specifications - thenationalcouncil.org · web viewcompleting treatment authorization requests...

Specifications PRI MU RESP Included Add'l Cost

No Comments

Wait List: The maintenance of a roster of clients who have been deemed eligible for covered services, but cannot yet receive services due to provider or program capacity constraints. As active clients complete or are removed from a program or service, individuals on the wait list are accepted into the program or service for treatment.Managing Program Capacity: Maintaining accurate and up-to-date information on the program's capacity to provide different types of treatment to different types of clients, and how much of the capacity was utilized during specific time frames..The system shall permit authorized users to define the capacity for each program.

H

Managing Wait List: Supports manual and automatic placement and movement of individuals on a list awaiting program services. For inpatient or residential settings, this is related to 9.0 Bed Management.The system shall maintain a wait list of clients who need to be scheduled in the next available opening

H

The system shall capture, maintain, and store wait list parameters for a client (e.g., how long on, when taken off, etc.).

H

Prioritizing Wait List: Identifies individuals, or categories of individuals, considered a higher priority for services based on acuity measures found in selected assessmentsThe system shall order the wait list according to a user-defined acuity measure pulled from each client's assessment.

H

SAMPLE EHR REQUIREMENTS WORKSHEET


No Comments

Call Intake: Accepting inquiries (both written and verbal) from clients and other individuals, documenting client and call information and responding appropriately to the inquiry on a timely basis. Policies and procedures are established in response to inquiry on a timely basis (via telephone, letters, email, fax, internet, intranet, etc.), including both routine and emergency inquiries.The system shall capture service request related information for inquiries coming in through a centralized Line (at the time of call intake), direct contact with a potential client, or direct contact with a contract provider.

H

The system shall allow a user to route crisis contacts to crisis workers and requests for routine care to outpatient clinics.

H

The system shall capture information from client calls pertaining to complaints, grievances, appeals, and compliments, including disposition of such calls.

H

The system shall permit real-time data checking and data entry while a user is on the phone with a consumer, prospective consumer, or related party.

D

The system shall provide the ability to capture, maintain, update, and report on demographic.

H

The system shall list client/patient demographic by: ZIP code and census tract

H

The system shall list clients/patients who have not received services for a specific date range

H

The system shall list clients/patients currently receiving on Chapter 51 commitment or settlement agreements

H

The system shall list all clients/patients by service program

H

The system shall list dually-diagnosed clients/patients H



No Comments

Intake Screening: A determination is made if a client should be seen by the Central Intake program, another agency program or by another clinic/24-hour facility. Screening is facilitated by medical and financial eligibility information provided by the client.The system shall provide online client screening forms (e.g., Service Request Form) that capture information on access needs, presenting problems, and other clinical information required to assist in determining whether the client requires crisis services

H

Call Disposition: Based on results from available information or from research or fact-finding process, inquiries or complaints are addressed and resolved.The system shall capture the disposition of the call, including documentation of client situation and status relative to disposition decision.

H

Logging Calls: Recording information on all calls and contacts (e.g., name, phone number, primary language, reason for call, etc.)The system shall capture and maintain all appropriate information on the call or contact (e.g. caller name, phone number, language requirement, etc.).

H

The system shall report the number of calls received by:Attributes of caller (i.e., gender, ethnicity, age, location)

H

Non-crisis support HAssessments (child and adult) HThe system shall report the number of calls received by time frame by program?

H

Performing Tracking and Follow-up: For unresolved inquiries or complaints, call status is tracked and monitored for completion. Follow-up efforts are made to ensure inquiries or complaints are completed or closed.The system shall track and monitor the status of unresolved inquiries or complaints until the call is completed or the case is closed.

H



No Comments

Performing Tracking and Follow-up: (continued)The system shall list clients/patients recently referred to outside services

H

The system shall list how and where client/patient was transported to the admitting facility, including but not limited to: Law Enforcement, System of Care staff, Ambulance, Referred by Organization, Self, etc.

H

Managing Quality and Performance of Process: Quality and performance of the call center is monitored and evaluated. For example, call monitoring is considered a widely used method of quality and performance measurement.The system shall capture and report on all information required by Federal, State, and local agencies, such as penetration rates, telephone access, and CSI data, to assess performance of the call intake process and improve the quality of service.

H



No Comments

Referrals: The process of sending and receiving a client from one provider to another for services. This includes the tracking of outgoing and incoming referrals made to/from the Health Agency, as well as to/from network providers, community based organizations (CBOs), and other institutions (e.g., state hospital, IMDs).Incoming Referrals: Capturing and maintaining information on incoming referrals (e.g., referral source, reason for referral, client demographics, release of information, etc.). Referrals may be from contracted populations, community members, Dane County social workers, community-based organizations, and independent fee-for-service network providers.

The system shall have the capability to receive electronic referrals.

H

The system shall track clients/patients by referring organization.

H

The system shall record, acknowledge, and track incoming referrals.

H

The system shall track incoming referral information on the Service Request Form.

H

The system shall send referral confirmation when a referral has been received.

D

The system shall document, track, and report on the disposition of an incoming referral.

H

The system shall automatically notify external referral sources of attendance at intake appointment

D

The system shall capture patient financial liability at the time of referral.

H

Assigning Referral: For accepted client, deciding which clinician will serve as the lead therapist or counselor, and adding the client to the clinician's case load.The system shall match client to clinician using multiple variables determined through the selection of user-defined criteria (e.g., provider location, specialties, non-English language capability, etc.).

D

The system shall assign staff to a client /referral by a user at the time a referral is received.

H



No Comments

Maintaining Information: Referral information is revised or updated, along with established standards and protocols.The system shall capture, maintain, and periodically update County 610 data through an electronic download or interface.

D

The system shall capture and maintain other user-defined information on community resources.

D

The system shall capture and maintain community resource information into a searchable database that can be filtered based on user-defined criteria.

D

The system shall store community resource information in a way that keeps these records separate from the list of network providers, or in a separate table that has the same lookup and tracking capabilities of the provider referral database.

D

The system shall have the ability to transfer appropriate referral information to assessment and treatment plan forms.

H

External Referrals: Recording and maintaining information that client has been referred to another provider (e.g., housing, social services, and primary care). These referrals may be within or outside of the Health Agency.The system shall streamline sending health record information to outside providers (e.g., the client's primary care provider).

D

The system shall have the capability to receive electronic referrals.

H

The system shall support the issuance and tracking of service referrals to Network Providers.

D

The system shall comply with the Chapter 20 requirement that DUI client shall be enrolled within 21 days of the date of application.

D

The system shall validate the discharge status prior to completion of referral out.

H



No Comments

External Referrals: (continued)The system shall document, track, and report on the disposition of an outgoing referral (e.g., whether client was seen by the provider or organization to which she/he was referred).

H

The system shall provide the capability for authorized users to send referrals via email or e-fax.

H



No Comments

Managed Care: This is the process of determining the necessity, appropriateness, and efficacy of services provided to clients. Managed Care includes utilization management (UM), which involves managing the use of services through prospective, concurrent, or retrospective review of care/service. Service authorization or certification is the process of obtaining approval for treatment or services, based on medical necessity prior to receiving treatment/service. Without prior service authorization, a client may be deemed not eligible; the treatment/service may not be covered, or must be paid for out-of-pocket by the client.

Recording Service Requests: A request for service may be received via telephone, e-mail, fax, or online. Service requests are documented on the Service Request Form.The system shall capture all the information in the Service Request Form.

H

Determining Authorization: Deciding whether to authorize a service request based on established criteria or standards (e.g., medical necessity and financial eligibility). For medical necessity, authorization decisions are based on acuity information collected through the Service Request Form. For financial eligibility, authorization decisions are based on determining if a client meets payer or program requirements or thresholds.The system shall support authorizations for treatments and services.

H

The system shall support authorizations for inpatient psychiatric services day treatment, and Outpatient behavioral services.

H

The system shall provide the ability to list the services for which the client/patient is eligible and authorized to enroll.

D

The system shall maintain and track service authorizations according to client funding. This will include Medicaid and Medicare and others.

H

The system shall capture patient financial liability at the time of authorization.

H

The system shall permit for the issuance, letter generation, tracking and closing of internal authorizations that the County issues for clients served at County clinics.

H

The system shall permit for the issuance, letter generation, tracking and closing of authorizations received from health plans and managed care companies authorizing services rendered by JMHC staff.

H



No Comments

Determining Authorization: (continued)The system shall permit for the issuance, letter generation, tracking and closing of authorizations that the agency issues to providers in the provider network as part of the agency’s role of utilization management for contracted Medicaid/Badgercare HMO health plans.

H

The system shall support the setting of service limits for each type of authorization, including but not limited to number of visits or days, number of client or clinician service hours, number of days or weeks, specific service codes, and/or specific dollar limits.

H

The system shall support the definition and enforcement of authorization rules that lockout the provision of services to a client based on any user-defined service/client/patient/provider/payer combination.

H

The system shall allow for the issuance, letter generation, tracking and closing of a variety of authorization types (e.g. acute inpatient, client/patient, and outpatient).

H

The system shall compare documented services provided to authorized amounts and notify providers and utilization managers of remaining balances and impending authorization expirations.

HH

The system shall lockout (during authorization) individual/organizational/private provider services according to the service limits established for that type of authorization or in the case of Medicaid/Medicare crossover cases.

H

The system shall permit authorized staff to override lockouts.

H

The system shall permit authorized staff to add, change, or delete services within an individual authorization.

D



No Comments

Determining Authorization: (continued)The system shall permit authorized staff to print or display a bilingual Notice of Action (NOA) and other service denials to clients/patients based upon coded reasons.

D

Completing Treatment Authorization Requests (TARS): Completing Treatment Authorization Request forms (for Fee For Service and SD/MC inpatient services). The MHP authorizes psychiatric inpatient hospital service admissions, continued stay services and administrative days for all Medicaid recipients based on county of residence. Emergency admissions are exempt from prior authorization. However, the hospital must notify the MHP in the recipient's county of residence within 24 hours of admission. If notification is not received within 24 hours, the MHP may deny the hospital stay.

The system shall support the process per insurance and payer requirements, including but not limited to: developing the TAR, tracking the status of the TAR (e.g., pending, denied, or approved), and tracking the history of all TARs.

H

The system shall permit authorized staff to print or display the Service Authorization and/or Treatment Authorization Request (TAR).

H

Managing Utilization: Proactively ensuring appropriate use of services, including establishing medical necessity, obtaining or requiring prior authorizations, obtaining treatment authorizations, and performing prospective/ concurrent/ retrospective utilization review.The system shall identify services that can and cannot be reauthorized.

H

The system shall list services for which the client/patient is authorized.

H

The system shall track prospective clients/patients who have been authorized for services but who have not yet been evaluated or assessed.

H

The system shall update (renew) client/patient record and authorize additional services or treatment when required for qualified clients/patients.

H



No Comments

Managing Utilization: (continued)The system shall track authorizations issued by third parties (e.g., Administrative Services Organization (ASO) and Fee-For-Service (FFS) in-patient hospitals).

D

The system shall provide the ability for a user to verify that a program, service, or plan has been authorized.

D

The system shall permit staff to enter narrative comments regarding authorized treatments or services.

H

The system shall automatically alert the appropriate users (e.g., the authorizing agent, network provider) when authorized services have been depleted.

H

The system shall prevent the approval and billing of authorization requests from Network Providers requesting authorization for intern services for Medicaid eligible children and Medicaid eligible adults.

H

The system shall permit authorized users to suspend authorization of services based on Medicare-Medicaid rules.

H



No Comments

Provider Contract Management: Provider contract management involves the process of monitoring contractual agreements between service organizations, providers, and various agencies (e.g., State, EOC, CHC) that facilitate service delivery and financial obligations. A contract is a legal, binding agreement that stipulates terms and conditions between the County and another party. One of the major objectives for contract management is the development of a business partnership with providers to ensure the delivery of quality services, proper reimbursement, risk mitigation, facilitation of administrative functions (e.g., authorizations, claims), and availability of funding.Maintaining and Tracking Contract Status: Contract maintenance involves keeping contract terms and conditions accurate, up-to-date, and in compliance with applicable rules and regulations. Track contracts with network providers and CBOs based on clinical outcome measures defined by the program-- measures depend on type of program. Includes tracking the arbitration/dispute progress, insurance requirements, quality and utilization performance, financial condition (reimbursement, payment, cash flow), licensure status and other factors important in monitoring provider contract-compliance.Since the agency has multiple contracting practices with organizational and individual members of its provider network, the system shall support multiple contractor agreements that include services funded by multiple payers with differing benefit designs and multiple provider reimbursement systems such as case rate, fee for service, capitation, and fixed fee payments.

H

The system shall maintain a Rate schedule for internal providers.

H

The system shall maintain a Rate schedule for external providers.

H

The system shall record and track communications with provider organizations and individual clinicians, such as notes related to provider requests, complaints, and contacts initiated by County staff.

H

The system shall indicate that the provider has been sent current handbooks and other materials.

D

The system shall indicate receipt of required documentation from provider.

D

The system shall support a centralized repository for all contract-related templates and documentation (e.g., contract templates).

D



No Comments

The system shall maintain all required information on each contract being managed (e.g., contract status, term/duration, contractor information, financial information, amendment information, termination date and reason).

D

The system shall allow the design and implementation of workflows specific to the type of contract being managed.

D

The system shall provide an audit capability that tracks all revisions and/or changes to an original approved contract.

D

The system shall generate and provide reminders for events requiring user attention (e.g., contracts pending renewal, fee schedule changes, deadlines for submitting information, invoice approval).

D

The system shall reconcile contract amount (e.g., invoices, payments) with amount encumbered for that contract.

D

The system shall provide a complete revision history to an approved contract package upon request.

D

The system shall incorporate workflow to design, implement, and manage standardized processes for contract management.

D

The system shall provide a checklist of all requirements that must be met before a contract is approved or that are needed to ensure that a contract will continue in force (e.g., licensing / credentialing requirements needed for Medicaid contracts.)

D

The system shall generate and provide alerts when specific contract requirements are not being met for contract approval or renewal.

D



No Comments

The system shall provide a notification when a contractor’s date of certification approaches expiration, has expired, or been revoked.

D

The system shall provide a notification when a contract approaches expiration, has expired, or been revoked.

D

The system shall support configurable workflow to route contract request and/or contract electronically to obtain required approvals.

D

The system shall provide for electronic approval of contract request and/or contract.

D

The system shall permit an approver for a contract request and/or contract to delegate his/her approval authority as needed.

D

The system shall provide the capability for an authorized user to query the status of a specific contract request and/or contract.

D

The system shall provide the capability for authorized users to create and maintain blanket contracts with releases.

