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7.5.1
Introduction
The collection and reporting of accurate complete, and timely enrollment,
demographic, clinical and disenrollment data is of vital importance
to the successful operation of the ADHS/DBHS behavioral health service
delivery system. It is necessary for behavioral health providers
to submit specific data on each person who is enrolled into the
behavioral health system. As such, it is important for behavioral
health provider staff (e.g., intake workers, clinicians, data entry
technicians) to have a thorough understanding of why it is necessary
to collect the data, how it can be used and how to accurately “code”
the data.
This data in
turn is used by ADHS/DBHS to:
- Monitor and
report on enrolled persons’ outcomes (e.g., changes in diagnosis
or GAF, employment/educational status, place of residence, substance
use, number of arrests);
- Comply with
federal and state funding and/or grant requirements;
- Assist with
financial-related activities such as budget development, rate
setting;
- Support
quality management and utilization management activities; and
- Respond
to requests for information.
The intent of
this section is to describe requirements for behavioral health providers
to submit the following data in a timely, complete and accurate
manner:
- Enrollment
(intake) and disenrollment (closure) transactions;
- Demographic
and clinical data, including substantive changes in a person’s
behavioral health status; and
- Information
about persons disenrolled from the behavioral health system, when
necessary and appropriate.
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7.5.2
References
The following citations can serve as additional resources for this
content area:
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7.5.3
Scope
To whom does this apply?
This applies
to all behavioral health providers who are delivering behavioral
health services to persons who are enrolled in the ADHS/DBHS behavioral
health system. It has particular relevance for those behavioral
health providers that conduct intakes, assessments, ongoing service
planning, and annual updates.
7.5.4
Did you know…?
- HIPAA 834-enrollment
transactions must be submitted by T/RBHAs to ADHS/DBHS within
14 days of first contact with a behavioral health recipient. Behavioral
health providers will be required to submit 834 transactions to
the T/RBHA within a shorter timeframe (see subsection 7.5.7-A.
for required timeframe).
- Behavioral
health providers are permitted to submit and change single data
fields when necessary, without being required to re-submit every
data field contained in a transaction.
- Behavioral
health providers delivering services to a Non-Title XIX person
are not required to submit fund source changes if the person posts
retroactive Title XIX eligibility. The ADHS/DBHS system will be
notified by AHCCCS to change the person’s fund source from
Non-Title XIX eligible to Title XIX eligible and requires no action
from the behavioral health provider. In instances where fund source
is changed, a corresponding retroactive behavioral health enrollment
will also occur. Behavioral health services provided during the
retroactive eligibility period will be the responsibility of the
T/RBHA.
- Personal
financial information does not have to be collected during the
intake process for persons that are Title XIX/XXI eligible.
- ADHS/DBHS
has developed a flow chart that includes the timeframes for enrollment
(intake), clinical and demographic, and disenrollment (closure)
data. See PM
Attachment 7.5.1.
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7.5.5
Definitions
834
Transaction Enrollment/Disenrollment
Behavioral
Health Category Assignment
Client
Information System (CIS)
Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
7.5.6
Objectives
To ensure that data elements specified by ADHS/DBHS and
the T/RBHAs are collected and submitted in a timely, complete and
accurate manner for each person enrolled in the public behavioral
health system.
7.5.7
Procedures
7.5.7-A.
Enrollment and disenrollment transactions
General requirements
- All persons
who are served through the ADHS/DBHS behavioral health system
must be enrolled, even if the person only receives a single service
(e.g., crisis intervention, one time face-to-face consultation).
- For a person
to be enrolled, behavioral health providers must submit an 834
enrollment transaction to the T/RBHA.
- Behavioral
health providers must submit enrollment data for any person receiving
covered behavioral health services or the provider will not be
reimbursed.
- A person
who needs a covered behavioral health service must be enrolled
effective the date of first contact by a behavioral health provider.
When is
enrollment information collected?
Information necessary to complete an 834 transaction is usually
collected during the intake and assessment process (see Section
3.9, Intake, Assessment and Service Planning).
What kind
of data must be submitted to complete an enrollment or disenrollment?
The data fields that are included in the 834 transmittals are dictated
by HIPAA and consist of:
- Key client
identifiers (e.g., person’s name, address, social security
number, date of birth) used for file matching;
- Basic demographic
information (e.g., gender, marital status); and
- Information
on third party insurance coverage.
For a specific
list of data elements necessary to create an 834 enrollment (intake)
and disenrollment (closure), see PM
Attachment 7.5.2.
What happens
if there is not enough information to complete an enrollment?
Behavioral health providers must actively secure any needed information
to complete the enrollment (834 transaction). An 834 transaction
will not be accepted by the T/RBHA if required data elements are
missing.
What are
the timeframes for submitting enrollment and disenrollment data?
The following data submittal timeframes apply to the enrollment/disenrollment
transactions:
The 834-enrollment transaction must be submitted to [T/RBHA add
name here] within [T/RBHA insert number of days] days of the first
contact with a behavioral health recipient;
The 834 disenrollment transaction must be submitted to [T/RBHA add
name here] within [T/RBHA insert number of days] days of the person
being disenrolled from the system; and any changes to the enrollment/disenrollment
transaction data fields (e.g., change in address, insurance coverage)
must be submitted [T/RBHA insert number of days] days from the date
of identifying the need for the change.
