Introduction to Community Care Online CST

Claims Submission Tool

2013

Table Of Contents

Introduction to Community Care OnLine CST

Getting Started

HCFA Claims Prelog screen

Member Search

Provider Entry

Provider Search

HCFA - Claim Entry Practice

Adding / Finalizing a Service Line

Deleting a Service Line

Finalizing a Claim

Closing a Batch

UB Claims Prelog screen

UB - Claim Entry

Claim Detail Entry

Adding / Finalizing a Service Line

Deleting a Service Line

Finalizing a Claim

Closing a Batch

Create Batches

Claims Inquiry

Authorization Inquiry

Authorization Detail

Available Reports

Batch Summary Report

Posted Claims Report

Questions

Tip Sheet

Introduction to Community Care OnLine CST

Community Care OnLine CST (Claims Submission Tool) provides a complete Internet Portal solution for services provided by Community Care Behavioral Health Organization (Community Care) network providers.

Community Care OnLine CSTis a website that allows providers to manually enter claim data for processing and viewing online.

Community Care OnLine CST is the gateway into the transactional system for claimentry. All adjudication and rules are driven by the Community Care transactional system.

All claims are entered and submitted in batches. A Submitter can be any type of user that has been configured to process claims or submit electronic inbound or outbound transactions. After a batch is posted to the transactional system, the claims run through the adjudication process. Claim errors are returned indicating invalid data that would prevent the claim from moving into the transactional system. Community Carestaff is responsible for correcting claim errors. After the errors have been corrected, the claims will either adjudicate automatically or hold for review in the transactional system.

The Community Care OnLine CST Administrator will have full and unlimited access to all the features of this program including maintenance and security. The Administrator will be responsible for assigning user access, setting user parameters, processing requests, monitoring claim submissions and reports, communicating with users and general control of all ongoing processes.

Login

To access the Community Care OnLine CST click on the Internet Explorer Icon.

Type the following Internet address: to access the Community Care OnLine CST.

To begin entering claims the user must first log into the system.Community Care has supplied you with a User ID and Password. The User ID and Password is unique for each user. Under the HIPPA privacy guidelines, passwords are to remain confidential.

Enter your User ID and Password.
Press Enter, or click on the ‘Login’ button.

Community Care OnLine CST Screen– Field Descriptions
Field / Usage
User ID / All User ID’s will be assigned by the Community Care OnLine CST Administrator.
Password / All passwords will be assigned by the Community Care OnLine CST Administrator.

Getting Started

When you have logged in successfully, you will see the ‘Welcome’ message page.

Click on ‘Provider Services’ in the sidebar menu.

Click on ‘Claims Prelog’.

Note: To Log Off the system at any time, click the ‘Log Off’ sidebar menu option, or exit by clicking on the X at the top right of the screen.

Provider OnLine Welcome Page

Click on ‘Enter Claims’ to access the Claims Prelog screen.

Prelog Verification

You must click ‘Yes’ to the Prelog Verification statement in order to submit claims through Provider Online. If you click ‘No’ you will be directed to submit paper claims.

The Claims Pre-Logging screen has many fields of entry. Let’s review some pointers before we get started:

Claims Prelog is case sensitive,except in search screens, the Caps Lock key must be on.
Tabkey = Move field to field.

Shift + Tab = Go back a field.
Decimal points are required for dollar amounts and diagnosis codes.

Fields marked with a red asterisk * are system required fields of entry.

Binoculars indicate a search screen to aid in selecting or completing information. To display a search window, click the binoculars to the left of the field.

