Claims User Manual

Owned by Spencer
Dec 22, 2021
12 min read

  1. Purpose and Introduction

    1. General Information

  2. Client Eligibility

  3. Client Registration

  4. Client Find

  5. Client Contact Information

  6. Client Mandated Data

    1. Add Check-In

    2. Deactivate Client

  7. Client Notes

    1. To Add a Note

  8. Services

  9. Client Tracking Items

    1. Active Clients

    2. Deactivated Clients

    3. Check-In Required

  10. Claims History

    1. Claims History Search

  11. Project Tracking Items

    1. To Review your Pending Invoices

    2. To Add Comments

    3. To Review your Invoice History

    4. Reports

  12. Questions

Purpose and Introduction

This document describes the basics of navigating the STAR Claims application.

General Information

  1. You must have your own unique email address to have an account.

  2. All activity done using an account is tracked and recorded in STAR. Do not share your account information.

  3. It is important to know your organization's primary and/or secondary account manager for STAR. They will be able to answer most questions for you about how they want you to use the application.

  4. Online videos, super-quick guides, and comprehensive user guides are available on bhsdstar.org. For questions that can’t be answered by the online resources or your primary/secondary contact or any issues you may encounter in STAR, please email support@fallingcolors.com to create a support ticket.

  5. Any identifying client information sent through email is a HIPAA violation. Use only the STAR Client ID when needing to reference a specific client.

  6. The tracking module for any given program provides quick links and information about important items specific to the program. This is located on the landing page for the program.

Client Eligibility

Vendors are responsible to determine the eligibility of a client at the time service is rendered. Non-Medicaid funds are intended for services to individuals not covered by Medicaid. Vendors must check the Medicaid portal prior to administering a service for non-Medicaid reimbursement. By submitting a service for non-Medicaid reimbursement, Vendors are attesting that they have verified a client’s non-Medicaid eligibility. Done here: https://nmmedicaid.acs-inc.com

Depending on the specifics of the scopes of work, additional eligibility criteria may exist. If you are unsure of the eligibility of a client for the non-Medicaid funding you are receiving, please contact your State Agency program manager.

Client Registration

From the Home screen:

  1. Click Client, Register.

  2. Click the First Name field and enter a name.

  3. Click the Last Name field and enter a name.

  4. Click the Date of Birth Field and enter DOB.

  5. Click Search.

  6. The system displays possible matches or the registration screen if no matches are found. (Click None if These if the client is not listed)


    Tip: Registration is used to identify existing records in STAR first to avoid duplication of individuals in the system. One individual can be participating in other programs with other providers or have done so in the past.

  7. Click the Middle Initial field and enter the middle initial.

  8. Click the Suffix drop-down and click suffix.

  9. Click the SSN field and enter SSN or click the No SSN checkbox to select.

  10. Click the Medical Record Number field and enter MRN.

  11. Click the Medicaid Recipient checkbox to select.

  12. Click the Medicaid ID field and enter ID.

  13. Click the MCO drop-down and click MCO.

  14. Click the CCL drop-down and click CCL.

  15. Click the Gender field and click gender.

  16. Click the Sexual Preference drop-down and click preference.

  17. Click the Ethnicity drop-down and click Ethnicity.

  18. Click the Race drop-down and click Race.

  19. Click the Active Military drop-down and click status.

  20. Click the Language drop-down and click language.

  21. Click the Other Language field and enter the other language.

  22. Click the Tribal Affiliation drop-down and click affiliation.

  23. Click Save and Continue.

  24. Click the Address 1 field and enter an address or click the Homeless checkbox to select.

  25. Click the Address 2 field and enter an address.

  26. Click the City field and enter a city.

  27. Click the State drop-down and click state.

  28. Click the Zip Code field and enter the zip code.

  29. Click the Phone field and enter a number or click the No Phone checkbox to select.

  30. Click the Message drop-down and click Yes or No.

  31. Click the Other Phone field and enter a number.

  32. Click the Message drop-down and click Yes or No.

  33. Click Save and Continue.

  34. Click the Name field under Parent 1 and enter a name

  35. Click the Phone Number field under Parent 1 and enter a phone number

  36. Click the Relation to Client drop-down under Parent 1 and select a relationship status

  37. Click the text box under Parent 1 and describe the relationship if ‘Other’ is selected in step #36

  38. Click the Name field under Parent 2 and enter a name

  39. Click the Phone Number field under Parent 2 and enter a phone number

  40. Click the Relation to Client drop-down under Parent 2 and select a relationship status

  41. Click the text box under Parent 2 and describe the relationship if ‘Other’ is selected in step #36

  42. Click the Name field under Legal Representative/Guardian and enter a name

  43. Click the Phone Number field under Legal Representative/Guardian and enter a phone number

  44. Click the Relation to Client drop-down under Legal Representative/Guardian and select a relationship status

  45. Click the text box under Legal Representative/Guardian and describe the relationship if ‘Other’ is selected in step #36