Other considerations
- When a person
re-locates from one T/RBHA’s geographic area to another
T/RBHA’s geographic area, an inter-RBHA transfer must occur
(see Section 3.17, Transition of Persons). The steps that are
necessary to facilitate an inter-RBHA transfer include the following
data submission requirements:
- The home
T/RBHA must submit an 834 disenrollment transaction on the
date of transfer; and
- The receiving
T/RBHA must submit an 834 enrollment transaction on the date
of accepting the person for services.
- When a T/RBHA
enrolled person is determined eligible for the Arizona Long Term
Care System (ALTCS) Elderly and Physically Disabled (EPD) Program,
the behavioral health provider must submit an 834 disenrollment
transaction, effective the date of ALTCS/EPD eligibility.
What technical
assistance is available to help with problems associated with electronic
data submission?
At times, technical problems or other issues may occur in the electronic
transmission of the data from the behavioral health provider to
the receiving T/RBHA. If a behavioral health provider requires assistance
for technical related problems or issues, please contact [T/RBHA
enter contact name and telephone numbers for IT technical assistance]
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7.5.7-B.
Demographic and clinical data
When is demographic and clinical data collected?
Demographic and clinical data will primarily be collected during
the intake and assessment process. Additional clinical data may
be acquired at subsequent assessment and service planning meetings
with the enrolled person (e.g., education, vocation) as well as
during periodic and annual updates.
What are
the specific data elements?
ADHS/DBHS has established a set of required demographic and clinical
data elements that must be collected and submitted within required
timeframes (see PM
Attachment 7.5.3). The T/RBHA has developed a form
for behavioral health providers to use to collect this information
[T/RBHA reference and attach link to form here]. Any additions,
changes and/or modifications to the ADHS/DBHS required demographic
data elements must be prior approved by the ADHS/DBHS Policy Office.
What are
the timeframes for submitting demographic and clinical data?
The following timeframes apply to demographic and clinical data
submission (see PM
Attachment 7.5.3):
- All required
demographic data submitted to [T/RBHA insert name here] within
[T/RBHA insert number of days] of the initial intake for all enrolled
persons.
- Behavioral
health providers are encouraged to update demographic data elements
on an ongoing basis, as appropriate, and are required to update
all applicable demographic data elements when:
- There is
a significant change in the person’s condition resulting
in a change in the person’s diagnostic code for behavioral
health (Axis I or II); or a change in the person’s behavioral
health category assignment;
- Completing
the annual update (see Section 3.9, Intake, Assessment and Service
Planning); and
- All required
data elements submitted to [T/RBHA insert name here] within [T/RBHA
insert number of days] of disenrollment. The required data elements
include the reason for the person’s disenrollment.
Determining
a behavioral health recipient’s behavioral health category
assignment
Behavioral health providers must designate a person’s behavioral
health category assignment during the intake and assessment process
as well as at any other times that necessitate changes to the person’s
assignment (e.g., transition to adulthood). Behavioral health categories
include:
- Child;
- Adult with
SMI
- Adult, non-SMI
with general mental health need; and
- Adult, non-SMI
with substance abuse.
Behavioral health
providers must initially assign and update, as necessary, behavioral
health category assignments as follows:
- For child
enter “C”;
- For a person
determined to have a serious mental illness enter “S”;
- For an adult
non-SMI person with a general mental health need (who does not
have a substance abuse problem) enter “M”; and
- For an adult
non-SMI person with a reported substance abuse problem enter “G”.
The child behavioral
health category is determined by the behavioral health recipient’s
age. For adults, each category is solely determined by the person’s
diagnosis, with the exception of a person determined to have a serious
mental illness (SMI). A person determined to have a serious mental
illness must meet diagnostic and functional criteria as described
in Section 3.10, SMI Eligibility Determination. PM
Attachment 7.5.4 contains diagnostic codes and corresponding
behavioral health category assignments.
How can
demographic and clinical data be used?
Behavioral health providers are encouraged to utilize demographic
and clinical data to improve operational efficiency and gain information
about the persons who receive behavioral health services. Behavioral
health providers may consider:
- Utilizing
and integrating collected demographic data into the person’s
assessments;
- Monitoring
the nature of the provider’s behavioral health recipient
population; and
- Evaluating
the effectiveness of the provider’s behavioral health services
towards improving the clinical outcomes of persons enrolled in
the ADHS/DBHS system.
What technical
assistance is available to help with problems associated with demographic
and clinical data submission?
At times, technical problems or other issues may occur in the electronic
transmission of the clinical and demographic data from the behavioral
health provider to the receiving T/RBHA. If a behavioral health
provider requires assistance for technical related problems or issues,
please contact [T/RBHA enter contact name and telephone numbers
for IT technical assistance]
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7.5
Enrollment, Disenrollment and Other Data Submission
Last Revised: 06/24/2004
Effective Date: 08/01/2004
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