HCFA Claims Prelog screen

Community Care OnLine CST HCFA Claims – Field Descriptions
(*) Denotes System Required Field
Yellow Fields are mandatory entry fields
Green Fields are situational
White fields are auto populated or not required
Field / HCFA / Usage
Form Type: HCFA / * / Identifies the Form Type (HCFA = Professional, UB = Facility). Click on HCFA to create a separate batch for every physical Professional batch entered.
New Batch / * / Prelog batch numbers (radxxxxx) are system assigned by clicking on the New Batch button. This is necessary each time a new batch is created. Each batch can be mapped to its own Prelog batch number. Prelog batch numbers are consolidated during the initial posting process to the transactional system.
Close Batch / Clicking on the Close Batch button will close a batch of entered claims. Necessary each time you change the Form Type.
Received Date / The system will auto-populate the current date.
Document Control Info
Doc Control # / Auto populates with a system assigned Prelog batch number. This number consists of the batch number and today’s date (YYYYMMDD)
Form Name / Auto populates with the claim form name - HCFA or UB.
Doc Type / Auto populates with the type of claim entered, Professional or Hospital.
Doc ID / Not used at this time.
Microfilm Doc # / Not applicable.
Member Info
Insured ID
/ * / 1A / Click on the binoculars next to the Insured ID field to access the Member Search screen.
Field / HCFA / Usage
Patients Name / * / Auto populates with the member’s name based on the Insured ID entered.
Patients DOB / * / Auto populates with the member’s date of birth.
Patients Sex / * / Auto populates with the member’s gender.
Patient Account # / * / 26 / Patient Account Number assigned to the patient by the billing provider. If not billed, press the space bar and tab to leave blank.

Member Search

Once you have accessed the member search screen, tab to the Employee No field. Enter the member’s 10-digit Medicaid Recipient # or the 7-digit ALDA #.

Member Search screen

Member Search Fields
Field / Usage
SSN: / Not used at this time.
Medicaid ID: / Not used at this time.
Employee No: / Medicaid 10-digit Recipient #or the 7-digit ALDA #.
HCFA No: / Not used at this time.
Member Name: / Not used at this time.
Member ID: / Community Care assigned 9-digit Member number (internal use only)

Once the member has been selected, all other Member Info fields will auto populate. Use the patients name and date of birth to verify that the correct member was selected.

Provider Entry

To enter the Billing Provider, click on the binoculars in the Billing Provider ID field.

Field / HCFA / Usage
Provider Info
Billing
Provider ID
/ * / 25 / Vendor or Billing Provider. The TAX ID #should be the only search method used. To access the Provider Directory Search screen click the or press [Enter].

Provider Search

The Provider Directory Search screen allows for several methods of searching for a provider but searching by the Federal Tax ID # is the only search method that should be utilized.

Provider Directory Search screen

Provider Directory Search Fields
Field / Usage
Provider NPI / Not used at this time.
Provider
ID / Not used at this time.
Fed. Tax I.D. / Used to search by the Provider’s Tax ID#. (This is the only search method that should be used for the Billing Provider.)
Fed. Prov. ID
(UPIN #) / Not used at this time.
Provider
Name / Not used at this time.
Medicaid I.D. / Not used at this time.

Once the provider has been selected, the following fields will auto populate. Use the providers name and address to verify that the correct provider was selected.