  46. Click the Name field under Emergency Contact and enter a name

  47. Click the Phone Number field under Emergency Contact and enter a phone number

  48. Click the Relation to Client drop-down under Emergency Contact and select a relationship status

  49. Click the text box under Emergency Contact and describe the relationship if ‘Other’ is selected in step #36

  50. Click the Name field under Non-medical person and enter a name

  51. Click the Phone Number field under Non-medical person and enter a phone number

  52. Click the Relation to Client drop-down under Non-medical person and select a relationship status

  53. Click the text box under Non-medical person and describe the relationship if ‘Other’ is selected in step #36

  54. Click the Name field under Other and enter a name

  55. Click the Phone Number field under Other and enter a phone number

  56. Click the Relation to Client drop-down under Other and select a relationship status

  57. Click the text box under Other and describe the relationship if ‘Other’ is selected in step #36

  58. Click Save and Continue.

  59. Click Date of Initial Registration calendar and select date.

  60. Click Veteran drop-down and click status.

  61. Click Marital Status drop-down and click status.

  62. Click Pregnant drop-down and click status (female clients only).

  63. Click Family Member / Significant Other drop-down and select an option.

  64. Click Living Arrangement drop-down and click arrangement.

    1. If ‘Place not meant for habitation' is selected, click Length of Time in this Arrangement drop-down and click status.

  65. Click Education drop-down and click status.

  66. Click School drop-down and click status.

  67. Click the Employment Status drop-down and click status.

    1. If ‘Not in Labor Force’ is selected, click the Not In Labor Force drop-down and click status.

  68. Click Source of income drop-down and click source.

  69. Click Voluntary/Involuntary at Admission and click status.

  70. Click Referral Source and select an option.

    1. If ‘Court/Criminal Justice Referral/Dui/Dwi’ is selected, click the Criminal Justice Referral drop-down and select an option.

  71. Click Arrest in the Past 30 days drop-down and click # of arrests.

  72. Click Health Insurance drop-down and click insurance carrier.

  73. Click SMI drop-down and click status.

  74. Click SED drop-down and click status.

  75. Click Substance Abuse Problem and/or Mental Health Diagnosis drop-down and click status.

    1. If any option other than ‘None’ is selected:

      1. Click the Drug Code drop-down and select an option.

      2. Click the Route of Administration drop-down and select an option.

      3. Click Frequency of Use drop-down and click status.

      4. Click Age at First Use and select an option.

      5. Click Days Waiting to Enter SA Treatment and select an option.

      6. Click Attendance at SA Help in the last 30 Days and click status.

      7. Click Opioid Therapy drop-down and click status.

      8. Click Substance Abuse Diagnosis and enter a code (must be a valid code).

      9. Click Substance Abuse Problem (Secondary) and select an option.

        1. If any option other than ‘None is selected’ repeat steps 19.a.i – 19.a.ix

  76. Click Is There a Mental Health Diagnosis? and click status (system enforces ‘Yes’, if SMI and/or SED is set to ‘Yes’).

  77. Click Finish.

  78. The Client Dashboard is displayed.

Client Find

Tip: Find is used to find clients registered at your provider only.

From the Home screen:

  1. Click Client, Find Client.

  2. Click the First Name field and enter the name.

  3. Click the Last Name field and enter the name.

  4. Click the Date of Birth Field and enter DOB.

  5. Click the Individual ID field and enter ID.

  6. Click the Last 4 SSN field and enter the last 4 digits of the SSN.

  7. Click Medical Record Number and enter a number.

  8. Click the Medicaid ID field and enter a number.
    Tip: Not all fields are required to Find a Client. You can Find by First Name only as an example.

  9. Click Find Client.

  10. Click the Client ID of the individual found on the list of possible matches.

  11. The Client Dashboard is displayed.

Client Contact Information

From the Client Dashboard:

  1. Click Profile, Address & Phone, or Contact tab.

  2. Click any of the fields and enter/edit the information.

  3. Click Save.

  4. The Client Dashboard is displayed.

Client Mandated Data

Add Check-In

From the Client Dashboard:

  1. Click the Mandated Data tab.

    1. The Mandated Data tab will have an orange exclamation indicator if Initial Registration is missing, or if the last record occurred over 210 days ago.

