Quick Guide for Claims Submission

Check Medicaid Eligibility for the Client

Before any claim is submitted to Falling Colors, be sure that you can check the client’s Medicaid eligibility for the date the service was provided. We do not accept claims for services that should be billed to Medicaid.

Register the Client in STAR

Before any claim is submitted to Falling Colors, be sure that you register the client in STAR. The Client ID from STAR needs to be included in the claim. To register a client, review our guide here: Client Registration

Required Claims Fields

Always be sure to include:

Client First and Last Name
Client Address
Client Date of Birth
Client Gender
STAR Client ID
Rendering Physician NPI or STAR Staff Id (if the staff member does not have an NPI)
Billing NPI
Rendering location NPI
Date of Service
Procedure/Service Code and Appropriate Modifier (Must be from the Vendor’s approved BHSD/CBHD Fee Schedule)
Diagnosis(es) (Must be ICD-10)
Diagnosis Pointer(s)
Units
Charge Amount
Billing Provider Tax ID

Services that also require an Attending Provider NPI

Services Code

0014
0124
0134
0144
0459

Check the Diagnosis and Services for Incorrect Combinations

Be sure to bill for Mental Health services with a Mental Health Diagnosis.

Be sure to bill for Substance Abuse services with a Substance abuse Diagnosis.

Claim Format

For details on the 837P and I required fields, refer to the 837 Companion Guide.

Submit Claims To

Claims can be submitted to Falling Colors through our Clearinghouse Claim MD. http://www.claim.md

Providers can enroll with Claim MD at https://www.claim.md/fallingcolors/ and submit claims via manual entry or via electronic upload of an 837P or 837I. There is no cost to the provider for submitting claims directly to Falling Colors via Claim MD. (existing Claim MD customers do not need to re-enroll, but will just submit a claim using payer ID FCC20).

Providers can also submit claims to Claim MD via an already established relationship with their own Clearinghouse. Please ask your Clearinghouse to contact Claim MD at (855) 757-6060. Our Payer ID is FCC20.