D

Maintaining History: Establishing and maintaining historical and current fee schedules.The system shall retain historical rate information. H



No Comments

Provider Network Management: The purpose of provider network management is to ensure that the proper mix of providers (clinicians) is available to deliver necessary, covered services to clients throughout the service area. Network management involves determining client needs, screening potential provider applicants, verifying potential provider applicants’ credentials, license, and qualifications, writing contracts, ensuring contract compliance, and re-credentialing and renewing provider contracts as appropriate to maintain the provider network.

Assigning Providers: Assigning a provider to a client based on client need and network provider availability. In the future, it is envisioned that following the assessment, referral process, and eligibility process, a client will be able to search for providers by specialty, gender, language spoken, and geographic location (e.g., zip code).Following the assessment, referral, and eligibility processes, the system shall support a client's ability to conduct an online search for providers by specialty, gender, and geographic location (e.g., zip code) - Also see 11.0 Portal

D

Maintaining Network Provider Database: Maintaining accurate and current data on provider status (e.g., provider name, type, address, ages served, therapeutic modalities, experience with cultural groups, experience with spiritual groups, languages spoken, specialty services, specific areas of practice, and whether accepting new referrals).

The system shall capture detailed practice information for clinicians in the provider network (including agency staff clinicians).

H

The system shall automatically populate user-defined forms, lists, and reports from data entered in to the provider payment database (e.g., Scope of Practice Sheet).

H



No Comments

Application Enrollment: The process of completing a group of initial administrative functions necessary to provide behavioral health services to an individual. Includes application for services, initial intake prior to prospective client completing an application to enroll in a covered program or service. May include assessment and placement (for DA/S).

Completing Enrollment Application: Prospective client or other appropriate party completes enrollment paperwork via paper forms or online (Internet, intranet) for the purpose of obtaining Health Agency behavioral health services. Includes gathering 3rd party payer information.

The system shall capture initial client demographic and financial information for individuals requesting service

H

The system shall automatically forward all pre-registration or application/enrollment information to registration if the individual becomes an active client.

H

The system shall permit staff to assign clients to programs.

H

The system shall permit authorized staff to print or display language specific bilingual (English and Spanish) enrollment letters, provider change letters, or other letters as identified.

H

To ensure compliance with Title IX, the system shall flag staff that a DUI client must be enrolled or transferred to a new program within 21 days of the date of application.

D

The system shall support client kiosks (in waiting room areas) with computer access that allow clients to enter application data themselves

D



No Comments

Establishing Eligibility Criteria: Eligibility criteria for benefits may be based on a client's medical necessity, financial status, age, diagnosis, court referral, etc. A client may not qualify for one program, but may qualify for an alternative program, depending on payer-specified criteria.The system shall permit users to define program-specific clinical eligibility criteria

H

The system shall automatically alert staff when a client has met clinical eligibility criteria that qualify them for a specific program.

H

Obtaining Client's Eligibility Information for Payment: Client or other appropriate party provides eligibility information, which is available during the enrollment process. Eligibility data may include the client's total benefit package information.The system shall indicate whether client has provided proof of income.

H

The system shall support eligibility determination for: Medicaid

H

The system shall support eligibility determination for: Drug Medicaid

H

The system shall support eligibility determination for: Medicaid/Medicare crossover

H

The system shall support eligibility determination for: Medicare

H

The system shall support eligibility determination for: Grant and contract funding

H

The system shall support eligibility determination for: Badgercare HMO plans

H

The system shall support eligibility determination for: Private insurance

H



No Comments

Electronically Verifying Eligibility: Accessing the Forward Health system to determine if a client is eligible to receive Medicaid services. Also includes providing online, real-time eligibility verification for non-Medicaid payers who support this capability.The system shall support a real-time interface to the Forward Health database to view the current status of a client's eligibility at any time during the client course of treatment (e.g., during the billing process).

H

Downloading Electronic Eligibility Data: Periodically downloading electronic eligibility data from payers and plans, including Medicaid and Medicare Parts A & B.The system shall support periodic (i.e., monthly) downloading of the Forward Health files from the State.

H

The system shall support eligibility loading for Medicare.

H

The system shall support eligibility loading for all health plans and insurers with whom the agency contracts.

H

Verifying and Updating Medicaid Eligibility and Share of Cost Information: Automatically verifying and updating each client's Medicaid eligibility and share of cost balances in the Medicaid Management Information System (MMIS) using the most recently downloaded state MEDS file.

When the Forward Health system has been accessed, the system shall update the Eligibility Verification Code (EVC) in a client's Medicaid insurance record.

H

Verifying Benefits: Collecting enrollee eligibility information and allowing staff to verify benefits through a variety of mechanisms for Medicaid, Medicare and Private Insurance clients.

The system shall verify against all downloaded eligibility files and automatically update the benefits for which a registered client is eligible.

H



No Comments

Processing Eligibility Information: Client's information is verified with established eligibility criteria to determine qualification. In addition, client episode or encounter information is cross-referenced with eligibility information for appropriate authorization and payment. A client can belong to more than one reimbursement group; with respect to coordination of benefit process. Grouping can be based on criteria such as insurance, age, grant status, legislation, and so forth. If a client is determined to be eligible, then an assignment of eligibility period is determined with begin/end date. Other eligibility information may include, Medicaid mandated benefits, co-payment, deductible, co-insurance, coordination of benefit (COB), subrogation (workers compensation), exclusions, and other limits/restrictions.The system shall automatically populate Client insurance fields when no prior eligibility has been determined.

H

The system shall automatically update Client insurance information when the eligibility status has changed, including retroactive updates for clients previously served.

H

The system shall provide recommendations as programs/plans to fund services provided to a client based on client needs, financial ability, and Medicaid eligibility.

H

The system shall support eligibility processing for all health plans and insurers with whom the agency contracts.

H

Notifying Agency Staff: Alerting counselors, therapists and other appropriate parties of Medicaid eligibility status changes, either prospective or retrospectively.The system shall identify clients who have lost their insurance coverage.

H

Notifying Clients: Eligibility result is communicated to client or other appropriate party in person, or via online, mail, telephone, fax, etc. Includes generating a notice to the client when the client's annual financial evaluation expires.The system will prompt staff to print selected forms to give to the client at the conclusion of the eligibility/financial assessment (e.g., the Advanced Beneficiary Notices, PHF aftercare plan, etc).

H



No Comments

Maintaining Eligibility Information: Eligibility information is maintained and updated to include client's qualification or disqualification status; includes updating client financial and employment status; and revising eligibility criteria.The system shall maintain Medicaid eligibility for all individuals identified in the monthly Medicaid download from the State, not just individuals who are enrolled as clients. Similar capabilities should be available for Medicare and health plans with whom the agency contracts.

H

The system shall permit manual on-line reviewing and updating of insurance records for clients with special handling conditions including: a partial eligibility match requiring investigation, Medicaid Share of Cost responsibility, CMSP eligibility, other State aid codes, Medicare and private insurance.

H

The system shall track client/patient eligibility to a program/service/plan.

H

The system shall maintain multiple eligibility/program statuses.

H

The system shall maintain multiple eligibility sub-programs to ensure that ineligibility for one service does not override eligibility for other services.

H



No Comments

Demographics Management: The collection and retention of current information that describes characteristics of individuals (e.g., clients and providers) for the purpose of accurately and properly identifying individuals who provide, request and/or receive treatment and services.Capturing, Updating, and Maintaining Client Data: Capturing data on client name, aliases, address, SSN, DOB, age, sex, race, primary language spoken, education, and other characteristics. Correcting, modifying or updating data to reflect changes or new information.The system shall verify client status in a given program against the defined program outcome measures.

H

The system shall identify to an authorized user whether a client is on probation and if yes, capture probation Terms and Conditions and permit the user to view or print this information.

H

The system shall capture the following mandatory data for a client: date of birth, date of death, and date of bankruptcy.

H

The system shall track participants in defined programs

D

The system shall provide the ability to capture, update, maintain, and report on State-mandated CSI demographic data.

H

The system shall track the number of services within program against annual estimated service number.

H

The system shall provide a summary screen, and generate a summary sheet (or face sheet), that contains key demographic information, administrative status (including Medicaid/insurance eligibility), pending appointments and dates of last service.

H



No Comments

Capturing, Updating, and Maintaining Clinician Data: Capturing data on clinician name, address, SSN, DOB, age, sex, race, primary language spoken, education, licenses, credentials, and other characteristics. Correcting, modifying or updating data to reflect changes or new information. Accommodates HIPAA-compliant National Provider Identifier (NPI).The system shall track cases by staff member assigned to a case.

H

The system shall capture and verify the status (active/inactive) of a provider.

D

The system shall capture mandatory characteristics for all employee and contract clinicians: name, date of registration, location, discipline, licensure, specialties, and category (i.e., employee, contract, community-based program).

D

The system shall indicate practitioner status for eligibility or good standing in Wisconsin; billing Medicaid and other payers, where applicable; and other practitioner data for all providers (both Network and employed providers) that ensures clinicians and practitioners are duly licensed.

H

The system shall support the registering, tracking and reporting on provider organizations and individual clinicians that contract with the agency

H

The system shall capture and track type of provider (e.g., Out-of-County, credentialed, organizational).

H

The system shall associate providers authorized to provide services under a given program.

H

The system shall capture and maintain National Provider Identifiers (NPI).

H



No Comments

Registration: The process of recording and tracking the presentation of a client to an outpatient setting for service. The registration process captures relevant information about a client; his/her assigned clinician, and service type.Entering/Updating Client Profile: Upon a client's arrival or check-in based on a scheduled appointment or walk-in, client information is captured or updated.The system shall support the collection of demographic and other data that is appropriate for the client's diagnosis, age, service setting, etc. at the time a client registers for service.

H

The system shall be configurable to support client focused data collection (e.g., as a client is being admitted for alcohol problems, the information system will automatically prompt for particular data items appropriate to the client).

H

The system shall prompt the user performing client registration for missing data.

H

The system shall during the registration process cross check client name against other possible aliases.

H



No Comments

Admission, Discharge, and Transfer (ADT): ADT is the process of tracking a client's admission, discharge, and transfer (change in location), and often within an organization's health care system. ADT also keeps track of clients who are placed on leave of absence but who remain active clients. Includes transfers between settings, programs, or clinics; special population client status tracking. Episode management is maintaining single or multiple, simultaneous episodes/statuses for clients who are receiving services on a concurrent or overlapping basis until the case is closed.Admitting a Patient/Client: Upon a client /patient's arrival, client information is captured or updated and acceptance in to the facility for treatment is acknowledged.The system shall support the collection of data appropriate to a client's diagnosis, age, service setting, etc. as a client is admitted for service.

H

The system shall support a client's admission to an organizational provider through an admission order or form.

H

The system shall provide the capability for an authorized user to enter a client/patient's advance directive and power of attorney into the electronic record upon admission.

D

The system shall provide the capability for authorized users to generate and print an admission checklist/flow sheet that includes all necessary clinical and administrative activities and forms required for admission.

D

The system shall alert a designated staff member when a specific admission activity involving them is due.

D

Inventorying Property: Documenting all property and effects that a patient has on their person or in their possession upon admission to the facility. Including noting location of each article (e.g., in the room, on the unit, in a locker). At discharge or transfer, property is again inventoried to ensure patient leaves with his/her own personal effects.The system shall capture and track information on client valuables that are held on each unit of an inpatient facility.

H



No Comments

Discharging a Patient: after the discharge, order has been written and patient has been prepared to leave the facility, acknowledging in the system that the patient has been released from the facility.The system shall support schedules organized by provider.

H

The system shall permit authorized staff at one clinic to schedule an appointment for a clinician at another clinic.

D

The system shall provide the ability to search and find the first available appointment for a any given provider.

D

The system shall prompt a user with suggestions for the next available appointment based on the master schedule and appointment parameters.

D

Transferring a Patient: Acknowledges a change in patient status or location during an inpatient stay, e.g., transfers outside of the facility, but still within the same inpatient episode of care.The system shall permit authorized users to transfer an admission from one organizational provider to another.

H

Maintaining Admission Status: Acknowledges a change in patient status or location during an inpatient stay, e.g., transfers outside of the facility, but still within the same inpatient episode of care.The system shall capture data from and for other organizational providers.

H

The system shall maintain mandatory inpatient data: date of admission, referring provider, inpatient sponsor, outpatient authorization type, outpatient case manager, date of discharge, admit and discharge diagnosis, and legal status.

H



No Comments

Episode Tracking: Defining and tracking episodes of care for clients based on State and local definitions of episodes. This includes tracking all of the care provided to an individual within a given service program during a given time period (e.g. a client could have more than one program open at the same time and services would be tracked separately). This also includes tracking outpatient services separately from inpatient facility admissions that may occur during the same time period.The system shall have the ability to define and track episodes of care for clients based on State and local definitions of episodes

H

The system shall have the ability to track all of the care provided to an individual, by service or program, during a given time period (e.g., a client could have mental health and drug/alcohol episodes open at the same time and services would be tracked separately).

H

The system shall have the ability to track separate behavioral health episodes at the same time (e.g., tracking outpatient services and an admission to an inpatient facility during the same time period).

H

The system shall automatically flag episodes for closing if a user-defined, pre-determined period of no service has elapsed.

H

The system shall capture a client's requested guardianship and conservatorship.

D

Crisis Tracking: Tracking crisis episode data including date and time of first contact, referral source, clinical notes about the crisis including user-defined checklists and text-based crisis notes that allow for the recording of diagnosis, level of functioning and other relevant clinical data.The system shall track crisis episode data to include date and time of first contact, referral source, and clinical notes about the crisis.

H

The system shall provide user-defined checklists and text-based crisis notes that capture diagnosis, level of functioning, and other relevant clinical data.

H

The system shall track and permit easy viewing of the services provided during the crisis episode.

H

The system shall automatically alert the client case manager to track and monitor a crisis episode.

H



No Comments

Share of Cost/UMDAP/Sliding Scale/Co-Pay/ABN: Share of cost is a mechanism by which a client's ability to pay for services received is calculated. Usually applicable to lower income clients, fees may be calculated according to the Uniform Method for Determining Ability to Pay (UMDAP) or another method, depending on the payer source. Sliding fee scales are calculated based on gross income and insurance status. Co-pay is the amount an insured person is expected to pay for a medical expense at the time of the visit.Maintaining Fee Schedule and Structure: Developing annual fees for each program, using various methodologies, including creating sliding scales based on UMDAP. Maintaining accurate and up-to-date information on payer-specific or County charges for all services rendered and programs offered to clients.The system shall track Universal Method Determining Ability To Pay (UMDAP) liability for billing purposes.

H

The system shall determine Universal Method Determining Ability To Pay (UMDAP) liability by “family units” and individuals.

