Submitting Claims

This section of the Clinical Management for Behavioral Health Services (CMBHS) provides information on submitting claims to the Department of State Health Services (DSHS)for services provided to eligible clients. 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 Submitted Claims Page

• The Submitted Claims 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 Submitted Claims menu item when it appears to the right.

How to Search for Submitted Claims

• To search for a Submitted 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 Submitted Claims page will display the claims matching your search criteria. The page can display up to 50 matches at a time.
• If no matches are found for the search criteria, the page will display “No Records Found”.
• If you can not locate a Submitted Claim, you may need to check the Submitted Claims page as once a claim has been submitted, it no longer appears on the Submitted Claims page.

Search Criteria Data Fields - Complete one 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 your search data fields, CLICK ON the Search button to the right. Your results, if any, will display.
• After you search CMBHS for submitted claims, your results, if any will display with the following information:
• Claim Type
• Begin Date
• End Date
• Units
• Service Type
• Name
• Plan ID
• Rate
• Claim Amt
• CP Amt
• Adj Amt
• FE #
• SD #
• SD Type
• Claim Status
• CID
• VID
• Payment Amt
• Payment Date

Funding Source (Required)

• Select a funding source from the dropdown list by CLICKING ON the arrow and highlighting your selection.
• The choices are:
  • DSHS -Texas Department of State Health Services – refers to DSHS payment for substance abuse services
  • BHO -Behavioral Health Organization
  • Medicaid – The client is currently receiving Medicaid services.
  • PI – The client has private insurance coverage.
  • Other – Other funding source. Type In the specific information in the text box.

Claim Type (Required)

• Make your choice by CLICKING IN the radio button next to your choice.
•  The choices are:
  •  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 (Required)

• Select the CMBHS Location where the service was provided from the dropdown list.
• The locations that display were entered in the original set-up of your organization. If you need a location that does not display, contact your Local CMBHS Security Administrator.

Service Begin Date (Required)

• This is the date the service was delivered.

Service End Date (Required)

• This is the date the service was ended.

Service Provider (Required)

• TYPE the Clinician’s Name in the text box.

Service Types (Required)

• Select a Service Type from the dropdown list.

Procedure Codes (Required)

• Select a Procedure Code from the dropdown list.

Client (Required)

• Type in the Name of the client you are searching for into the text box.

Plan ID (Required)

• Select the Plan ID from the drop down list.

 

Supporting Document Number (Required)

• Type in the Supporting Document Number.

Claim Identification Number (Required)

• Text box

Output (Required)

• Same as Query Criteria

Selection option (Required)

• This check box is checked by default.

Client Payment Amount (Required)

• This field is displayed only if the client was required to pay a certain amount for the services.

Link (Not Required)

• This is a Link not a data entry field. This link is a tool that allows the user to view Individual Claims.

 

Claims Status Inquiry

You can search for Claims by filling in one or more of the fields below.

Funding Source (Required)

Make a selection from the Dropdown list

• DSHS: This client meets the criteria for DSHS funding.
• Others: This client has a funding source other than DSHS.

Claim Type (Required)

CLICK IN the Radio Button to select one of the following:

• Professional – This claim type is used by an individual practitioner not working
• Institutional – This claim type is used for services provided in group practice, facilities and institutional settings.

Business Location (Required)

• To select an answer, CLICK ON the arrow at the end of the dropdown list box and use the scroll bar to see all the answer choices for this question.

Service Begin Date (Required)

• Document the date that this service began for the client.
• You can enter the 8 numbers of the date, mmddyyyy with no punctuation and CMBHS will format them with slash marks into the proper format or you can enter the 8 numbers of the date with slash marks mm/dd/yyyy.

Service End Date (Required)

• This is the date this service ended for this client.
• You can enter the 8 numbers of the date, mmddyyyy with no punctuation and CMBHS will format them with slash marks into the proper format or you can enter the 8 numbers of the date with slash marks mm/dd/yyyy.

Service Provider (Required)

• This field documents the /service provider submitting the claim
• Clinician

Service Types (Required)

• Dropdown

Procedure Codes (Required)

• Dropdown

Client (Required)

• Text box

Plan ID (Required)

• Dropdown list

Supporting Document Number (Required)

• Text box

Claim Identification Number (Required)

• Text box

Claim Status (Required)

• Radio button

Check/EFT Number (Required)

• Text box

Voucher ID (Required)

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

Output (Required)

• Same as Query Criteria

Link (Not Required)

• This is a Link not a data entry field. This link is a tool that allows the user to view Individual Claims.

Claims Status: (Required)

• This field reflects the status of the claim.
• The answer choices are:

• Pending -When the source document is completed but no action has been taken.
• Submitted-When the user submits the document.
• In-Process - The claim has been received by Source
• Vouchered - The claim is accepted and is in process by the DSHS Source program.
• Rejected - The DSHS contract manager rejects/denies the claim
• Paid - The claim has been paid by state comptroller.

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