User Guide



QA Review User Guide-VendorVersion 1.0Updated 05/02/18Table of Contents TOC \o "1-3" \h \z \u 1.Purpose and Introduction PAGEREF _Toc513040268 \h 31.1General Information PAGEREF _Toc513040269 \h 32.Log In and Account Settings PAGEREF _Toc513040270 \h 32.1To Log in: PAGEREF _Toc513040271 \h 32.2To edit Profile Settings: PAGEREF _Toc513040272 \h 42.3To edit Password: PAGEREF _Toc513040273 \h 52.4To contact Support via Email: PAGEREF _Toc513040274 \h 52.5To Logout: PAGEREF _Toc513040275 \h 63.Non-Medicaid Recoupment PAGEREF _Toc513040276 \h 64.Client Eligibility PAGEREF _Toc513040277 \h 65.Boxing Ring PAGEREF _Toc513040278 \h 75.1Overview: PAGEREF _Toc513040279 \h 75.2To open the Boxing Ring: PAGEREF _Toc513040280 \h 75.3Record Icon Definitions: PAGEREF _Toc513040281 \h 85.4Record Action Timeline: PAGEREF _Toc513040282 \h 95.5To Read/Unread Record(s) marked for Recoupment: PAGEREF _Toc513040283 \h 95.6To Accept Record(s) marked for Recoupment: PAGEREF _Toc513040284 \h 95.7To Petition Record(s) marked for Recoupment: PAGEREF _Toc513040285 \h 95.8To Submit Clarification on Record(s) marked for Recoupment: PAGEREF _Toc513040286 \h 105.9To Export Record(s) marked for Recoupment to Excel: PAGEREF _Toc513040287 \h 116.Questions PAGEREF _Toc513040288 \h 11Purpose and IntroductionThis document describes the basics of navigating in the BHSDSTAR QA Review application.General InformationYou must have your own unique email address to have an account.All activity done using an account is tracked and recorded in BHSDSTAR. Do not share your account information.It is important to know your organizations primary and/or secondary account manager for BHSDSTAR. They will be able to answer most questions for you about how they want you to use the application.Online videos, super-quick guides and comprehensive user guides are available on . For question that can’t be answered by the online resources or your primary/secondary contact, or any issues you may encounter in BHSDSTAR, please email support@ to create a support ticket.Any identifying client information sent through email is a HIPAA violation. Use only the BHSDSTAR Client ID when needing to reference a specific client. 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.Log In and Account SettingsTo Log in:From the desktop double-click your internet browser to launch. (For best results we recommend Goggle Chrome but other browsers can also be used.)Enter in the browser window and press the Enter key.Click the Provider Login button.Click in the Username field and enter user name.Press the Tab key or click in the Password field and enter user password.Click the Login button.The Home screen will display listing Programs on the Left Navigation and when selected their Tracking Icons and Graphs.Tip: This screen can be viewed at any time by clicking Programs in the upper right corner of the screen or by clicking the Overview on the left navigation.Tip: Items requiring action are displayed with an Icon listing the # of items for each Tracking Item and the Take Action button is displayed.To edit Profile Settings:Click on your logged in Name in the upper right corner.Click Update Profile.Click the field you want to edit and enter new information.Click Save.To edit Password:Click on your logged in Name in the upper right corner.Click Change Password.Enter current password.Enter a new password.Re-enter the new password.Click Update.Tip: Password must be changed every 90 days, contain at least eight characters, contain at least one number, contain at least one lower case letter, contain at least one upper case letter, and contain at least one special character.To contact Support via Email:Tip: Never send a client’s name in the free text section of the email-refer to them by the last 5 digits of their BHSDSTAR Client ID.Click on your logged in Name in the upper right corner.Click Contact Support.To Logout:Click on your logged in Name in the upper right corner.Click Logout.Non-Medicaid RecoupmentFalling Colors, Inc., as the Administrative Services Organization (ASO) for The Behavioral Health Collaborative, is the payer of last resort for adult BH services funded by the Behavioral Health Services Division (BHSD). Services for members covered under Medicaid benefits must be billed to the Managed Care Organization (MCOs) or Fee for Service (FFS) Medicaid. Likewise, services covered by other third-party payers, whether public or private, must be billed to the appropriate payer(s). Services covered by Medicaid or other payers that have been billed inappropriately to Falling Colors but paid, will be recouped by BHSD. Also, non-Medicaid funds cannot be used to balance bill the unpaid portion of billing by another payer, such as deductibles, co-pays, or amounts exceeding