Billing
Through CalMHIN's revenue cycle management services, a county's billing and finance staff should be able to hand off the month-end claims cycle (billing, remittance, denials and required state reporting) instead of running it all themselves.
Why this matters
Behavioral health billing carries a workload most county finance teams were not built to absorb alone. Claims have to go out to Medi-Cal, Medicare and other health coverage on a monthly cycle; remittances have to be attained and posted; denials have to be tracked down and re-billed; and a long list of state-required reports (CalOMS, CSI, CANS, PSC-35, ASAM and others) have to be generated and submitted on schedule, correctly, every time. Missing any piece of that cycle risks delayed payment, denied claims, or reporting non-compliance with DHCS. Revenue cycle management services take that entire cycle off the county's plate, professionally managed and aligned to DHCS requirements.
What this is
CalMHIN provides participant counties with professional services to manage all stages of revenue cycle management for all county payors and guarantors, along with the generation and submission of required DHCS reporting. Each month, this includes pre-billing error identification, coordination with county staff to resolve those errors, and the generation of both initial and supplemental claims batches (Other Health Coverage compiles, Medicare and Medi-Cal 837 claims, and claims to secondary payors) submitted on the county's behalf.
Once claims are out, CalMHIN attains and posts the resulting remittance information (835 data) from Medicare and Medi-Cal fiscal intermediaries directly into the EHR, and coordinates with the county on denials until each one reaches an appropriate resolution, generating and submitting re-billed claims as needed. On the reporting side, CalMHIN reviews the county's data for DHCS submission readiness and edits, creates and submits the required state files: CalOMS, CSI, CANS/FAST, PSC-35, Network Adequacy (274) reporting, and ASAM or Full-Service Partnership reporting where applicable.
Who it is for
County billing, accounts receivable and finance staff responsible for the monthly claims cycle, as well as program and compliance staff responsible for state reporting requirements.
Billing staff get pre-billing error checks, claims generation, remittance posting and denial management handled as an ongoing service rather than an in-house workload. Compliance and program staff get the state-required reporting files prepared and submitted on their behalf, with data reviewed in advance to meet DHCS submission and HIPAA compliance standards.
Capabilities
What the service covers
Monthly billing and claims generation
Produces initial and supplemental claims batches for Other Health Coverage, Medicare, Medi-Cal and secondary payors each month, submitted on the county's behalf.
Remittance processing
Attains 835 electronic remittance information from Medicare and Medi-Cal and posts the transactions directly into the EHR.
Denials and rebilling
Coordinates with county staff to resolve denied claims, generates and submits re-billed claims, and manages each denial through to resolution.
Required state reporting
Edits, creates and submits DHCS-required electronic files, including CalOMS, CSI, CANS/PSC-35 (FAST Reporting), Network Adequacy (274) reporting, and ASAM or FSP reporting where applicable.
Compliance-ready data review
Reviews claims and reporting data ahead of submission to help ensure HIPAA compliance and DHCS submission readiness.
Ongoing support and issue tracking
Provides training and support for month-end processes, and logs consequential issues into a shared support system so the county has visibility into open items and their resolution.