H

The system shall permit establishment of the UMDAP year and family members for the family group.

H

The system shall permit client/patient payment options such as co-pays or Universal Method Determining Ability To Pay (UMDAP) amounts.

H

The system shall be configurable to offer a variety of sliding scale fee schedules, allowing the independent configuration of each scale according to the rules of the payer or funding source.

H

The system shall offer a variety of sliding fee schedules using data that includes but is not limited to family size, income, and other assets and liabilities.

H



No Comments

Calculating Share of Cost: Automatically calculating a client's share of their service/program costs.The system shall calculate differential pricing/payment based on program/plan providing the service.

H

The system shall indicate share-of-cost and co-pay information by plan/program.

H

The system shall track clearing of Medicaid share of cost for both MH and non-MH services and coordinate with State annual UMDAP requirements.

H

The system shall immediately update and report client/patient financial accounts to include Share-of-cost.

H

The system shall immediately update and report client/patient financial accounts to include Co-payment.

H

The system shall be able to generate an Advanced Beneficiary Notice (ABN) and to document the consumers receipt of the ABN.

H

Determining Client’s Fulfillment of Share of Cost: Automatically calculating a client's total payments made toward his/her account and indicating to what extent payments made fulfill their share of cost.The system shall automatically apply a client's payment history against their share of cost.

H

The system shall automatically calculate a client's fulfillment of their share of cost.

H

Calculating Sliding Fee: Automatically calculating a client's fee on the basis of client income and number of people applied to a standard (full) fee schedule.The system shall permit a variety of client/patient income verification practices depending upon the service or program parameters.

H

The system shall automatically calculate sliding fees. HGenerating Advanced Beneficiary Notices (ABNs): Generating ABNs and tracking whether client signatures have been obtained. ABNs mostly include standard language but include some client-specific information such as name and medical record number.The system shall automatically generate Advanced Beneficiary Notices (ABNs) for Medicare beneficiaries.

H

The system shall automatically populate Advanced Beneficiary Notices (ABNs) with client name and Medical record number.

H



No Comments

Screenings / Assessments / Evaluations: Screenings, assessments, and evaluations are tools used by service providers to determine the current condition (e.g., psychological, psychiatric, medical, emotional, severity of abuse) of a client across a variety of parameters for the purpose of deciding appropriate intervention, treatment, and follow-up. Review eligibility for appropriate program(s) or service(s). Assessments and evaluations provide information on persons who likely or definitively have a behavioral health problem and/or substance abuse problem. Assessments and evaluations may be periodically re-administered to ensure that clinicians have up-to-date information on a client's current behavioral health status. Documentation of medical history, physical exams findings, and vital signs may be included (e.g. PHF, outpatient detox).

Intake Assessment: Gathering a comprehensive history about a client including current level of functioning (behaviors, symptoms, and ability to function in a community) and needs of client per report for client as well as outside systems and agencies. This is performed by a clinician in order to determine medical necessity (mental health, diagnosis) and/or eligibility for services.The system shall provide a variety of pre-defined assessment forms including, psychosocial assessments, intake assessments, inpatient evaluations, and client/patient placement evaluations.

H

The system shall ensure that data captured during previous non-clinical client contacts (e.g. demographic data, address, current diagnosis) are automatically populated in assessments.

H

The system shall capture data directly from Mobile Crisis providers so crisis info is immediately available during the intake assessment process.

D

The system shall automatically calculate a client's UPC score from previously entered data.

D

The system shall grant users the option to create a mental status exam using a previously completed exam as a template.

D



No Comments

Risk Assessment/ Management: Safety plan, Address high-risk concerns (e.g., detox), Referrals to immediate treatment.The system shall flag assessments that are incomplete due to client behavior.

H

The system shall automatically flag clients at high-risk for suicide/homicide/sex offender/assaultiveness based on user-defined criteria.

H

The system shall restrict access to the record for specific client populations (e.g., registered sex offenders, HIV, clients in substance abuse programs).

H

The system shall support the periodic tracking of patients by location according to user-defined frequency (e.g. every 5 minutes).

H

The system shall support Safety related to seclusions and restraints.

H

The system shall permit the creation of a variety of critical incident types that can be easily entered and retrieved.

H

The system shall support user-defined policies that determine procedures and responsibilities for following-up all incident types.

H

The system shall provide user-defined, configurable alerts that support incident tracking.

H

The system shall maintain a priority list or Hot List; of at-risk clients/patients that can be accessed electronically by staff at all times.

H



No Comments

History and Physical (PHF): Gathering a comprehensive health history and current health concerns in order to make medical treatment recommendations. May be completed by a MD or nurse practitioner.The system shall capture the periodic recording of patient vital signs according to user-defined frequency (e.g. twice per day for every patient).

D

The system shall support the assessment of a client's developmental history.

H

The system shall maintain History & Physical assessment data for a client.

H

The system shall permit authorized users to view and report on Client/Patient-related health parameters over time as part of H&P history.

D

The system shall support the graphical trending of information within the health and physical part of the Client/Patient record to include vital signs.

H

Nursing Assessment (PHF): Gathering a health history and conducting a brief exam.The system shall support user-defined nursing assessments.

H

Interim Treatment Recommendations: Provides referral to outside resources/agencies, Outpatient therapy, Explain recommendations to client, Schedule initial appointments (w/ doctor, group, individual, etc.), Develop interim treatment plan for first 60 days of services.The system shall automatically populate the Care Plan from the interim treatment recommendations.

H



No Comments

General:The system shall offer a forms development tool set that supports the creation of user-defined assessment forms.

H

The system shall allow for optional 3rd party licensed assessment tools to be incorporated into the system.

H

The assessment function shall be configurable to generate targeted problems for treatment and such problems can flow to the treatment planning process.

H

The system shall have a standard template for assessment that can be tailored to client needs and specific programs. Details shall include trauma history, client strengths, cultural and spiritual identity.

H

The system shall trigger prompts for portions of assessments that need continual monitoring (e.g., progress notes)

H

The system shall support collection of mandatory (required) data (e.g., clinician cannot leave section blank, must indicate why information is not available.)

H

The system shall ensure all ancillary documentation is completed before the assessment is deemed complete.

H

The system shall support role-based access and authorities ensuring appropriateness of staff (e.g., ensure licensure is correct).

H

The system shall support the capability to declare a version (designated by section) as final (i.e., official) and prohibit further change to that version.

H

The system shall maintain multiple historical iterations of assessments.

H

The system shall permit an authorized user to access the appropriate assessment tool/template based on the care being provided for a Client/Patient.

D



No Comments

General: (continued)The system shall permit an authorized user to complete the assessment according to the rules associated with that assessment.

D

The system shall permit an authorized user to access and view assessment data.

D

The system shall permit an authorized user to review a completed assessment.

D

The system shall permit an authorized user to update (append to) the assessment as needed.

D

The system shall permit an authorized user to electronically sign the completed assessment, if required.

D

The system shall pre-populate data from other sources or previous assessments into the current assessment to reduce double data entry.

D

The system shall maintain completed assessments in the clinical section of the Client/Patient record.

D

The system shall provide the capability for authorized users to develop, manage, and implement standard and custom assessment templates and result formats.

D

The system shall allow support the ability to create user-defined reports based on Client/Patient-related health parameters

D

The system shall provide the capability for authorized users to access and view the status of periodically required screening, evaluations, and/or assessments.

D

The system shall support electronic versions of the assessments listed in Appendix #.

D



No Comments

General: (continued)The system shall generate notifications to a clinician when an assessment is due based on workflow and documentation requirements for that type of assessment.

D

The system shall send notifications to members of a Client/Patient’s Interdisciplinary Team (care team) when inconsistencies in assessment results are reported.

D

The system shall provide the capability for authorized users to schedule periodically required screening, evaluations, and/or assessments

D



No Comments

Treatment/Care Plans: Preparing and documenting a multi-disciplinary approach to addressing a client's problems, condition and needs for the purpose of restoring the individual to health. Treatment/Care Plans vary by program and are based on assessments and evaluations conducted by multiple disciplines, often with client and/or family input during treatment team meetings. Treatment/Care Plans provide documentation often required by payers to substantiate claims submitted for reimbursement of covered services. Treatment/Care Plans are re-evaluated per program guidelines.Interim Treatment Recommendations: Client and assessing clinician come up with a plan that is supervisor approved. An Interim plan is developed for the initial 30 days.The system shall automatically populate the Initial treatment plan and subsequent treatment plan reviews from other assessment instruments.

H

Crisis Plan: Client and Case Manager develop a Crisis Management Plan. Access to this plan must be secure yet easy to access by the care team and other providers who have contact with the client.The system shall provide a template to aid the client and their case manager in the development of a Crisis Management Plan.

H

The system shall track and report crisis episode data including date and time of first contact, referral source, clinical notes about the crisis including checklists and text-based crisis notes that allow for the easy recording of diagnosis, level of functioning, and all relevant clinical data.

H

The system shall alert the case manager (referral source) and appropriate clinician that a crisis contact has occurred.

H

The system shall permit authorized clients and providers secure access to view the services provided during the crisis episode.

H



No Comments

Treatment/Care Plan: Completed by treating clinician. Identifies symptoms, diagnosis, strengths, functional impairments, and recommended services. Health Agency policy states that the Care Plan must be completed within 30 days of Interim Treatment Recommendations being approved.The system shall provide a Care Plan that captures diagnosis codes, notes, assessment information, service types, RU's, authorization information, and staff signatures.

H

The system shall permit Interim treatment recommendations that were automatically brought forward to be edited or deleted.

H

The system shall provide the capability for an authorized user to define a care plan, documenting problems identified, goals established, and care plan tasks required

D

The system shall provide the capability for an authorized user to update the care plan, including problems, goals, and required care plan tasks

D

The system shall provide the capability for an authorized user to record completion of care plan tasks, including protocols, orders, and interventions completed and follow-up and evaluation activities performed for a Client/Patient

D

The system shall provide the capability for an authorized user to document outcomes

D

The system shall support the templates that can be used to create reusable Treatment/Care Plans based on protocols, "standing orders", or common interventions.

D

The system shall allow simultaneous review of Treatment/Care Plans by multiple authorized users.

D

The system shall provide the capability for authorized users to maintain a list of goals for a client/patient's care needs.

D



No Comments

Treatment/Care Plan: (continued)The system shall provide the capability for authorized users to maintain an interdisciplinary problem list.

D

The system shall generate notifications to clinicians when care plan updates are required according to the documentation rules established for that care plan.

D

The system shall provide the capability for an authorized user to create user-defined fields and/or free text in the care plan.

D

The system shall provide the capability for an authorized user to create and manage standardized inter-disciplinary problem lists.

D

The system shall support practice guidelines and evidence-based practices that provides an alert to a user resulting from a response to an assessment query.

D

The system shall have the capability to provide suggestions for updates and revisions to a care plan based on problems identified in recent clinical assessments based on best practice guidelines and evidence-based practices.

D

The system shall maintain an intervention list based on rules defined in the system for best practice guidelines and evidence-based practices.

D

The system shall provide the capability for authorized users to re-activate a plan of care for a discharged Client/Patient who is re-admitted. (e.g., returns from an outside facility).

D



No Comments

Care Plan: (continued)The system shall provide the capability for authorized users to re-activate a plan of care for a Client/Patient who is transferred within the agency.

D

The system shall provide the capability for authorized users to access and incorporate external communication and health education materials that correlate with a client/patient's care plan.

D

The system shall print suggested communication and health education materials that correlate with a client/patient's care plan.

D

The system shall generate and send a notification to physicians to when a client/patient's treatment plan is to be certified.

D

The system shall provide the capability for an authorized user (e.g., nurse) to view the current list of care plan problems.

D

The system shall provide a Master Service Plan that captures at least three objectives for each service type on the Care Plan.

H

The clinical data set, which offers the various statements describing the key components of the treatment plan, is tailored to the appropriate target population.

D

The system shall populate the treatment plan from target areas in the assessment, all field are updateable by the user.

H



No Comments

Treatment Plan: (continued)The system shall permit some data from the treatment plan to automatically populate the case/contact note.

H

The system shall prohibit clinicians from entering notes without an approved treatment plan.

D

The system shall alert the case manager when a new treatment plan is due according to a user-defined time period (e.g., 30, 40, 60 or 90 days), and with the ability to defer (or "snooze") until complete.

H

The system shall permit clinicians to build Treatment/Treatment/Care Plans for multiple target populations using a clinical database of best practice guidelines that move clinicians through the diagnoses, problem, goals, objectives and interventions.

D

The system shall provide a Master Service Plan that captures time frames and metrics (measurable) for each objective on each service type on the Care Plan.

H

The system shall electronically route and authorize treatment/plan/service with notification to appropriate staff.

H

The system shall capture additional services with goals, interventions, and outcomes as needs are identified.

D

The system shall print pertinent information on forms and reports (e.g. assessments).

H



No Comments

Transfer/Discharge Summary: Clinician completing a brief summary of client's progress and treatment and recommendations for future treatment.The system shall automatically create a discharge summary using as much information as possible from information previously captured (e.g., admission diagnosis from the face sheet, mental status exam from initial evaluation, discharge meds, etc.).

H

The system shall produce a hard copy of the discharge summary and provide an audit trail of printing as well as the ability to track the authorized signature attesting to the sending of this document to the consumer.

H

Treatment Protocols and Care Guidelines: Best practice clinical guidelines.The system shall provide industry standard clinical libraries of best practice information on treatment interventions for inquiry by clinicians.

D

Clinical best practice information is available for inquiry at any time during the clinical decision-making process (e.g., when entering progress notes, during treatment planning, and prescribing).

D

The system shall permit authorized users to create, edit, and delete elements of the clinical best practice guidelines.

D

The system shall maintain an interface to multiple best practice libraries.

D



No Comments

General:The system shall maintain treatment plan templates that contain structure and standard content. The system shall allow these templates to be modified as needed by an authorized user.

H

The system shall permit the creation of user-defined treatment plan data fields.

H

The system shall record and track multiple treatment and discharge plans for a single client at one time, and consolidate information into a single report.

D

The system shall allow for the development of structured planning formats as well as the entry of free-form text.

H

The system shall support the use of clinical rule-bases for aiding in the development of Treatment/Treatment/Care Plans that are consistent with clinical best practices.

H

The system shall maintain an updated client service / treatment plan readily accessible to defined users that capture thresholds of client adherence through feedback loops and automated alert capabilities.

H

The system shall allow for periodic updates to the existing treatment plan as client needs arise.

H

The system shall permit simultaneous viewing of multiple Treatment/Treatment/Care Plans on a single client.

