page# CLM068

Search and Submit Pending Claims

ThePending Claims page provides the user access to claims that have not yet been submitted (are “pending” submission) to Department of State Health Services (DSHS) in Clinical Management for Behavioral Health Services (CMBHS). Various search criteria can be entered by the user to search for a Pending Claim. This page then displays your search results. From there you can select a specific claim, view the claim source document and submit the claim to DSHS.

This function in CMBHS currently applies only to substance abuse services. It does not apply to mental health services at this time.

How to Access the Pending Claims Page

• The Pending Claims Search page number is CLM068 and it can be accessed by Hovering over the Business Office Tab on the Administrative toolbar at the top of any page of CMBHS and then CLICKING ON Pending Claims menu item when it appears to the right.

 

How to Search Pending Claims

• To search for a Pending Claim, complete one or more of the search criteria data fields described below and then CLICK on the Search button.
• 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 you are searching for.
• 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 can not 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 Data Fields - Complete two or more of the following Search Criteria data fields:

Funding Source (Optional for search)

Select the appropriate funding source from the drop-down list.

• DSHS Program Funding
• Medicaid
• Medicare Part D
• Medicare Part D
• Self Pay
• Facility Pay
• NorthSTAR
• Other

 

Claims Type (Optional for search)

• Select one of the following claim types:
  • 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 (Optional for search)

• This search criterion displays the business entities’ service locations.
• Select a location from the drop-down box to use Location as search criteria.

 

Service Begin Date (Optional for search)

• TYPE in the 8 numbers of the Service Begin Date mmddyyyy and CMBHS will format them into the correct CMBHS date format,mm/dd/yyyy.

 

Service End Date (Optional for search)

• TYPE in the 8 numbers of the Service End Date mmddyyyy and CMBHS will format them into the correct CMBHS date format, mm/dd/yyyy.

 

Service Types (Optional for search)(Substance Abuse Only)

• The user may search the claims using the Service Type.
• Select one service at a time to use as Search Criteria.

 

Procedure Codes (Optional for search)

• Select a Procedure Code from the drop down menu to use it as Search Criteria.

 

CMBHS Client Number(Optional for search)

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

 

Supporting Document Type (SD Type) (Optional for search)

• Select one of the following types of Supporting Documentation to use as search criteria. This means if you are searching for a claim that was documented using a Day Rate Attendance Record, select Day Rate Attendance Record from the dropdown list.
  • Day-Rate Attendance Record
  • Progress Notes
  • Medication Service

 

Supporting Document Number (SD #) (Optional for search)

• Select the Supporting Document Number from the drop down menu.

What Next?

• After you have completed the data fields for your search, CLICK ON the Search button in the upper right-hand 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, CLM068, however, the search fields are hidden, replaced by a table Submit Claims with the following data fields:

• Claim Type – the claim type is either Professional (individual practitioner) or Institutional (group practice, facilities and institutional)
• 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
• Service Units – the client’s CMBHS number; contains only numbers, no letters
• Service Type – the service type that was provided to the client
• Plan ID - Use the Contract drop down box to select the DSHS contact that corresponds to the claim. 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 DSHS billing system
• Rate - After the contract is selected, the rate will display in the table. 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 contract is selected, the amt (amount) of the claim to be paid by the client, if any will display in the table. 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
• 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, )

• The user may now perform the following functions:
  • View the claim source document
  • Submit claims to DSHS
  • Export the data to your computer
  • Print the results
  • Search again
• How to…
  • View the claim source document for a selected claim, CLICK on the words View Claim Source. A popup box will appear and display the requested document.
  • Submit one or more claims to DSHS, CLICK in the boxes (column after SD Status) for those claims you want to submit. A green check mark appears for the records will be submitted.
  • Export the data to your computer – CLICK on the Export button.
  • Print the results – CLICK on the Print button.
  • Search again – to Search again, CLICK on the Search Again button in the upper right –hand corner of the page.

NEXT,

Submitted Claims