treatment limits.Audits of payments for Non-Medicaid services will occur on an ongoing basis. BHSD has set the following rules in place to audit claims paid through non-Medicaid funds. The recoupment details are intended to assist providers on how to appropriately bill non-Medicaid funding.Client EligibilityVendors 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: on specifics of 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.Boxing RingOverview:Functionality for Vendors to petition records that have been flagged for recoupment by Lead Agencies has been introduced.? For any action taken by Vendors, the Lead Agency will have 7 days to respond, or the petition will be auto-accepted and the record not recouped.? Likewise, for any action taken by the Lead Agency, Vendors will have 7 days to respond, or the record will be automatically recouped.????In order for a Lead Agency to flag records for recoupment, they must first contact the Vendor to inform them.? The Lead Agency will have to enter in the system whom they spoke to and when in order for records to be considered 'Flagged' and appear for the Vendor to review.?Vendors can petition records flagged for recoupment and attach supporting documentation to accommodate the petition.?After a petition is made, the Lead Agency can request clarification on the petition.? The Lead Agency may or may not require the Vendor to include supporting documentation as part of clarification.?Vendors and Lead Agencies can go back-and-forth between 'Clarification Required' and 'Clarification Provided' as many times as necessary. The Lead Agency can also choose at any time to 'force' a recoupment.?Vendors can choose to accept the recoupment, in which case they agree to repay the aggregate amount via future payment offsets, direct reimbursement, or a combination of both.?To open the Boxing Ring:From the Home screen:Click the QA Review drop-down.Click Boxing Ring.Records flagged for QA review are displayed grouped by Reason with closest to the auto-recoupment deadline on top.Click a record to see details in the Record Status, Record Details, and Record History sections. (Clicking the record will also mark it as Read when clicked for the first time)Click the ^ icon of each section to expand/hide the section as needed.Enter data in the search criteria fields on the top of the screen to search for specific records.Record Icon Definitions:IconDefinitionRecord has been flagged for Recoupment by the Lead AgencyPending Vendor Notification by the Lead AgencyClarification to Petition has been provided to the Lead Agency by the VendorClarification to Petition Requested by the Lead AgencyRecoupment has been Confirmed by the VendorRecoupment has been Abandoned by the Lead AgencyRecord Action Timeline:Vendors have 7 days to Accept or Petition to Records marked for Recoupment. If they do not Accept or Petition within the 7 days the system will auto-recoup the records.Vendors have 7 days to Submit Clarification on Records marked for Clarification by the Lead Agency. If they do not submit within the 7 days the system will auto-recoup the records.The Record Status section for each Record will display the # of days remaining in the 7 day count-down.To Read/Unread Record(s) marked for Recoupment:Click the Record(s) in the Envelope column to highlight and mark as Read or Unread.To Accept Record(s) marked for Recoupment:Click the Record(s) in the Checkmark column to highlight.Click Accept.The system will display a total of the record(s) to be recouped.Click Submit to confirm the acceptance.The status icon for the record(s) will change from an orange triangle to a handshake.To Petition Record(s) marked for Recoupment:Click the Record(s) in the Checkmark column to highlight.Click Petition.Click the Why are the selected records being petitioned field and enter a reason.Click the file upload field or drag and drop to add supporting documents.Click Submit to confirm the petition.The status icon for the record(s) will change from an orange triangle to a P.To Submit Clarification on Record(s) marked for Recoupment:Click the Record(s) in the Checkmark column to highlight.Click Submit Clarification.Click the Detailed response to clarification request field and enter information.Click the file upload field or drag and drop to add supporting documents. (To delete an attachment click the trach can icon next to the document)Click Submit to confirm the clarification.The status icon for the record(s) will change from a ? to a P.To Export Record(s) marked for Recoupment to Excel:Click the Record(s) in the Checkmark column to highlight.Click Export to CSV.An excel csv file will be displayed.QuestionsFor any questions email support@. ................
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