D



No Comments

Appointment Scheduling / Attendance: The purpose of appointment scheduling is to accept requests for, and to record, the date and time of a client's future visit(s), reason for the visit(s), and with which service provider. Appointments can be based on a block schedule or a first come/first served basis. Appointments may be individual, couples, family, or group. Appointment scheduling includes providing appointment schedules for all affected personnel and distributing hard copy of appointment schedules to clients. Attendance is documenting or recording whether a client was present at a scheduled appointment, group, or event. Includes noting absences and reasons for not being present, such as excused absences. Attendance also includes recording the presence of a client who dropped-in at a group or event for which there was no scheduled appointment.Requesting an Appointment: Request for an appointment can be made in person, via telephone, fax, or online.The system shall offer a fully integrated appointment-scheduling module that allows for rapid entry and retrieval of client appointments with staff.

H

The system shall support centralized scheduling for authorized staff throughout the agency.

H

Maintaining Staff Schedules: Indicates dates and times individual clinicians are available to see clients.The system shall permit authorized users to develop staff schedules.

D

The system shall permit authorized users to enter staff timekeeping information.

D

The system shall maintain provider profiles; including dates and times, a provider is available and not available for client appointments.

H

The system shall display counselor/clinician caseload, including maximum, actual, and available.

H

The system shall permit adjustments to counselor/clinician caseloads at will.

H

The system shall permit authorized staff to schedule staff based on the census and acuity regulations.

D



No Comments

Maintaining Staff Schedules: (continued)The system shall generate daily and monthly staff schedules organized by user-defined locations, shift, and staff classification.

D

The system shall track by individual required hours worked per month, hours worked within a 24-hour time period, and overtime hours worked.

D

The system shall provide the capability for an authorized user to enter unit-based scheduling with the ability to make ad-hoc changes to staff assignments as needed.

D

The system shall provide the capability for authorized staff to schedule staff for overtime, holidays, and leave.

D

The system shall make scheduling information available for staff workload planning.

D

Rostering: Setting up groups (e.g., counseling, therapy, etc) for various programs and assigning individuals to one or more group.The system shall support the creation of groups and the assignment of an individual to and removal from one or more group(s).

H

The system shall display real-time group availability and capacity.

H

The system shall integrate the client-signed roster with Progress Notes and automatically apply the appropriate charge(s) to the client's account.

H

The system shall permit a client to be associated with one or more group.

H

The system shall support multiple program-specific requirements for group structure (e.g., minimum/maximum number of clients per group).

H



No Comments

Scheduling the Appointment: The individual, couple, family, and/or group appointment(s) is scheduled based on program availability and preferences of the client(s) and provider(s). Information regarding appointment time, place, provider(s), and client is captured and/or updated. Requests for room, equipment, and supplies are also scheduled.The system shall support schedules organized by provider.

H

The system shall permit authorized staff at one clinic to schedule an appointment for a clinician at another clinic.

H

The system shall provide the ability to search and find the first available appointment for a any given provider.

H

The system shall prompt a user with suggestions for the next available appointment based on the master schedule and appointment parameters.

D

The system shall provide a list of possible times for scheduling education, therapy, and counseling appointments for a client based on the availability of required resources.

D

The system shall provide a program for scheduling education, therapy, counseling for a client that interfaces with staff calendar.

H

The system shall allow the integration of appointment scheduling with clinician maintained calendars.

H

The system shall permit appointment scheduling for: Individual, Couple, Family, Group, Medication Support, Services to be Performed, and Unit of Time.

H

The system shall permit simultaneous appointment scheduling for multiple providers.

H

The system shall support the scheduling of recurring appointments according to user-defined frequency (e.g., weekly, biweekly, monthly).

H



No Comments

Scheduling the Appointment: (continued)The system shall permit over-booking groups. HThe system shall permit double-booking clients into a time slot for a clinician.

H

The system shall coordinate client schedules into a master schedule to avoid double booking clients.

H

The system shall automatically alert staff when an appointment would result in a client being double-booked in multiple programs.

H

The system shall allow for the scheduling of group rooms.

D

The system shall support scheduling random drug testing.

D

The system shall permit authorized users to enter and maintain resource requirements for a scheduled appointment.

D

The system shall generate a notification to providers that includes a list of the resource requirements associated with a scheduled appointment.

D

The system shall permit Physicians to generate daily patient list that is integrated with and driven by patient appointments scheduled for a specific date.

D

The system shall allow an authorized user to add, delete, re-schedule, or cancel individual pending and booked appointments.

D

The system shall generate an appointment notification based on any schedule requirements associated with a physician order.

D

The system shall indicate the appointment type during scheduling activities.

D



No Comments

Scheduling the Appointment: (continued)The system shall indicate non-available appointment times based on the schedule of selected resources.

D

The system shall permit an authorized user to define appointment parameters based on insurance, program, or payer rules for individual and group services.

D

The system shall alert authorized users when conflicting appointments are entered.

D

The system shall permit authorized users to view clinic schedules.

D

The system shall permit authorized users to view provider schedules.

D

The system shall permit authorized users to view Client/Patient schedules.

D

The system shall permit authorized staff at one program to view the appointment schedule of a clinician at another program.

H

The system shall maintain standard appointment disposition types (e.g., no-show, cancel, complete).

D

The system shall permit an authorized user to establish the priority of an appointment.

D

The system shall permit an authorized user to override the priority associated with a booked appointment.

D

The system shall maintain daily rosters of appointments.

H

The system shall generate an appointment list for current and future business day(s) by various parameters.

H

The system shall generate appointment schedules for user-defined timeframes by: Clinic, Resource (e.g., staff, room), Client/Patient.

H



No Comments

Confirming the Appointment: Confirmation of the scheduling information is provided to client, providers, and other appropriate parties. DUI clients receive a paper copy of their appointment schedule (Title IX).The system shall have the ability to print a paper copy of a client's schedule of appointments that can be provided to the client.

H

The system shall generate a list of scheduled appointments "x" number of business days in advance that staff can use to call and confirm the appointment.

D

Reminding Consumers of Appointment: In addition to hard copy patient reminders sent via US Mail, mechanisms can include e-mail, fax, and telephony approaches. Development of an automated information system to improve patient compliance is considered.The system shall automatically generate, upon booking of an appointment, a card/notification letter containing instructions for the client to prepare for the appointment.

D

The system shall permit authorized users to customize the appointment notification letter, including editing and formatting changes.

D

The system shall generate notices of pre and post appointments: Bilingual

D

The system shall generate notices of pre and post appointments: Consideration to confidentiality

H

The system shall initiate electronic call to remind client/patient of upcoming appointments: Bilingual (D/AS confidentiality concerns)

D

The system shall initiate electronic call to remind client/patient of upcoming appointments: Consideration to confidentiality

D



No Comments

Reminding Patient of Appointment: In addition to hard copy patient reminders sent via US Mail, mechanisms can include e-mail, fax, and telephony approaches. Development of an automated information system to improve patient compliance is considered.The system shall permit an authorized user to add, delete, re-schedule, or cancel group pending and booked appointments.

D

The system shall support pending and booked appointment list management that allows an authorized user to add, delete, re-schedule, or cancel appointments at a clinic level.

D

The system shall generate a master appointment calendar showing a client's/patient's other appointments for other programs within the system.

H

The system shall permit staff to enter text notations and/or other pertinent information to convey to the client/patient at the time the appointment is being scheduled.

D

The system shall indicate the client's special requirements prior to his/her appointment (e.g., if a client should be pre-medicated prior to the appointment, primary language, second language, hearing impaired, physically challenged).

D

The system shall associate any follow-up information with the original appointment.

D

For user-defined "sensitive cases," the system shall hide appointments and entire case information from all but authorized staff (e.g., electronic sealing).

H

The system shall automatically remind staff when follow-up appointments for a client are needed.

H



No Comments

Capturing Attendance: Documenting client attendance at individual or group counseling sessions. DA/S documents client attendance via group rosters. Rosters are automatically generated from appointments and completed at the point of service, noting clients who are present, absent, and reason(s) for absence.The system shall capture confirmation of appointment status, including: Doctor/ Staff or client canceled, client no show, Appointment kept

H

The system shall automatically assign "Patient no show" status if there is no lab test result for a client who is on the drug test schedule.

D

The system shall track client attendance at group sessions, identifying clients scheduled for group and failed to show, including the reason they failed to show.

H

The system shall report on the reason why a client or client(s) failed to show for group.

H



No Comments

Health Record Management: Health record management encompasses maintaining the organization's legal health record in a way that is compliant with Federal, State, and local regulations and/or policies (e.g. HIPAA and 42CFR). Health record management involves recording, maintaining, retaining, and archiving client information to meet various functions, and ensuring the record is accurate, complete, and secure.Maintaining Master Patient Index (MPI): Automatically assigning a unique client/patient identifier that will be used for all client encounters and for client look-ups. Checking for and managing duplicate identities/identifiers, and retaining only a single valid client identifier and record.The system shall assign and maintain for each client a unique identifier.

H

The system shall allow an authorized user to search and locate the record of a client in the MPI so that the correct person is identified before any actions are taken regarding that person.

H

The system shall support client look-up by one or multiple identifiers (e.g., name, alias, birth date, etc).

H

The system shall identify variations in name such as: Middle Initial, Driver's License No., AKA (also known as), and Soundex (sounds like)

H

The system shall maintain all client alias names. HThe system shall rapidly retrieve the administrative status of any particular client (e.g., Medicaid/insurance eligibility, pending appointments and dates of last service).

H

The system shall automatically check for duplicate clients.

H

The system shall automatically alert the user if there is a duplicate Family Number, Client/patient Number, Client/patient Name, Case Number.

H

The system shall prevent users from entering duplicate clients.

H

The system shall permit authorized users to override warnings of duplicate clients.

H



No Comments

Maintaining Master Patient Index (MPI): (continued)The system shall support photo ID with bar code capability.

H

The system shall store client/patient number(s) for other programs, as needed.

H

The system shall store client/patient number(s) for Managed Care Network.

H

The system shall store client/patient number(s) for County Board numbers.

H

The system shall store client/patient number(s) for Medicaid Eligibility Data System (MEDS).

H

The system shall have a record for each Client/Patient that contains a unique identifier (e.g. system-generated database key.)

H

Managing the Record: Retention, reproduction, storage, merging records including checking and merging records if a client has more than one record, and retaining only a single valid client identifier and record. Retains all historical information.The system shall be able to input, modify, inactivate, delete, update, display, copy, and print a unique Master Client Record.

H

When a client has more than one record, the system shall provide a way to merge information from one record into another.

D

The system shall permit authorized users to merge client records.

D

The system shall require user confirmation prior to merging any client demographic information.

D



No Comments

Managing the Record: (continued)When merging duplicate records, the system shall merge information associated with the incorrect client identifier(s) with the correct record and client identifier.

D

When merging records, the correct client identifier(s) shall be retained and the incorrect client identifier(s) will be retained as void.

D

The system shall be able to create separate records from client records erroneously merged.

D

The system shall retain the history of all prior Addresses, Multiple Phone numbers, Multiple e-mail addresses, Photos, Eligibility Statuses, AKAs (also known as), Record Numbers

H

The system shall maintain an historical audit trail on record of all changes, such as additions and deletions, by user

H

The system shall have client/patient data purging and archiving capability with the flexibility to set variable time parameters and limits.

H

The system shall support electronic retrieval of records from archive.

H

The system shall flag a sensitive or confidential client/patient case.

H

The system shall meet co-occurring disorders (dual diagnosis) data access requirements.The system shall permit configurable Clinical history screens.

H

The system shall electronically restrict access to and secure all client records.

H



No Comments

Managing the Record: (continued)The system shall maintain all history of past diagnoses, Treatment/Treatment/Care Plans, services, and medications.

H

The system shall utilize the unique client identifier to mange client records.

H

The system shall automatically date and time stamps all entries in the client record.

H

The system shall provide the capability for authorized users to customize templates for medical reports that can be modified by authorized users.

H

The system shall have the capability to capture, retain, retrieve, and update a client/patient's legal representative as part of the client/patient record.

H

The system shall generate a summary of a client/patient's current demographic, financial, insurance, and clinical data (Face Sheet) as defined by agency.

H

The system shall provide the capability for authorized users to enter a diagnosis and effective dates, to include primary, secondary, and tertiary diagnoses for AXIS I through V.

H

The system shall generate a notification to licensed providers to co-sign documentation prepared by unlicensed providers (e.g., students).

H

The system shall support the use of established templates to configure the electronic Client/Patient Record according to the clinical care being provided.

H



No Comments

Managing the Record: (continued)The system shall provide the capability for an authorized user to configure the structure and fields within the electronic Client/Patient record within parameters provided by the system vendor.

H

The system shall provide the capability for an authorized user to determine the attributes that govern the valid values to be used within the electronic Client/Patient record.

H

The system shall provide the capability for an authorized user to determine how the electronic Client/Patient record is organized and formatted for viewing and reporting.

H

The system shall provide the capability for authorized users to determine the access privileges by role for each section in the electronic Client/Patient record to meet privacy and security requirements.

H

The system shall provide the capability for an authorized user to enter charges related to services entered in Client/Patient record.

H

The system shall allow the agency to define the business rules as to which entries in the Client/Patient record require electronic signature for approval and when the approval is needed.

H

The system shall provide the capability for an authorized user to access any part of the Client/Patient history according to their system-defined role.

H



No Comments

Managing the Record: (continued)The system shall generate a chronological, diagnosis-driven problem list.

H

The system shall restrict access to and update of a diagnosis-driven chronological problem list by system-defined user role.

H

The system shall support the incorporation of checklist and/or health maintenance reminders for clinicians based on Client/Patient diagnosis.

H

The system shall provide the capability to define and automate workflows that involve any documentation associated with the Client/Patient record to include: Routing rules, Due dates for completion and/or approvals, and Notifications and alerts regarding past or future due dates.

H

The system shall provide an audit trail of users accessing and using electronic and physical Client/Patient records.

H

The system shall provide a means to track client/patient authorization by each specific type of Release of Information.

D

The system shall maintain the user name, location, date, and time, based on HIPAA privacy and security requirements, when a user duplicates any part of the electronic or physical Client/Patient record for any media.

H

The system shall generate and send notifications to users of any limited information disclosure request or requirement as specified in the electronic Client/Patient record.

H



No Comments

Managing the Record: (continued)The system shall generate a notification to users attempting to use sections of Client/Patient records currently open for update by another user.

H

The system shall generate reminders to appropriate staff regarding completion and/or resolution of documentation in the Client/Patient record to meet compliance requirements.

H

Record Completion: Monitoring unsigned/co-signed reports, results, etc.The system shall capture and maintain electronic signatures for providers/staff and clients.

