyperlink: View Hyperlink will navigate to Service Approver detail page where user can see the detail record for each service provider.

Buttons :

New Approver: This button is disabled for NON HHSC Users.

Close: This button will allow to the user to close the Service Approver page and go back to homepage.

Edit: This button is visible when you have selected “View” for one of the service providers. This button is disabled for NON HHSC Users.

Checkbox:

Display Expired Record: System will display all expired records along with active records. Expired Record – The records which end date has passed.