    2. After clicking the Mandated Data tab, the remaining days until the client’s next Check-in is due is displayed.

  2. Click the Client Check-In button.

  3. Click Date of Check-In calendar and select date.

  4. Click Veteran drop-down and click status.

  5. Click Marital Status drop-down and click status.

  6. Click Pregnant drop-down and click status (female clients only).

  7. Click Family Member / Significant Other drop-down and select an option.

  8. Click Living Arrangement drop-down and click arrangement.

    1. If ‘Place not meant for habitation’ is selected, click Length of Time in this Arrangement drop-down and click status.

  9. Click Education drop-down and click status.

  10. Click School drop-down and click status.

  11. Click the Employment Status drop-down and click status.

    1. If ‘Not in Labor Force’ is selected, click the Not In Labor Force drop-down and click status.

  12. Click Source of income drop-down and click source.

  13. Click Arrest in the Past 30 days drop-down and click # of arrests.

  14. Click Health Insurance drop-down and click insurance carrier.

  15. Click SMI drop-down and click status.

  16. Click SED drop-down and click status.

  17. Click Substance Abuse Problem and/or Mental Health Diagnosis drop-down and click status

    1. If any option other than ‘None’ is selected:

      1. Click the Drug Code drop-down and select an option.

      2. Click the Route of Administration drop-down and select an option.

      3. Click Frequency of Use drop-down and click status.

      4. Click Age at First Use and select an option.

      5. Click Days Waiting to Enter SA Treatment and select an option.

      6. Click Attendance at SA Help in the last 30 Days and click status.

      7. Click Opioid Therapy drop-down and click status.

      8. Click Substance Abuse Diagnosis and enter a code (must be a valid code).

      9. Click Substance Abuse Problem (Secondary) and select an option.

      10. If any option other than ‘None is selected’ repeat steps 19.a.i – 19.a.ix

  18. Click Is There a Mental Health Diagnosis? and click status (system enforces ‘Yes’ if SMI and/or SED is set to ‘Yes’).

  19. Click Save.

(INSERT CLIENT CHECK-IN MANDATED DATA SCREENSHOT)

Deactivate Client

From the Client Dashboard:

  1. Click the Mandated Data tab.

    1. The mandated Data tab will have an orange exclamation indicator if Initial Registration is missing, or if the last record occurred over 210 days ago.

    2. After clicking the Mandated Data tab, the remaining days until the client’s next Check-in is due are displayed.

  2. Click the Deactivate Client button.

  3. Click Date of Last Contact calendar and select date.

  4. Click Deactivation Reason and click status.

  5. Click Date of Deactivation calendar and select date.

  6. Click Veteran drop-down and click status.

  7. Click Marital Status drop-down and click status.

  8. Click Pregnant drop-down and click status (female clients only).

  9. Click Family Member / Significant Other drop-down and select an option.

  10. Click Living Arrangement drop-down and click arrangement.

    1. If ‘Place not meant for habitation’ is selected, click Length of Time in this Arrangement drop-down and click status.

  11. Click Education drop-down and click status.

  12. Click School drop-down and click status.

  13. Click the Employment Status drop-down and click status.

    1. If ‘Not in Labor Force’ is selected, click the Not In Labor Force drop-down and click status.

  14. Click Source of income drop-down and click source.

  15. Click Arrests in the Past 30 days drop-down and click # of arrests.

  16. Click Health Insurance drop-down and click insurance carrier.

  17. Click SMI drop-down and click status.

  18. Click SED drop-down and click status.

  19. Click Substance Abuse Problem and/or Mental Health Diagnosis drop-down and click status

    1. If any option other than ‘None’ is selected:

    2. Click the Drug Code drop-down and select an option.

    3. Click the Route of Administration drop-down and select an option.

    4. Click Frequency of Use drop-down and click status.

    5. Click Age at First Use and select an option.

    6. Click Days Waiting to Enter SA Treatment and select an option.

    7. Click Attendance at SA Help in the last 30 Days and click status.

    8. Click Opioid Therapy drop-down and click status.

    9. Click Substance Abuse Diagnosis and enter a code (must be a valid code).

    10. Click Substance Abuse Problem (Secondary) and select an option.

      1. If any option other than ‘None is selected’ repeat steps 19.a.i – 19.a.ix

  20. Click Is There a Mental Health Diagnosis? and click status (system enforces ‘Yes’ if SMI and/or SED is set to ‘Yes’).

  21. Click Save.

(INSERT DEACTIVATE CLIENT - MANDATED DATA SCREENSHOT)

Client Notes

From the Client Dashboard:

  1. Click the Notes tab.

  2. Current Notes for the client will display.

Tip: As notes are added the (0) on the tab will update.