H

The system shall support the use of electronic signatures (i.e., non-repudiation) for final, legal approval.

H

The system shall support tasks and workflow associated with supervision of interns (e.g., required approval or co-signature of an intern's note before it can be billed).

H

Managing Release of Information: Ensuring clients, staff, and external sources have access to or receive needed personal health information (PHI) in a manner consistent with HIPAA and other pertinent business requirements.The system shall generate, maintain, and monitor various Release of Information forms.

H

The system shall maintain and store signed release of information forms.

H

The system shall enable users to select standard release forms using a pull-down menu.

H

The system shall capture the following disclosure information: Date of disclosure, To Whom the information was disclosed, Reason for disclosure, Information disclosed, and Person releasing the information.

H



No Comments

Managing Release of Information: (continued)The system shall track all disclosures of information. HThe system shall provide the capability to de-identify/redact data reported and released according to agency policy.

H

The system shall provide the capability to define, document, manage, and track in the electronic record:- All requests for Release of Information- Authorizations- Revocations- Consents

D

The system shall track the status of each Request for Information as received, pending, denied, or completed.

D

The system shall mark all released information with the appropriate standard disclosure clause for a specific type of release of information.

D

The system shall mark all released information "not available for further disclosure"; unless client/patient authorization is provided.

D

The system shall support the implementation of specific rules regarding Release of Information policies, procedures, and protocols to include: the creation of forms appropriate to the type of Request, defining user roles who are permitted to release information, and defining necessary correspondence related to a type of Release.

D

The system shall generate an invoice for any associated fees triggered by a specific type of Request for Information.

D



No Comments

Managing Release of Information: (continued)The system shall generate any necessary correspondence related to a Release of Information.

D

The system shall provide an audit trail (i.e., disclosure log) on any information related to the release or disclosure of client/patient information.

D

Managing Consents and Authorizations: Ensuring accurate, current, and necessary consents and authorizations are completed, stored, and accessible to providers; includes tracking disclosures, directives, etc.The system shall generate, maintain, and monitor various Consent and Authorization forms.

H

The system shall generate, maintain, and monitor various Advanced Directives, Durable Power of Attorney forms, etc.

H

The system shall maintain and store signed consent and authorization forms, Advanced Directives, DPAs, etc.

H

The system shall capture and retain current and historical dosage range for inpatient medications directly on the consent or authorization form.

H

Transcribing: Includes editing information created by natural language processing (NLP).The system shall support speech/voice recognition, dictation, transcription, and text-to-speech.

D

The system shall support the electronic export/import of dictation/transcription of all notes.

D



No Comments

Managing External Documents: Document and image management, including receiving, scanning, storing, and indexing documents received from external sources (e.g., Court reports) in paper-based or electronic formats.The system shall have the capability to capture/import and store an external file, associate it (i.e., image, document, audio) with any record or its associated metadata in the system (i.e., Client/Patient record), and manage (i.e., inedex. print, annotate,) the file in an compatible Agency-standard format.

H

The system shall support the display, management, and annotation of standard image formats (e.g., TIFF, JPEG, GIF, BIIF, BMP, PNG)

H

The system shall support the capability for voice to text on voice files and to manage the output together with the audio clip.

D

The system shall assign a unique identifier to each image (or other file) being referenced by the system.

D

The system shall have the capability for performing optical character recognition (OCR) on image in standard formats and to manage the resulting output together with the original image.

D

The system shall be extensible to incorporate the display and management of other electronic file formats described by a formal standard or vendor specification.

D

The system shall provide the capability for an authorized user the ability to annotate a file electronically and save the annotation with the file.

D



No Comments

Education / Counseling / Therapy / Groups / Activities: Education, counseling, therapy, and medication are common approaches to treatment of behavioral health problems. The processes by which these services are provided are core components of a client's treatment and are provided in accordance with the treatment plan. Documentation of units of service is required by funding sources and payers.

Education: Occurring in individual or group (including family) settings, providing rehabilitation interventions to assist client in gaining skills. Includes delivering didactic education classes (DA/S), disseminating client/patient education material, and providing prevention activities aimed at educating the community.The system shall maintain a record of current curriculum components for educational activities.

D

Counseling/Therapy: Providing individual, group, family, or Couples therapyThe system shall alert authorized users when client/therapist ratio exceeds user-defined program standards.

H

When services are entered for a group, all group members are displayed for rapid data entry.

H

The system shall notify the clinician when a client's treatment or program requirements are not being or have not been met.

H

The system shall capture therapist and co-therapist time.

H

The system shall automatically perform error checks to verify accuracy of data entered and reduce therapist billing errors.

H



No Comments

Notes / Documentation: Notes and documentation refers to entering information into a client's record. Notes and documentation are required to record service, treatment, or care-related comments and findings that may be related to assessments, evaluations, history, physicals, lab results, reaction to medications, special diets, etc. In addition to individualized notes, notes and documentation for group sessions are also prepared.Determining Format and Content of Note: Determining note and documentation format, content, and document workflow based on program and payer guidelines and requirements. Includes an interface with 26.0 Coding to ensure proper note completion.The system shall support multiple note types needed to document the various activities required to manage client/patient placement cases.

H

The system shall permit user customization of progress note types, formats, and content according to the requirements of each program.

H

The system shall provide the ability to modify the case notes template by the type of service.

H

The system shall prompt users to enter notes within a user-defined time period from the date of service

H

The system shall support progress notes for individuals, families, couples, and for groups.

H

The system shall support supplemental notes. HThe system shall integrate hand-written notes into the record (e.g., able to scan and apply intelligent character recognition).

H

The system shall include standard word processing functions with spell check to compose notes.

H

The system shall support field workers sending real-time data or uploading data to central system daily when computer is docked (Note: Does not denote wireless)

H

The system shall have Free-text fields that accommodate lengthy entries.

H



No Comments

Completing Note/ Documentation: Ensuring that providers meet the requirements for providing services and document services provided according to program/payer requirements.The system shall provide the capability for authorized users to enter electronic progress notes and recommendations.

D

The system shall restrict user access to sections of a progress note according to user role.

D

The system shall permit clinicians to view the current treatment plan while writing a progress note.

H

The system shall incorporate the treatment plan into the inpatient shift summary.

H

The system shall permit access to both inpatient and outpatient notes within a single client record simultaneously.

H

The system shall support importing inpatient unit notes into outpatient notes.

D

The system shall link progress notes to the treatment plan as required by regulatory guidelines.

H

The system shall have the option to prohibit clinicians from entering notes without an approved treatment plan.

D

The system shall flag the need to complete the progress note for individual participation in a group session.

H

The system shall automatically populate individual notes with Group note information (that details the group content / structure) for each individual in the group.

H



No Comments

Completing Note/ Documentation: (continued)The system shall permit the annotation of an individual group note to describe how each person responded to that content.

H

The system shall enable Group notes to be set up so that the entire group can be opened at one time, ensure consistent documentation across the group, and make sure that individualized information can be entered.

H

The system shall support linking a client's notes to other information including the linkage related to the client's family as defined by program requirements.

D

Notes are automatically populated with information previously captured (e.g., patient demographics, RU, time, diagnosis, and mental status exam).

H

The medication entered in the "prescribe today" field on the progress note automatically populates the prescription, medication consent, and medication log.

H

The system shall provide the capability for a progress note to be organized by discipline.

D

Tracking Note/ Documentation Status: Tracking applicable notes/documentation for clinical appropriateness, timelines, and overall system of care.The system shall provide the capability for authorized users to view and print progress notes in chronological order.

D

The system shall generate notifications to designated recipients when time-specific progress notes/documentation is required according to documentation rules established for progress notes.

D



No Comments

Tracking Note/ Documentation Status: (continued)The system shall generate a notification to the pharmacist, physician and nurse when the monthly pharmacy drug regiment review is due.

D

The system shall provide the capability for authorized users to maintain daily and weekly discharge information.

D

The system shall automatically generate a service transaction that is linked to an approved progress note.

H

The system shall not forward a service transaction to the billing until the progress note is final (i.e., not pending).

H

The system shall be configurable so the automatic generation of the service transaction may be disabled and the process completed manually. This may be required for particular organizational providers or clinical staff.

H

The system shall immediately validate all services entered into the system.

H

The system shall automatically validate that services rendered were performed by appropriately credentialed staff.

H

The system shall maintain the note history by program, site, and admission episode.

H

The system shall integrate attendance records for scheduled sessions with client notes.

H



No Comments

Case Management: Case Management is the process of linking and monitoring the appropriateness of treatment or ancillary services to an individual client throughout the client's episode of care. Services may include housing, dental care referral, etc. Case management often involves referral to providers outside of the Health Agency's purview (e.g., to IMDs, state hospitals, after care).Case Management and Monitoring: The process of actively managing a client's case according to the individual client treatment or service plan, including making referrals as appropriate. Coordinating and monitoring all service delivery in compliance with the plan to improve outcomes, quality of care, and cost-effectiveness.The system shall track clients/patients receiving services from community based organizations, including but not limited to capturing Service accepted, Service denied, Active/Inactive, and Disposition.

H

The system shall permit Physicians to have access to case manager's section of the record.

H

Documentation: Documenting the activities, outcomes, results, issues, etc. of activities performed.The system shall allow for flexible presentation of information.

H

The system will assign a case manager to each client. H



No Comments

Orders / Results: Orders include the issuing and documentation of a physician's request for lab tests, medications, diagnostic exams, special diets, various treatments, services etc. Results include receiving and retaining the outcome of tests that were ordered and performed. After determining appropriate tests and services (e.g., medical, drug, and diagnostic) based on assessment, clinician orders tests and services. Tests are performed at facilities, in-house or other divisions within HA. Orders are currently stored in database and paper file.Determining Format and Content of Note: Determining note and documentation format, content, and document workflow based on program and payer guidelines and requirements. Includes an interface with 26.0 Coding to ensure proper note completion.The system shall support a protocol-driven order process that is based on best clinical practice.

D

The system shall support the design and implementation of standard workflow processes for order entry that consist of one or more steps, establishes the time periods for each step in the workflow process, defines approval process (including the specific parameters needed for approvals and the approving user/role needed at each specific step), and enforces the approval process through the use of electronic signature.

D

The system shall associate the ordering provider and the attending physician with a single order.

D

The system shall provide the capability for additional, multiple providers and/or clinicians to be associated with a single order, such as members of the client/patient's care team.

D

The system shall provide the capability for an authorized user to define a series of orders or recurring orders to be entered once with multiple dates in the future.

D

The system shall support best clinical practice/protocol-driven order sets (e.g., bundled lab orders per MD-ordered withdrawal protocol).

D



No Comments

Determining Format and Content of Note: (continued)The system shall provide the capability to create order sets, save standard orders sets for re-use, update order sets, and tag order sets as inactive or not in use.

D

The system shall support standing orders. HThe system shall allow an authorized user to mark an order as 'no charge' during entry or update.

D

The system shall provide a user interface for an authorized user to enter an order online, via voice recognition, and via transcription of a hand-written or verbal order.

H

The system shall route the order to the appropriate recipient(s) as defined by the clinical workflow.

H

The system shall transmit the order to a designated recipient using routing methods internal to the system (i.e., workflow), E-mail, and FAX

D

The system shall transmit the order to external providers by: FAX, electronic interface with other systems (e.g., HL7), email, on-line access by external provider (e.g., D/AS results to court).

H

The system shall provide the capability for a user to enter directly into the system (i.e., Client/Patient record) at the point of care/service the treatment, services, and/or and supplies being provided.

D

The system shall automatically generate all appropriate forms (e.g., consent form) and navigate to appropriate screens according to the order or protocol.

D



No Comments

Determining Format and Content of Note: (continued)The system shall flag contraindications when a medication is ordered, including allergies, food-drug, or drug-drug interactions.

D

The system shall generate an alert when a medication ordered exceeds the dosage range.

H

The system shall generate a medication consent form when specific medications are ordered by an inpatient provider (e.g., Benzodiazepines, hypnotics, narcotics, neuroleptics, mood stabilizers, and other medications that alter one's sensorium).

H

The system shall generate a medication consent form when any medication is initially ordered.

H

The system shall permit inpatient providers to adjust medications without generating or requiring a new consent or authorization form.

H

The system shall generate a medication consent form when an outpatient mental health service provider changes the dosage range for a medication already ordered.

H

The system shall support medication-specific, protocol-based triggers for inpatient lab orders and clinic-based lab work.

D

The system shall provide alerts relative to time limits or expirations of orders (e.g., medications, lab results).

D

The system shall provide an electronic MAR that is automatically updated by orders, and is integrated with the record.

H



No Comments

Determining Format and Content of Note: (continued)The system shall automatically transfer the order to the MAR and to the pharmacy system.

H

The system shall provide a universal medication profile for a client that ensures medication orders, medications dispensed, and medication administration records adhere to protocols associated with the medication profile.

H

The system shall provide a universal medication profile for a client that ensures standing orders and order sets for tests (e.g., lab) are appropriate.

H

The system shall match a client's drug test profile to a client's drug of choice to ensure that appropriate tests are ordered based on medications reported by client (e.g., if client is on Vicodin, make sure that the test ordered is appropriate).

D

The system shall provide alerts and notifications based on due dates (e.g., labs are overdue) and protocols (e.g., medication protocols require recurring lab, seclusion and restraint protocols).

H

Receiving Results: Receiving test results for tests done in-house (e.g., dipstick), receiving results for tests done by outside lab facilities or other divisions within the Health Agency via fax or e-mail notifications. Results are stored in database and paper file.The system shall link results to the original order. HThe system shall generate a notification to authorized users when new results from any clinical assessments, tests, labs, or follow-up services are received into the system.

D

The system shall alert the authorized user (e.g., sponsor, original provider) that results have been received or are overdue.

D



No Comments

Receiving Results: (continued)The system shall automatically notify appropriate staff that a result has been received for which an interpretation is required.

D

The system shall flag abnormal values that fall outside of user-defined normal levels, thresholds, or ranges.

H

The system shall accept and capture results into the electronic record using the following methods: on-line entry, inbound FAX, scanned documents.

H

The system shall accept order results into the Client/Patients Electronic Health Record either through on-line (screen) entry by an authorized user and/or import of results captured in system-accepted formats.

D

The system shall provide the capability for an authorized user to indicate in the client/patient's EHR the location of results on physical media or paper.

D

The system shall support the use of an electronic signature as a means for final approval either of laboratory test results, single or in batch.

D



No Comments

Laboratory Services: The key function of laboratory services is to furnish providers with accurate lab test results on a timely basis. The Agency performs limited testing in-house and outsources other lab services.Placing People in Testing Groups: Randomly assigning individuals to testing groups that specify dates, times, frequency, and location of test(s) to be performed.The system shall create rosters of people testing on a user-defined date or date range, gender, program and/or treatment site.