Field / HCFA / Description
Prov. FED. TAX ID # / * / Auto populates with the Tax ID of the Billing Provider (Vendor) selected.
Prov. Name / Auto populates with the Billing Provider’s name.
Prov. Address / Auto populates with the Billing Provider’s address.
Prov.
City / Auto populates with the Billing Provider’s city.
Prov.State / Auto populates with the Billing Provider’s state.
Prov.
Zip / Auto populates with the Billing Provider’s Zip Code.
Prov. Phone # / Auto populates with the Billing Provider’s Phone #.
Prov. PCP Flag / Not used at this time.
Servicing Prov ID
/ * / 31 / The individual provider who is authorized to render the service. Identified in Prelog with a 6-digit provider number. Press to access the Provider Directory Search screen. Click the Search button or press enter. Prelog is configured to return only the providers listed under the Vendors Tax Id # selected. Search for the last name of the provider who rendered the service (Box 31 on the CMS-1500 form). Based on your contract, this may be a Group name.
Referring Phys ID / Not used at this time.
Ref Phys Name / Not used at this time.
Facility Where Services Were Rendered (Block 32)
Facility / 32 / Enter the name of the facility where services were rendered.
Address 1 / 32 / Enter the number and street address of the facility where services were rendered.
Address 2 / 32 / Enter additional address information
City / 32 / Enter the city of the facility where services were rendered.
State / 32 / Enter the 2-digit state of the facility where services were rendered.
Zip / 32 / Enter either the 5-digit or 9-digit zip code of the facility where services were rendered.
Phone # / 32 / Enter the 10-digit phone # of the facility where services were rendered.
NPI / 32a / Enter the NPI # of the facility where services were rendered.
Box 32 B / 32b / Enter up to a 20-digitservice location or school code
Claim Header Information
From
Date / * / 24 / Earliest date of service billed on the entire claim. Date format is MMDDYY – no dashes or slashes.
Through Date / * / 24 / Last Date of service billed on the entire claim. Date format is MMDDYY – no dashes or slashes.
Diagnosis 1-4
/ * / 21 / Diagnosis code(s). Decimal points are required after the 3rd character (ex. 7809 is entered 780.9). If the diagnosis code has only 3 characters drop the decimal (ex. 650 is entered as 650). Click the or press [Enter] to access the Diagnosis Code search screen. Diagnosis codes must be billed up to the 5th digit, if applicable.
Total Amount Billed / * / 28 / Total charge of all services billed on theentire claim. A decimal point is required (ex. $150 billed, enter 150.00)
Total Amount Allowed / Not used at this time.
Field / HCFA / Description
Additional Claim Header Info
Claim Paper Work / ONLY USED when billing corrected HCFA claims. Enter the value of ‘CC’in this field; the ‘CC’ must be capitalized. Important Note- corrected claims requiring Community Care review of ANY paper documentation i.e. COB, Medical notes, certificates, cannotbe entered via Prelog.
Claim Note 1 / 10d,
19 / Used in conjunction with the Claim Paper Work field above. Enter the original claim number for the corrected claim you are submitting.
Claim Note 2 / 10d,
19 / Not used at this time.
Claims Detail Information
From Date of Service / * / 24A / Earliest or only date of service billed. Date format is MMDDYY – no dashes or slashes.
To Date of Service / 24A / System will default with the ‘From Date’ of service. Date format is MMDDYY – no dashes or slashes.
Place of Service
/ * / 24B / Place of Service indicates where services were rendered. Click the or press [Enter] to access a list of valid codes.
Type of Service / * / Auto populates with 01.
CPT/HCPCS
/ * / 24D / The 5-digit CPT or HCPCS procedure code that identifies the service that was performed. Click the or press [Enter] to access the Procedure CodeSearch screen.
Diagnosis Reference / * / 24E / Enter the number of the diagnosis code linked to the service line. There are four fields, enter the numbers 1234 that correspond with the diagnosis codes billed for the service line. Linking the correct diagnosis codes to a service line can affect payment.
Modifier 1st – 4th
/ 24D / Modifiers are an extension to the CPT / HCPCS codes. Alpha characters must be entered in Upper Case (ex. AA).
Amount Billed / * / 24F / The total amount billed for the individual service line. Decimal points are required for entry of dollar amounts. When a service line is billed with a zero dollar amount, enter $00.00 for the amount billed. If the service line is billed with $0, enter 00.00 in this field.
Days or Units / * / 24G / Number of units / services for the procedure performed. Enter the number of units billed.
OIC Allowed / Not used at this time. COB claims cannot be entered via Prelog. Submit paper COB claims.
OIC Paid / Not used at this time. COB claims cannot be entered via Prelog. Submit paper COB claims.
Start Time (HHMM) / Not used at this time.
End Time (HHMM) / Not used at this time.
Total Minutes (MMMM) / Not used at this time.
Amount Allowed / Not used at this time. System will default to 0.00
EPSDT Indicator / Not used at this time.

