[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-146599-en":3,"doc-seo-146599-105":30,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":4,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},146599,1099523885336,"Taylor Morgan","https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c",7,"Healthcare","Claim-Adjudication - Behavioral Health Claims Processing Guidelines","These guidelines define how the Barry County Community Mental Health Authority (BCCMHA) administers behavioral health claim processing, including required submission methods under HIPAA transaction standards and the BEHRI/EHR system, acceptable billing formats (electronic 837, manual BEHRI entry, UB04/CMS 1500 when paper is permitted), and the elements of a clean claim used to establish the clean claim date. The document sets filing deadlines, appeal and re-billing requirements for denied claims, authorization constraints using CPT/unit matching, provider login and training expectations, and standards for timely processing, including interest and potential penalties for late claim payments.","I. PURPOSE  \nTo establish guidelines for the administration of claims processing by Barry County Community Mental Health Authority (BCCMHA), incorporating all applicable state and federal regulations relative to the processing of behavioral health services claims.  \nII. POLICY  \nBCCMHA is responsible for the administration of claims processing for services provided and purchased through contracted providers.  \nClaims received shall be filed using current data layout in accordance with HIPAA transaction standards or via the Electronic Health Record (EHR) software system unless the provider is granted permission to submit claims in a paper format.  \nIII. STANDARDS  \nThe following information is critical to the submission and payment of valid claims:  \n1. Address to file claims  \n2. Telephone contact numbers  \n3. Information that must be contained in a claim in order for it to be considered valid or “clean”  \n4. Acceptable standard billing formats  \n5. Dates by which claims must be filed to be considered for payment  \n6. Process for appealing a denied claim  \n7. Names and addresses of delegated claims processors  \nAll provider submitted claims must be billed using electronic 837, or manual entry into the BEHRI claims system. The only exception to this is secondary claims, which must be submitted with EOB. Any deviation from these forms or formats must be pre-approved. All elements ofa clean claim are required to enter the claim and identify the “clean claim date”:  \n1. Hospital claims, with prior approval, to submit on paper shall be billed on the UB04 using Medicaid billing rules.  \n2. All other claims, with prior approval, to submit on paper shall be billed on the CMS 1500 using Medicaid billing rules.  \nAll external providers must enter claims using BEHRI unless prior arrangements are made with the Reimbursement Department at BCCMHA.  \nFor new providers, external provider shall request a log in from designated BCCMHA staff. BCCMHA will supply provider with this information within two weeks of initial request. New  \nprovider will also receive a training packet from BCCMHA. Providers will contact BCCMHA with any navigational questions.  \nClaims submitted for reimbursement must be initially received and acknowledged by BCCMHA within 90 days from the date of service when BCCMHA is the primary payer. In addition, denied claims must be re-billed within 30 days from the date of the last rejection.  \nExceptions to the 90-day filing limit will be considered under the following circumstances: administrative error by BCCMHA; Medicaid beneficiary eligibility was established retroactively; judicial action/mandate in which a court or departmental administrative law judge ordering payment of the claim; involvement of a third-party payer (TPL) such as when commercial insurance is primary; and Medicare processing delays. TPL claims must be submitted to TPL plan within 90 days of the date of service and submitted to BCCMHA within 30 days of the claim resolution. All TPL claims must be accompanied by the primary payer’s EOB.  \nContracted providers will be given 30 days’ written notice prior to all changes. The 90-day claimfiling limit will be excused and payment allowed when required written notice of change was not provided.  \nClaim Timeliness  \nAll claims will be processed by BCCMHA within 30 days, 90% of the time and within 45 days 99% of the time from the time a clean claim is received. Claims lacking necessary information will be returned requesting the necessary information within 30 days from receipt of claim. BCCMA will keep a file of all denied claims.  \nLate Claim Payments  \nFailure to pay claims in a timely manner is considered an unfair trade practice unless the claim is reasonably in dispute. As outlined in the Michigan Insurance Code, a claim that is not paid within 45 days shall bear simple interest at a rate of 12% per annum. The interest shall be paid in addition to and at the time of payment of the claim. Failure to pay claims ","cbCaihWUSzTZ8i5b","https://ap.wps.com/l/cbCaihWUSzTZ8i5b","pdf",218077,1,6,"English","en",105,"# PURPOSE\n# POLICY\n# STANDARDS\n## Valid claim submission requirements\n## Claims timeliness and filing limits\n## Late claim payments and enforcement\n## Valid codes and authorization rules\n# PROCEDURES\n## BEHRI claim submission\n## Hospital claim authorization and payment\n## Medicaid primary payer workflow","[{\"question\":\"How must providers submit behavioral health claims to BCCMHA?\",\"answer\":\"Providers submit claims using current HIPAA transaction standards or through the BEHRI/EHR system. Paper submission is allowed only when the provider receives permission, and secondary claims must include the primary payer’s EOB.\"},{\"question\":\"What makes a claim “clean,” and how is the clean claim date used?\",\"answer\":\"A clean claim requires all critical information needed for validity and payment processing, including address/contact and submission elements listed in the standards section. All required elements must be present to enter the claim and identify the clean claim date.\"},{\"question\":\"What are the filing deadlines and rules for denied or late claims?\",\"answer\":\"When BCCMHA is the primary payer, reimbursement claims must be received within 90 days from the date of service, and denied claims must be re-billed within 30 days from the last rejection. Claims are processed within set timeframes, and unpaid claims beyond 45 days may incur simple interest at 12% per annum and may lead to civil fines or court action if not reasonably disputed.\"}]","Claim-Adjudication - Behavioral Health Claims Processing Guidelines | PDF",1787746362,15,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":28},"claim-adjudication-behavioral-health-claims-processing-guidelines","",{"@graph":36,"@context":85},[37,54,68],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/document/","Document",2,{"item":49,"name":12,"@type":43,"position":50},"https://docshare.wps.com/document/healthcare/",3,{"item":52,"name":13,"@type":43,"position":53},"https://docshare.wps.com/document/claim-adjudication-behavioral-health-claims-processing-guidelines/146599/",4,{"url":52,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":23,"description":14,"dateModified":62,"datePublished":62,"encodingFormat":61,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":41,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-08-26",true,{"@type":65,"interactionType":66,"userInteractionCount":4},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"How must providers submit behavioral health claims to BCCMHA?","Question",{"text":75,"@type":76},"Providers submit claims using current HIPAA transaction standards or through the BEHRI/EHR system. Paper submission is allowed only when the provider receives permission, and secondary claims must include the primary payer’s EOB.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"What makes a claim “clean,” and how is the clean claim date used?",{"text":80,"@type":76},"A clean claim requires all critical information needed for validity and payment processing, including address/contact and submission elements listed in the standards section. All required elements must be present to enter the claim and identify the clean claim date.",{"name":82,"@type":73,"acceptedAnswer":83},"What are the filing deadlines and rules for denied or late claims?",{"text":84,"@type":76},"When BCCMHA is the primary payer, reimbursement claims must be received within 90 days from the date of service, and denied claims must be re-billed within 30 days from the last rejection. 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