H

The system shall reference all specimens by Client/Patient identifier and by batch in which specimen was collected.

D

Generating Labels: Entering client information onto labels that will be printed and affixed to sample container for the purpose of ensuring valid correlation of test result to client sample. Includes automatically assigning accession numbers.The system shall automatically generate pre-defined specimen labels from a client roster.

H

The system shall generate test labels for tests that occur off-schedule (unscheduled) or on an ad-hoc basis.

D

The system shall automatically print user-defined aliquot collection labels, ensuring that test names are printed on labels and specimen requirements on labels or adjacent label stock.

D

The system shall provide the capability for an authorized user to print bar-coded collection labels at a designated location (e.g., Client/Patient ward/location).

D

The system shall reprint collection lists and associated collection labels on demand.

D

The system shall support the creation of collection lists automatically or on-demand according to user-specified date/time, route, or physical location.

D



No Comments

Performing Lab Test: Based on established protocols, certain tests are performed in-house (e.g., dip sticks) whereas other tests are outsourced.The system shall support both mobile and fixed bar-code wand scanners for logging a specimen into the system and tracking it.

D

Tracking Test Status: Tracking and monitoring the status of lab tests that have been sent out.The system shall permit an authorized user to manually log a specimen into the system.

D

The system shall automatically generate Accession numbers for tracking specimens.

H

The system shall support the capability for an authorized user to query Client/Patient laboratory results and orders by Client/Patient name, Client/Patient identifier, Lab billing number

D

The system shall support the capture and reporting of data for STAT and other priority order audits

D

The system shall support the use of bar-codes for the logging in and tracking of specimens by an authorized user.

D

Receiving Results: Electronic downloading of test results (e.g., from Redwood Toxicology in Santa Rosa, CA).The system shall receive test results via the web. HThe system shall receive and store electronic results securely.

H

The system shall generate alerts when laboratory results are received electronically.

H

The system shall automatically notify physician when lab result has been received.

H



No Comments

Receiving Results: (continued)The system shall automatically apply pre-defined text to the documentation of laboratory results based on user-defined parameters or the contents of the test dictionary.

H

The system shall provide the capability for the graphical display of laboratory results according to user-defined time periods, value ranges, and number of specified result sets.

D

The system shall support reference ranges, including critical high and critical low values by an authorized user.

D

Recording and Storing Test Results: Recording and storing lab results in the system.The system shall have the ability to manually enter lab results.

H

The system shall have the ability to electronically notify staff that lab results are posted.

D

The system shall automatically record test results in the client chart.

H

The system shall provide the capability for an authorized user to compare current and historical lab results by test or profile.

D

The system shall permit Amendments to ranges DThe system shall track historical ranges (by date and type of laboratory test)

D

Capturing Order Request: For inpatient PHF, laboratory order information is captured and documented via telephone, fax, or online (Internet, intranet). An interface between the pharmacy and laboratory functions is required to allow restricting issuing prescriptions until laboratory results are obtained.The system shall capture orders for lab tests electronically.

H

The system should generate lab slips. H



No Comments

Capturing Order Request: (continued)The system shall integrate laboratory order entry as part of electronic order entry.

H

The system shall permit authorized users to add procedures and specimens to a lab order.

H

The system shall permit authorized users to enter laboratory orders for Past date, Current date, Future dates

H

Transmitting Order: Transmitting the order to the lab that will fulfill the order.The system shall electronically transmit a HIPAA compliant secure order to an internal or external laboratory.

H

The system shall provide the ability to print a HIPAA compliant secure order to an internal or external laboratory.

H



No Comments

Pharmaceutical / Medication Management Services: Pharmacy services represents the process of accepting and fulfilling a prescription order, performing drug utilization reviews (DUR), billing for the pharmaceutical service, and maintaining a record of the transaction. The pharmacy process may include the acquisition, distribution, and control of all pharmaceutical products, including medications, injectables, and supplies. The process may also include educating clients and providers about drugs or advise providers on drug selection. Neither MHS nor DA/S operates a pharmacy; MHS and DA/S outsource the fulfillment of medication orders to Community Health Centers (CHC). CHC will continue filling PHF Pharmacy orders. The system should interface with the Med-Dispense unit located in the PHF.Capturing Order Request: Pharmacy order or prescription information is captured verbally or via telephone, fax, or online (Internet, intranet) and documented. The system will have a GUI interface that will encourage the prescribing clinician to enter the prescription directly into the system. Physician orders medications by phone, fax, or script. Checks JV220 status and complete form(s) as needed.The system shall support entry of original pharmacy orders directly into the system.

H

The system shall permit the update or edit of all pertinent fields of a pharmacy order (e.g. select another drug).

D

The system shall support Renewal of an order (e.g. stop-dated orders, transfer orders)

D

The system shall support Cancellation or Discontinuation of an order

D

The system shall reject invalid/inappropriate orders and route information to appropriate users to resolve.

D

The system shall support order "Holds" for specified term with automatic resumption and open-ended terms.

D

The system shall support ePrescribing. DThe system shall electronically transmit a HIPAA-compliant secure prescription to internal and external pharmacies.

H

The system shall provide the ability to print a prescription.

H



No Comments

Capturing Order Request: (continued)The system shall make Treatment/Treatment/Care Plans and progress notes accessible and viewable during the prescription-writing process.

H

The system shall support wireless prescription device solutions.

H

Dispensing and Administration of Orders: Based on formulary or special order protocols, pharmacy prepares or dispenses medications as ordered (internally or outsourced). Outpatient dispenses samples and both inpatient and outpatient administer injectables and other medications.The system shall support review of an order by pharmacist.

D

The system shall support verification and approval of a pharmacy order as entered.

D

The system shall support online drug interaction checks for drug/drug interactions, drug/lab, drug/food, and drug/allergy.

D

The system shall provide alerts for drug-drug, food-drug, drug-allergy interactions, etc.

H

The system shall support ordering injectables. HThe system shall comply with Federal Medicaid Guidelines and State regulations for tamper-proof prescriptions.

D

The system shall print prescription on tamper-proof paper without having to change the paper tray.

D

The system shall track medications received, dispensed, returned, etc.

H

The system shall provide notification of required follow-up activities for the administration of emergency medications, PRNs, and STATs within user-defined timeframes.

H

The system shall generate a single medication profile for each client that is viewable on a single screen

H



No Comments

Documentation: Documenting PHF pharmacy information, such as MD Note, transcribed to medication administration record (MAR), medical note, medical log, medical request slip.The system shall generate and maintain an electronic medication log.

H

The system shall support medication dispensing through an electronic Medication Administration Record (MAR) that tracks user-defined information for all medications that have been dispensed to clients.

H

The system shall generate medication consent forms, capture client/patient signatures electronically, and retain signed consent forms.

D

The system shall ensure that pharmacy management functions are fully integrated with the system electronic Medication Administration Record (eMAR) so that all orders, fulfillment of orders, and recapitulations are supported in the eMAR

D

The system shall have the ability to document and report various clinical monitors, e.g. Adverse Drug Reaction, Medication Error, Non-Formulary Drug request.

D

The system shall support the ability to add patient specific comments (e.g., reactions to medications) and identify the user who generated the comment.

D

Tracking Order Status: Tracking and monitoring the status of the order.The system shall automatically notify staff when CHC medication is ready for pick up.

D

The system shall automatically notify staff after the patient has picked up a medication.

D



No Comments

Tracking Order Status: (continued)The system shall provide the capability for an authorized user to enter information regarding the fulfillment of a pharmacy order (whether through dispensing or administration) directly into a client/patient's medical record.

D

The system shall provide the capability for an authorized user to access and view pharmacy orders over time for a user-defined Client/Patient or population to analyze drug usage and dispensing/administration patterns for that Client/Patient or population.

D

The system shall support pharmacy order renewals without re-entering them into the system, including conversion of existing inpatient orders to outpatient (pass or discharge) orders and conversion of existing outpatient orders to inpatient/admitting orders.

D

The system shall generate a notification to an authorized user when pharmaceutical orders are entered into the system.

D



No Comments

Medication Management Services: Performing or obtaining necessary assessments of the client/patient's health status; Obtaining authorizations, Formulating a medication treatment plan; Selecting, initiating, modifying, or administering medication therapy; Dispensing samples and related documentation; Administering injections and medications and related documentation; Monitoring and evaluating the client/patient's response to therapy, including safety and effectiveness; Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events; Documenting the care delivered (including medication log, MAR, patient reaction to medications); and communicating essential information to the client/patient's other primary care providers; Providing verbal education and training designed to enhance patient understanding and appropriate use of his/her medications. Providing information, support services, and resources designed to enhance patient adherence with his/her therapeutic regimens (including providing patient education material); Coordinating and integrating medication therapy management services within the broader health care management services being provided to the patient.The system shall prompt the doctor to obtain a medication consent in user-defined situations.

H

The system will maintain a single medication profile for each client that includes information about

medications prescribed by the agency, those being taken but prescribed by another provider, drug

allergies, and other related and relevant information for client protections.

H

The system shall link directly to client profiles in Genoa pharmacy and other retail pharmacies with whom JMHC has a business relationship.

D

The system shall automatically update the medication log based on physician orders.

H

The system shall provide an electronic record of client sign-off on Medication Consent Forms.

H



No Comments

Medication Management Services: (continued)The system shall contain or access the JV220(A) Form for physicians seeking authority from the court to prescribe psychotropic medications to wards of the court who are placed outside of their home.

H

The system shall provide an alert to the physician if a client reports side effects attributable to prescribed medications.

H

The system shall be capable of interfacing with external drug information sources.

H

The system shall require that a physician document the reason a medication was discontinued.

H

The system shall retain information about medications that were tried and considered ineffective, and medications that were discontinued for other reasons.

H

The system shall maintain a history of administered injection sites, including body site and when administered.

H

The system shall have online drug interaction, duplication of therapy, allergy alerts that are provided to an authorized user at the points of order entry and validation of the order.

D

The system shall produce drug ID description on label as required by regulation and the ability to edit drug ID descriptions at point of order entry for each fill/refill.

D



No Comments

Medication Management Services: (continued)The system shall have the capability to establish and meet time-specific reporting requirements as established by regulation and accreditation standards including CURES (controlled substance utilization Review and evaluation system).

D

The system shall have the ability to perform medication dose calculations.

D

The system shall generate alerts to designated recipients (e.g., client/patient's care team and physician) of pertinent medication clinical information.

D

The system shall permit an authorized member of the client/patient's care team to access a common client/patient medication history in order to deliver appropriate and/or coordinated pharmaceutical care.

D

The system shall permit pharmacists to approve an order as entered or select another drug as needed.

D

The system shall support control of Injectible medications.

H

Maintaining Formulary: Maintaining the inpatient formulary for the Psychiatric Health Facility (PHF)

The system shall capture and store data on medication types, dosages, and rates per dosage.

H

The system shall maintain and update a locally-defined formulary and display "first-choice" drugs.

H



No Comments

Maintaining Formulary: (continued)The system shall provide the capability to manage the primary drug formulary and support live updates of on-line formularies, pricing, and drug alternatives.

D

The system shall support Drug Formulary Management, with live updates to formularies and drug alternatives available via the solution provider or another service (e.g., First Data Bank).

D

The system shall permit an authorized user to submit an electronic Non-Formulary Request in accordance with policy for same. The request shall be viewable and editable (edit history viewable) by other authorized users.

D

Managing Inventory: Maintaining and controlling the inventory of medications (drug supplies). Maintaining the PHF's MAR, drug samples, lot lists, and ensuring secured storage. Tracking and managing identification and destruction of expired medicines. Interfaces with Bayside and Recovery HouseThe system shall manage inventory for samples drugs, including tracking and providing alerts for those medications that are reaching or have reached expiration dates.

H

The system shall use bar code technology to manage inventory of drug samples.

D

The system shall maintain a log and perpetual inventory of drug samples.

D

The system shall provide the capability for pharmacy inventory management that is fully integrated with the pharmacy management functionality.

D



No Comments

Managing Inventory : (continued)The system shall maintain pharmacy inventory control across multiple locations.

D

The system must be able to track sub-inventories for controlled drugs.

D

The system shall support sub-inventory control including controlled substances (e.g., narcotic drug dispensing (CII-V), ward stock distribution and dispensing) and generate various reports in order to manage and document these inventories.

H

Educating and Performing Research: Providing educational materials and researching drugs.The system shall have the ability to generate medication drug profiles.

H

The system shall have the ability to generate drug monographs.

D

The system shall be capable of printing out educational information on medications being administered or dispensed.

H



No Comments

Dietary: Dietary is the provision of snacks and meals to clients and supports the therapeutic monitoring of a client's dietary intake and output.The system shall support dietary functions on the PHF. HThe system shall support inventory management of meals and snacks across multiple locations.

H

The system shall permit an authorized user to maintain food supply inventory by location.

H

The system shall capture and store information on client food allergies.

H

The system shall track dietary requirements for each patient by unit, room and bed and create dietary orders for the kitchen.

H

The system shall capture and track dietary orders for outpatient meals and snacks.

H

The system shall support the delivery of medical nutrition services to a Client/Patient, including tracking weight, maintaining nutrition assessments and information, and maintaining calorie count information.

D

The system shall track a Physician Dietary Order and calculate the calorie intake associated with individual meals and/or total daily intake.

D



No Comments

1.9 Bed Management: The bed management function allows the Health Agency to track the availability of beds in Agency-owned or -managed client accommodations by type of facility (e.g., 24 hour care facility, apartments) and to generate rosters by facility that may be used to support resource management and payer requirements.Monitoring/Managing Bed Availability: Maintaining accurate and up-to-date status of occupied beds relative to total available bed capacity. Maintains information for inpatient PHF and all other Agency owned or managed beds in the community.The system shall alert staff when bed capacity is nearing maximum in order to avoid citation (e.g. alert when 14 of 16-beds are full)

H

The system shall provide a consolidated history of a client/patient's movement throughout his or her stay at diversion facilities, including reasons for movement.

D

Managing Placements: Based on assessment, client's level of care is determined. Client may be placed at a number of Agency owned or managed beds in facilities representing various levels of care.The system shall track entry and exit dates of each diversion placement for each client.

H

The system shall track what type of diversion facility is being used by the client on each diversion placement (standard user-defined housing classifications).

H

The system shall track total length of stay (number of days occupied), counting day entering placement, but not counting day of discharge.

H

The system shall track and report benchmarks of diversion placement (e.g., at the 30-day mark, 6-month mark and 12-month mark).

D

The system shall track where client entered and exited diversion placement, including who referred them and where they went after placement.