To Add a Note

  1. Click the Notes section and enter notes.

  2. Click the Date calendar and click date.

  3. Click Add Note.

  4. The newly added note is displayed in the Current Notes table with date, text, and entered by.

  5. (ADD NOTES SCREENSHOT FROM CLIENT PROFILE)

Services

From the Client Dashboard:

  1. Click the Services tab.

  2. Current Services for the client will display.

  3. Click the Service ID to view the service details.

Tip: As Services are added the (0) on the tab will update.

(ADD SCREENSHOT FROM ADD SERVICES - CLIENT PROFILE)

Client Tracking Items

Active Clients

From the Overview page:

  1. Click View underneath the Active Clients icon.

  2. A list of clients whose most recent Mandated Data record is not a Deactivation record is displayed.

Deactivated Clients

From the Overview page:

  1. Click View underneath the Deactivated Clients icon.

  2. A list of clients whose most recent Mandated Data record a Deactivation record is displayed.

Check-In Required

From the Overview page:

  1. Click View underneath the Check-In Required icon.

  2. A list of clients who meet the following criteria will be displayed:

    1. The client is enrolled in a financial, encounters-based project (i.e., Claims).

    2. The client’s most recent Mandated Data record is 120+ days old.

  3. (ADD SCREENSHOT OF OVERVIEW TRACKING WITH ACTIVE/DEACTIVATED/ETC)

Claims History

From the Overview tab:

  1. Click Claims History

  2. Claims data is displayed according to default parameters, including Total Submitted Amount and Total Allowed Amount for each day of received claims.

  3. Click the teal link under Total Claims to see all the claims received on that day.

  4. Click the teal link under Accepted to see all the accepted claims on that day.

  5. Click the teal link under Accepted to see all the failed claims on that day.

Claims History Search

From the Overview tab:

  1. Click Claims History

  2. Claims data is displayed according to default parameters, including Total Submitted Amount and Total Allowed Amount for each day of received claims.

  3. Enter a Client ID to search for a specific client within the given dates.

  4. Enter a Claim ID to search for a specific claim within the given dates.

  5. Enter a Provider Claim Number (PCN) to search for a specific PCN within the given dates.

Project Tracking Items

User Group

Action

Invoice Moves To…

Status (Sub-status)

User Group

Action

Invoice Moves To…

Status (Sub-status)

System

Invoice Generated

Pending Approval (Awaiting Action)

System

Process Payment

Invoice History (Paid)

Provider

Corrections completed

 

Pending Approval (Awaiting Action)
If Approver was the previous actor

 

Pending Payment (Awaiting Action)
If Payor was the previous actor

Approver

Approved by the lead agency

Pending Payment (Awaiting Action)

Approver

Denied by the lead agency

Invoice History (Denied)

Payor

Payment authorized by the payor

Invoice History (Paid)

Payor

Denied by the payor

Invoice History (Denied)

Payor

First level payment approval completed

Pending Payment (In Process)

Payor

Submit for Payment

Invoice History (Processed)

Approver or Payor

Provider corrections required

Corrections Required (Awaiting Action)

Approver or Payor

In review

Pending Approval (In Review)
If action is taken by the Approver

 

Pending Payment (In Review)
If action is taken by the Payor

Approver or Payor

Placed on administrative hold

 

Pending Approval (Administrative Hold)
If action is taken by the Approver

 

Pending Payment (Administrative Hold)
If action is taken by the Payor

 

To Review your Pending Invoices

From the Home screen:

  1. Click view under Pending Invoices.

  2. The invoices screen will display listing your pending approval and payment invoices.

  3. Click the Search field and enter Invoice #.

  4. The invoice will display in the table.

  5. Click the Invoice Details link.

  6. Invoice Details including Services and Invoice Decisions are displayed.

(INSERT SCREENSHOT OF PENDING INVOICE DETAILS)

To Add Comments

  1. Click Add Comment

  2. Enter free text comments.

  3. Click Submit Comment

  4. The comment is displayed and shared with the Program Manager.

To Review your Invoice History

From the Home Screen:

  1. Click view under Invoice History

  2. The invoices screen will display listing your processed invoices.

  3. Click the Search field and enter Invoice #.

  4. The invoice will display in the table.

  5. Click the Invoice Details link.

  6. Invoice Details including Services and Invoice Decisions are displayed.

Reports

From the Overview Project screen:

  1. Click Run Report drop-down and click report.

  2. Click/Select Report Criteria.

  3. Click Run Report.

  4. Report details are displayed.

Questions

For any questions email support@fallingcolors.com