HCFA - Claim EntryPractice

The HCFA form is a standardized form designed to contain all information necessary for billing and /or claim payment. The HCFA form is used primarily by individual providers/ groups.If sufficient information is not on the HCFA form, it could delay claim payment or may cause an unnecessary denial of charges. In order to correctly process claims, you must be able to read, interpret, and understand all of the data contained on the HCFA form.

After clicking on Enter Claims from the sidebar menu option…

HCFA - Click on ‘HCFA’ to select the HCFA claim form type.
New Batch – Click on the ‘New Batch’ button to create a new HCFA Prelog batch # (i.e. radxxxxx).

Creating a separate New Prelog Batch number is necessary each time you change the claim form type (HCFA / UB), or when the received date is changed.

Write down the Prelog Batch number assigned (radxxxx) in order to retrieve and/or close the batch in case the system shuts down or you erroneously click out of the Prelog screen.

3.Received Date–Field will auto-populate with the current date. Press [TAB].

4. Doc. Control # - Field will auto populate with the system assigned batch number and today’s date.

5. Form Name–Field will auto populate with type of form – HCFA or UB.

6. Doc. Type–Field will auto populate with document type – professional or institutional.

7. Doc ID – Field will remain blank.Not used at this time.

8. Microfilm Doc. # - Not used at this time, press [TAB].

9. Insured ID- Click on the or press [Enter] to access the Member Search screen, tab to the Employee No field. Enter the 10-digit Medicaid Recipient # or the 7-digit ALDA #. The patient’s name, date of birth and gender will auto populate. Verify that the correct member is selected by the name and date of birth.

10. Pat. Acct # - Enter the patient account #, press [TAB]. If none, press the space bar, press [TAB].

Billing Provider ID – Click on the to access the Provider Directory Search screen. Enter the TaxID # in the Fed.Tax ID field and click ‘Search’. Click on the ‘Select’ button for the correct provider/vendor.
Servicing Provider – The individual provider or group authorized to render the service. Identified in Prelog with a 6-digit provider number. Press the to access the Provider Directory Search screen. Click the Search button or press [Enter]. Prelog is configured to return only the providers listed under the Vendors Tax ID # previously selected. Press [TAB] twice.
Referring Physician ID–Not used at this time, press [TAB] twice.
Diagnosis 1 - Enter the first diagnosis on the claim, press [TAB], a decimal point is required if the diagnosis code is greater than 3 characters.
Diagnosis 2,3,4 – enter the second, third and/or fourth diagnosis on the claim, if applicable; press [TAB].
Total Amount Billed– Enter the total amount of the entire claim. A decimal point is required, press [TAB].
Total Amount Allowed– Not used at this time, press [TAB].
Claim Paper Work– Enter ‘CC’ when billing a corrected HCFA claim. ‘CC’ must be capitalized. Otherwise, press [TAB].
Claim Note 1– Used in conjunction with the Claim Paper Work field above. Enter the original claim number for the corrected claim you are submitting, press [TAB].
Claim Note 2– Not used at this time, press [TAB].
From Date of Service – Enter the initial date of service, press [TAB]. Date format is MMDDYY.
To Date of Service– The system will default with the From Date of Service, press [TAB]
Place of Service– Enter a valid place of service code, press [TAB].
Type of Service– The system will auto populate with 01, press [TAB].
CPT/HCPCS– Enter the 5-character CPT or HCPCS code, press [TAB].
Diagnosis Reference – Enter the number of the diagnosis code linked to the service line, press [TAB].
1st Modifier– Enter the 1st 2-digit modifier, if applicable; press [TAB].
2nd, 3rdand 4th Modifier– Enter the 2nd, 3rd and 4th modifier, if applicable; press [TAB].
Amount Billed– Enter the total amount billed for the service line using a decimal point, press [TAB].
Days Or Units– Enter the number of units billed for the service line, press [TAB].
OIC Allowed–Not used at this time, press [TAB].COB claims cannot be entered via Prelog. Submit paper COB claims.
OIC Paid–Not used at this time, press [TAB].COB claims cannot be entered via Prelog. Submit paper COB claims.