D

Completing Referral Packet: Documenting and assembling all paper work or other information required for an agency or a non-Agency owned or managed facility to decide if a referred Client is appropriate.The system shall automatically generate all forms that must be completed to support referrals to diversion facilities and group homes and other community placements.

H



No Comments

Program / Payer Management: Entering and maintaining information on the program, payer, or guarantor that is responsible for the cost of a client's care. A client may have one or more guarantors depending on the client, program, service, or source(s) of payment.Entering and Maintaining Payer, Program, Plan Information: Capturing information on an unlimited number of Payers/Programs/Plans, including specific benefit or payment limits. Maintaining numerous, complex rules that establish the sequence in which various payers can be billed for services rendered. Associates funding to programs and accommodates payer funding and source cascades.The system shall permit authorized staff to define, describe (e.g., narrative), and update a program/service/plan/payer without vendor support.

H

The system shall track and manage benefit limits, deductibles, co-pays, and covered and non-covered services for each plan.

H

The system shall capture and maintain details on multiple payers for a client.

H

The system shall support multiple fee schedules by payer with specific billing/adjust rules for each program and/or payer.

H

The system shall manage multiple reimbursement methods including fee for service, case rates, per diem, capitation and grant-in-aid

H

The system shall assign and maintain a unique identifier for each program.

H

The system shall support per program fees. HThe system shall support per session fees. HThe system shall support drug testing fees. HThe system shall support miscellaneous fees. HThe system shall permit adjustments to Client accounts at any point in the billing process.

H



No Comments

Entering and Maintaining Payer, Program, Plan Information: (continued)The system shall capture, track and link services delivered to a managed care client by out-of-network providers.

H

The system shall define, capture, and track information on any programs from which a client is receiving service to include:- Adult Protective Services (APS)- - Child Welfare Services (CW)- - Probation- -All County funded programs- Any new programs

D

The system shall track different funding sources, including:- Medicaid- - Medicare- - Funds from other counties- Insurance- Third Party Payers (e.g., victim witness)- Grants- Private pay

H

The system shall flag plan/program recipient services that are the responsibility of another county.

D

The system shall properly handle the sequential billing of payers (e.g. Medicare 1st, Private Insurance 2nd, Patient 3rd, and Medicaid 4th) ensuring that the sequence is based on both the coverage that the client has and the services that are covered by the various plans.

H

The system shall maintain a consolidated master list of Client/Patient insurance payers, organized by dates of coverage, and eligibility criteria.

D



No Comments

Entering and Maintaining Guarantor Information: Capturing information on an unlimited number of Payers/Programs/Plans, including specific benefit or payment limits. Maintaining numerous, complex rules that establish the sequence in which various payers can be billed for services rendered. Associates funding to programs and accommodates payer funding and source cascades.The system shall accommodate complex billing rules that are specified by a County-defined structure based on program, clinician and clinic licensure, and funding source(s).

H

The system shall link Client ID with what programs they are enrolled in, what payers they are eligible to be paid by, and the hierarchy of how the funding applies.

H

The system shall maintain current and historical rates for authorized services by program / provider in order to ensure payment of rate in force at time of service.

H

The system shall maintain and enforce current and historical billing rules by program/provider related to system-provided error checks on procedures and services (e.g., lockouts, cap on hours billed for service within a given program).

H

Updating All Information: Adjusting information at any time, with changes effected in real-time (e.g., tracks retroactive adjustments for cases in which a client is added to a program with an effective date prior to the date of service).The system shall permit the updating of the cascade level of insurance plans that have been changed for a client, and identify clients who have lost their insurance coverage.

H



No Comments

Coding: Selecting, documenting, maintaining and updating standard, industry-wide HIPAA compliant codes related to diagnoses (e.g., DSM-4TR, ICD-9) and procedures (e.g., CPT, HCPCS). Accurate and appropriate coding is essential to timely and optimal reimbursement for services rendered. Coding includes mapping proprietary vendor, County, and other program, payer, or plan codes to industry standard codes.Selecting Appropriate Code: Treating clinician selecting appropriate diagnosis or service code based on clinical judgment, including CPT, DSM, HCPCS, ICD, E&M codes.System alerts user for errors in coding, including reason for the error message.

H

The system shall have system edits that support clinician selection of the proper code.

D

The system shall enforce the selection of standard and appropriate service codes according to which services have been authorized for a client.

H

The system shall restrict service codes available to a provider to those services for which the provider is authorized to charge.

H

Grouping Codes (PHF): Aggregating individual codes to map to established DRGs.The system shall provide mapping / aggregating of individual codes to established DRGs.

D

Validating Charges: Ensuring that provider documentation in the health record supports diagnosis and all billing-related codes included in claims, bills, or invoices.The system shall maintain procedure codes and associated rates and be able to differentiate and maintain the procedure codes according to source/provider.

H

The system shall capture and retain current and past client/patient diagnoses.

H



No Comments

Maintaining HIPAA-Compliant Code Sets: Maintaining and periodically updating codes as needed (e.g., ICD-10).

The system shall support the ICD-9-CM, International Classification of Diseases, standard code set.

H

The system shall support ICD-10 by October 1, 2013. HThe system shall support the Current Procedure Terminology (CPT) standard code set.

H

The system shall support the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) standard code set.

H

The system shall maintain and update National Drug Codes (NDC).

D

The system shall allow authorized users to maintain and update all reference tables and libraries without requiring direct vendor support (i.e., diagnosis codes, procedure codes, drug codes, rates, and related reference tables).

H

The system shall provide the ability to establish, maintain, and update crosswalks of one code set to another (e.g., DSM-IV and ICD-9-CM standard code sets) and to support translate between these code sets according to the established crosswalk.

H

The system shall automatically update standard code sets (e.g., ICD-9, ICD-10, CPT-4 and DSM-IV-TR) in order for system to always have the most recent code tables.

H

Maintaining Proprietary Codes: Entering and maintaining local or State-specific codes (e.g., creating and maintaining disallowance codes in the new system that map to State codes for disallowed services.The system shall accommodate user-defined codes that are required at the local or State level (e.g., disallowance codes).

H



No Comments

Billing/Claims (MHS) and Client Statements (DA/S): A billing statement represents a collection of charges for a specific client over a particular period of time. The billing process involves generating a claim document that documents and substantiates a request for payment of provided services. A billing statement can be generated via paper forms or electronically. A claim represents a request for payment for services/procedures that have been provided to a client. Services/procedures provided must be appropriate for the diagnosis in order to receive maximum allowed reimbursement. Claims may be submitted to institutional payers in paper or electronic format. A bill may be sent to the client for the balance due after claims to all other payer sources have been adjudicated. Includes preparing and sending client statements to DA/S (fee-for-service) and MHS clients. Encounter: An encounter is a unit of service (or a collection of services) and is the basis for generating claims and bills.Deposit/Payment Collection & Receipting:The system shall capture various methods of client payment (e.g., via drop-down boxes).

H

The system shall assign a unique receipt number for each payment

H

The system shall support point-of-service check-out whereby charges are calculated and added to previous accounts receivable balances, payments are posted, and payment receipts are issued and printed.

H

The system shall permit the posting of payments to a client account even if there are no corresponding charges, and handles such payments as credit balances to be matched with charges at a later date.

H

Capturing Fees/Charges: Capturing billable services by linking back to rosters that document services received by virtue of a client's attendance at group or individual counseling or treatment sessions.The system shall capture all charges for unscheduled (Non-rostered) drug tests (e.g., outside lab charges and labor costs of staff dedicated to lab testing).

H



No Comments

Capturing Fees/Charges: (continued)The system shall recognize revenue, adjusted revenue, contractual allowances and sliding scale adjustments for each service from all sources at the time of entry based on the billing rules entered for insurance companies and self-pay clients.

H

The system shall support charges recorded at standard fees and any contractual allowances or sliding scale discounts are recorded as adjustments to the standard fees.

H

The system shall provide for Open-item accounting with the default of posting payments and adjustments to specific charges/invoices.

H

Payer and Client Statements (Billing): Generating statements indicating services provided for a specified date range, including client name, payer name, programs, date/time/type of services rendered, date and amount of all deposits/payments received, outstanding balance, due date, etc.The system shall calculate, bill and track client co-pays and deductibles.

H

The system shall calculate, bill and track client Share of Cost (SOC) Medicaid.

H

The system shall support other user-defined sliding scales, calculation of transfer in and out balances, and budget payment plans.

H

The system shall permit retroactive enrollment data to produce Medicaid claims for services originally billed to other sources that are now Medicaid eligible, and make the proper adjustments to appropriate revenue, receivable and adjustment accounts.

H

The system shall permit retroactive Medicaid billing for up to 18 months after the original date of service.

H

The system shall produce user-defined, detailed client statements on demand.

H



No Comments

Payer and Client Statements (Billing): (continued)The system shall produce user-defined detailed client statements on a cycle basis (e.g. every month).

H

The system shall permit authorized user to disable the production of statements for any client.

H

The system shall be able to classify clients into categories for which the user will have control over the decision to print statements (e.g., all clients under 100% of the federal poverty level are not sent statements).

H

The system shall permit reversal of charges on a bill (i.e., pulling out non-permitable charges).

H

The system shall generate a billing statement that reflects services provided, regardless of client's account status or payment liability.

H

The system shall generate electronic or hardcopy bills for Medicaid clients/patients.

H

The system shall generate a bill for services with or without diagnosis code.

H

The system shall identify Medicaid retroactive eligibility and bill for covered services.

H

The system shall permit authorized staff to suppress bills or other materials from being printed or displayed according to user-defined parameters.

H

The system shall generate CMS 1500 bills. HThe system shall generate UB04 bills. HThe system shall generate Superbills. HThe system shall support both real-time (i.e., DDE) and batch billing (i.e., claims) methods for any given client.

H

The system shall bill the right funding source for the right program.

H

The system shall permit authorized staff to perform post-payment adjustments.

H



No Comments

Payer and Client Statements (Billing): (continued)The system shall detect and prevent billing of low balance claims.

H

The system shall track each service provided, billed, and the amount paid, denied, or suspended at the client account level.

H

The system shall have the ability to print payer/client statements.

H

The system shall print or display a bill in chronological order for: Encounters

H

The system shall print or display a bill in chronological order for: Treatments

H

The system shall print or display a bill in chronological order for: Receipt number

H

The system shall print or display a bill in chronological order for: Date received

H

The system shall print or display a bill in chronological order for: Payer

H

The system shall print or display a bill in chronological order for: Payments

H

The system shall print or display a bill in chronological order for: Adjustments and/or rate changes

H

The system shall print or display a bill in chronological order for: Share-of-cost adjustments

H

The system shall print or display a bill in chronological order for: Payments

H

The system shall print or display a bill in chronological order for: Billings

H

Payer Invoice (Billing): Generating invoices to payers for Contracts and Grants for internal services provided.The system shall support the ability to bill third party payer sources.

H

The system shall support the authorization for payment to and reimbursement of third party payers.

H



No Comments

Payer Invoice (Billing): (continued)The system shall produce paper claims for any service transaction on-demand and in a batch mode.

H

When Remittance Advices are posted, the system shall automatically transfer outstanding charges to secondary and tertiary payers and/or client responsibility, and produce the appropriate electronic and/or paper claim (forms).

H

The system shall automatically calculate payments due applying appropriate pre-determined contractual terms.

H

The system shall automatically compute and write-off the positive or negative contractual allowance amounts for bills, including capitated or grant-in-aid funding streams.

H

The system shall automatically bill or invoice per contract terms and conditions, and automatically make contractual adjustments (e.g., if $1200 for PHF day and contract with insurer is for $800, system bills insurance $800 and makes contractual adjustment of $400).

H

The system shall permit authorized staff to adjust claims and provide an audit trail for payment and charge adjustments.

H

The system shall perform automatic drug Medicaid billing with internal checks for group size, correct diagnosis, etc.

H



No Comments

Payer Invoice (Billing): (continued)The system shall prohibit billing for services that were provided without prior authorization or approved Treatment/Treatment/Care Plans.

H

The system shall permit authorized staff to perform post-payment adjustments.

H

The system shall display and print payer invoices. HThe system shall print or display a bill in chronological order for: Type of billing (Medicare, Medicaid, co-pay, private insurance, etc.)

H

Daily Cash Journal: Reconciling payments received during a given date range. Reconciling by site/location (e.g., Atascadero, Arroyo Grande, San Luis Obispo), program (e.g., DUI, TX, P36), pay source type (e.g., cash, credit, money order, web, check), and payment for (e.g., program, testing, miscellaneous).The system shall provide the ability to reconcile cash payments received against cash received posting log (i.e., for what service, how much, from whom, where received, and in what form of payment).

H



No Comments

AR/Collections: The process of monitoring outstanding claims/bills, associating payments received with claims/bills issued, and following up on delinquent accounts. D/AS outsources its collections function to the Probation Department.Monitoring Status of Client Accounts: On an ongoing basis, tracking deposits and payments received from clients against programs/services rendered and client's liability, and determining accounts and amounts due that are current, 30 days, 60 days, etc.The system shall support the generation of invoices for services provided.

H

The system shall determine the appropriate code/rate for invoice processing.

H

The system shall track data by invoice-processing information (e.g., Tax ID, Agency, Provider Name) and client identifier.

H

The system shall support the entry of point-of-service check-out whereby charges are calculated and added to previous accounts receivable balances, payments are posted, and payment receipts and account statements are issued.

H

The system shall reconcile the following against deposit receipts: client, payer source (e.g., Grants, Medicare), date of service, billed amount, and paid amount.

H

The system shall permit adjustment of receivables for: Account adjustmentsTherapeutic adjustments (waiver).

H

The system shall permit adjustment of receivables for: retroactive rate adjustments.

H

The system shall permit adjustment of receivables for: forgiven debt waiver (i.e., write-offs).

H



No Comments

Monitoring Status of Client Accounts: (continued)The system shall allow remaining balances to be released upon case closure and redirected to other sources.

H

The system shall print or display the transaction history for a specific client account, including all charges, payments, and adjustments for all payers for a specified date range.

H

The system shall print or display the transaction history for a group of client accounts, including all charges, payments, and adjustments for all payers for a specified date range.

H

The system shall print or display the transaction history for a specific payer, including all charges, payments, and adjustments for a specified date range.

H

The system shall print or display the transaction history of client responsibility, including all charges, payments, and adjustments for a specified date range.

H

The system shall print or display the transaction history for all payers, including all charges, payments, and adjustments for a specified date range.

H

Identifying Delinquent Accounts: Identifying clients who have either not had a face-to-face encounter in 60 days, or who have not made a payment in 60 days.The system shall notify clinicians/therapists when a client on their caseload has not had a face-to-face encounter in 60 days

H

The system shall notify clinicians/therapists when a client on their caseload has not made a payment in 60 days

H

Sending Accounts to Collections: Since DA/S collection is outsourced, the process of collection involves sending delinquent account information to Probation Collections, and receiving and posting collections paymentsThe system shall allow a user to append notes captured during a collection call to the appropriate transaction and generate ticklers based on follow-up dates defined by the user.

H



No Comments

Electronic Transactions: Exchanging structured data, using agreed-upon HIPAA-compliant transaction and code sets, from one entity to another (e.g., electronic claims submission).Maintaining All HIPAA-Compliant Transactions: Sending and receiving HIPAA-compliant transactions, as required.The system shall comply with all HIPAA ASC X12N transaction set requirements.

H

The system shall be compliant with the ASC X12N 270/271 - Health Care Eligibility Benefit Inquiry and Information Response format.

H

The system shall be compliant with the ASC X12N 276/277 - Health Care Claim - Status Request and Response format.

H

The system shall be compliant with the ASC X12N 278 - Health Care Services Review - Request to Review and Response format.

H

The system shall be compliant with the ASC X12N 834 - Benefit Enrollment and Maintenance format.

H

The system shall be compliant with the ASC X12N 835 - Health Care Claim - Payment/Advice format

H

The system shall be compliant with the ASC X12N 837P - Health Care Claim - Professional

H

The system shall be compliant with the ASC X12N 837I - Health Care Claim - Institutional

H



No Comments

Maintaining All HIPAA-Compliant Transactions: (continued)The system shall support standard encounter formats, either proprietary or industry-standard (837P).

H

The system shall comply with X12 Version 5010 counterparts to the 4010A1 Implementation Guides as currently mandated under HIPAA.

H

The system shall support electronic transfer of data to/from Medicare.

H

The system shall support electronic transfer of data to/from Medicare.

H

The system shall support electronic transfer of data to/from Targeted Case Management (TCM).

D

The system shall support electronic transfer of data to/from Medicare Administrative Activities (MAA).

H

The system shall support electronic transfer of data to/from third-party payers.

H

The system shall support electronic transfer of data to/from County systems.

H

Internet Payments: Accepting online credit card payments from active clients.The system shall permit active clients to make payments on their account using a personal credit card.

D



No Comments

AP/Reimbursement: The process of monitoring and making payments (e.g., reimbursement or compensation) due to providers for services rendered to clients. Provider reimbursement methodologies may include fee-for-service (FFS) agreements, under which a provider is paid full charges for each service rendered; a capitation agreement under which the provider receives a set fee per month for each client under his/her care; a mixture of both FFS and capitation; cost-based reimbursement; negotiated rate reimbursement; or other contractual arrangements.Preparing Payment/Claims Adjudication: Provider reimbursement is calculated or determined based on contractual agreements, claims submission, and other requirements (e.g., utilization management and risk sharing). Payment can be made via paper check or electronic funds transfer.The system shall permit authorized network providers to enter CMS 1500 claims directly into the system.

H

The system shall accept scanned hard-copy paper claims (e.g., from billing companies used by certain network providers; from network providers who do not have e-mail).

H

The system shall automatically compare a contractor invoice to contract terms and conditions (contract compliance) and notify staff of discrepancies.

D

The system shall compare invoiced service units for a given period against services entered into the system by a contract provider and notify staff of discrepancies.

D

The system shall screen Claims for proper eligibility including whether other insurance plans are primary.

H

The system shall screen Claims for proper eligibility including the existence of an appropriate authorization.

H

The system shall screen Claims for proper eligibility including coverage for the specific service under the authorization.

H



No Comments

Preparing Payment/Claims Adjudication: (continued)The system shall screen Claims for proper eligibility including service by an authorized provider.

H

The system shall adjudicate claims on a per claim basis.

H

The system shall permit pending claims to be reviewed and denied if they do not have an appropriate authorization in the system.

H

The system shall permit claims that have been entered, adjudicated, approved, and paid to be reversed.

D

The system shall generate accounts payable transactions for interface to the County SAP accounting system (e.g., Network Provider, Managed Care).

D

The system shall automatically credit contractual allowances and other adjustments to accounts during payment posting based on pre-determined, carrier-specific criteria.

H

The system shall report Denial notices to providers for specific reasons, including but not limited to: Claim is incomplete, Client/Patient is not eligible, Provider is not eligible, Service dates do not match authorized dates, Service is not authorized, Diagnosis is not included in Scope of Benefits (specialty mental health carve-out), Retroactive coverage is not available, and Billing submittal is past the limitation period.

H

The system shall report on the activities and running balance of each account.

H



No Comments

Providing Payment: Payment is provided on a timely basis.The system shall generate a remittance advice by legal entity and/or by provider.

H

The system shall generate a remittance advice for each service paid that includes: Authorization Number, Service Date, Client/Patient Name, Amount Paid, Share-of-Cost (if applicable), Claims Paid, Claims Denied and Reason, Claims Suspended and Reason, etc.

H

The system shall permit adjustments to the Remittance Advice for specific providers/facilities.

D

The system shall permit the user to choose whether to include or exclude Denials and Pended Claims from Remittance Advice reports.

H

Coordination of Benefits: The COB (Coordination of Benefits) process determines the respective responsibilities of two or more health plans or payers that have some financial responsibility for a claim. A coordination of benefits, or "non-duplication," clause in either policy prevents double payment by making one insurer the primary payer, and assuring that not more than 100 percent of the cost is covered. Standard rules determine which of two or more plans, each having COB provisions, pays its benefits in full and which becomes the secondary payer on a claim (also called Cross-Over).The system shall support coordination of benefits for Medicare, Medicare, and other payers.

H

Explanation of Benefits: Explanation of Benefits (EOBs) are paper statements-- or electronic exchange of information-- provided by the payer that reconcile the amount billed to the amount paid, and indicate the reason(s) an item was not paid. The EOP also includes the amount of any charges that are the responsibility of the client (e.g., co-payment, coinsurance, deductible).For denied payments, the system shall automatically create the Notice of Action-C (NOA-C) using information on the Explanation of Benefit.

H



No Comments

Explanation of Benefits: (continued)The system shall track claims and payments made to out-of-network and automatically generate EOBs.

D

Disallowance: Disallowances are services that have not been--or will not be--reimbursed for a variety of reasons. Handling disallowances entails entering the unreimbursed service(s) and the reason(s) for non-payment using State and County codes. Disallowances must be entered in the County system and in the State system to capture detail on the service(s) and reason(s) for non-payment.The system shall flag "disallowed services" using County and State "reason" codes at any stage in the billing process.

H

Updating Reports: Payment records are updated to ensure accuracy and reliability. Payment records are posted to the general ledger, A/P and A/R as needed (e.g., recovery operations).The system shall provide a comment field restricted access by accounting staff (i.e., not part of the client record) for capturing text-based narrative, explanations, or comments related to accounts payable.

H



No Comments

Census: The census is the official count of the number of active clients or patients as of a specific date/time or date range. Some programs require a daily census (e.g., inpatient PHF and intensive day care services) whereas others may require less frequent, periodic census counts (e.g., DUI programs). The census is essential to manage capacity and to comply with payer requirements that may be driven by room and board.Counting Inpatients/ Active Clients: Counting the number of active clients in a specific program or setting as of a pre-determined day/date/time, based on a pre-determined frequency. In the inpatient PHF setting, the census is captured three times a day.The system shall capture and track census for patients in inpatient settings.

H

The system shall capture and track census for clients in outpatient settings.

H

The system shall capture and track inpatients by unit, room and bed.

H

The system shall support documentation of midnight bed checks.

H

The system shall generate Facility Alphabetical Rosters showing Client/Patient name and location within facility, physician, insurance, and phone number

H



No Comments

Compliance / Auditing: Meeting accreditation, regulatory, legal, and payer requirements. Compliance includes: implementing written P&P and standards of conduct; designating officer and committee; conducting effective training and education; developing effective lines of communication; enforcing standards through well publicized disciplinary guidelines; developing policies addressing dealings with sanctioned individuals; conducting internal monitoring and auditing; responding promptly to detected offenses; developing corrective actions; reporting to the Government. Auditing is a process of examining current practices to ascertain or verify conformance with pre-established requirements. Supporting all data analysis and reporting needs related to certifications, regulation, legislation, legal, DMH, WIC, Title IX, NNA, Medicare, Medicare, grants, HIPAA, County policies and procedures, internal/external chart audits, CBO security access, and audit criteria setting.The system shall automatically assign a unique transaction number for every transaction in the system (e.g., to support audits).

H

The system shall establish an electronic audit trail on checks received.

H

The system shall support electronic audits regardless of a user's current location (i.e., not requiring having to go to the clinic).

H

The system shall provide automatic quality assurance checks based on business rules (e.g., system automatically tracks compliance with requirement to provide client an appointment for service within 21 days of the first contact based on system calculation).

H

The system shall generate reports that identify discrepancies where the progress note date does not match the attendance date.

H

The system shall permit authorized users to access compliance information.

D

The system shall provide the capability to track compliance with documentation standards and regulations.

D



No Comments

Compliance / Auditing: (continued)The system shall compile and maintain necessary data for compliance reporting required by State, Federal, and other agencies that regulate agency.

D

The system shall provide the capability for authorized staff to define required activities and establish a workflow template for a given type of audit that can be saved for reuse.

D

The system shall generate and send notification(s) to staff involved in audit activities regarding agency-defined audit events and compliance status.

D

The system shall allow authorized users to query the status of activities related to specific audits.

D

The system shall generate and send notifications to authorized users when audit activities are approaching deadlines.

D

The system shall generate reports specific to audit status, outstanding activities, and percent completion of specific audits.

D

The system shall provide the capability for authorized users to enter information regarding resolution of audit activities

D

The system shall provide the capability for authorized users to enter corrective actions resulting from audits

D

The system shall provide the capability for authorized users to enter and update audit results.

D

The system shall provide the capability to establish a work queue for coding review prior to billing and/or claim submittal.

D



No Comments

Reporting: Reporting is the aggregation of financial, operational, and clinical data into meaningful information that facilitates decision-making, supports compliance/auditing needs, and meets mandated reporting requirements (e.g., Medicaid cost reports). Standard reporting adheres to a pre-determined format and data types and is produced on a routine basis. Ad-hoc reporting generates reports containing user-requested data on an as-needed or on-demand basis.General:The system shall provide all standard reports as defined by agency. (Note: Refer to the Procurement Library for standard reports currently used by agency.)

H

The system shall have standard reports providing a variety of views of administrative and clinical operations such as monthly trend reports, clinician comparison reports, etc. that provide summarized management-related data and that support tactical and strategic decision-making.

H

The system shall allow for the selection and filtering of report parameters by key variables such as date range, department, and clinician.

H

Generating Administrative Reports:The system shall provide reports on contact statistics (e.g., volume and type of inquiries, turnaround time, and number of abandoned calls) for contact management and call intake activities.

D

The system shall provide reports on wait-listed clients. HThe system shall generate statistical reports to the County identifying program census of clients treated and/or awaiting drug and alcohol treatment.

H



No Comments

Generating Administrative Reports: (continued)The system provides reporting capability to identify clients that may be eligible for Medicare based on multiple criteria.

H

The system shall provide reporting capability that identifies any changes in a client's eligibility for service (by payer, funding source).

H

The system shall provide reporting capability that identifies client eligibility for coverages other than Medicare (e.g., Medicare, insurance, private pay).

H

The system shall generate reports that identify aid code(s) by client/patient

H

The system shall generate appointment disposition reports by clinic or by provider for agency defined date range to include:Appointments keptCancellationsNo-shows

D

The system shall produce reports listing appointments by provider for user-defined date ranges.

D

The system shall provide a roster of current staff with contact information for routine communication.

D

Generating Clinical Reports:The system shall track and report on statistics regarding authorizations including: SubmissionsApprovalsDenialsProvider typeAge of authorizationOther parameters as defined by the County

H



No Comments

Generating Clinical Reports: (continued)The system shall provide reports that indicate the trending of authorizations by the following: Referring providerReferred to providerReferred to provider specialtyAuthorization status (approved/denied/pended)Any combinations of above

H

The system shall produce authorization productivity reports by authorizing user.

H

The system shall produce authorization turnaround report.

H

The system shall provide standard reports on unauthorized services by the following parameters: ClientProviderStatus of authorization (none, pending, denied, violated)Service Provider not authorized for (facility, program, payer, population, service)

H

The system shall track and report on the number of open cases/episodes by:Active clients or programsInactive clients or programsProvider, location, and diagnosisUnduplicated

H

The system shall track and report on the number of case/episodes opened and/or closed during a user-defined period of time by provider, location, and diagnosis.

H



No Comments

Generating Clinical Reports: (continued)The system shall track and report on a client by:Number of cases involving clientDiagnosis (e.g., Primary, Secondary, Tertiary; Axis I-V)Location where services are being provided to client

H

The system shall capture and report each client/patient who has been evaluated for 5150 status and disposition of each evaluation

H

The system shall track and report on the number of cases, either by program or total, assigned to a provider (e.g., Network and agency employed providers).

H

The system shall generate reports that indicate active cases by funding source

H

The system shall track and report on service activity for user-defined time periods by one or more of the following parameters:Client, providerFacilityServiceDates of serviceOther agency defined parameters

H

The system shall provide a standard report on services without supporting progress notes.

H

The system shall capture and generate reports on the number of clients/patients receiving services per program.

H



No Comments

Generating Clinical Reports: (continued)The system shall track and report clients/patients currently receiving services in any court involved programs

H

The system shall track clients/patients by housing arrangement to include:Assisted LivingBoard and CareTransitional HousingState/Private Hospital

H

The system shall generate bed rosters by unit and occupancy reports for all Agency owned or managed beds.

H

The system shall automatically calculate and generate Length of stay (LOS) reports where LOS is calculated by counting the day entering placement, but not counting the day of discharge.

H

The system shall automatically generate a 26.5/AB 3632 Assessment Report that shows all clients in this category by site and status.

H

The system shall provide the capability for authorized users to generate a report of information disclosures for user-defined time periods.

H

The system shall generate reports related to client movement (i.e., ADT).

H

The system needs to be able to report service and outcomeinformation related to special populations such as Homeless and CSOCconsumers.

H



No Comments

Generating Financial Reports:The system shall generate a history of: Payments received, Treatments, Date of Billing

H

The system shall generate a history of Medicare, Medicare, Insurance, Private Pay, Other

H

The system shall generate a history of Balance and reconcile receivables with receipt number

H

The system shall have the ability to itemize and extract costs, bills, receivables, and collections by Location, Program, Provider, Service Type, Case Number, Funding Source, Service Function Code, Mode of Service, and Legal Entity.

H

The system shall maintain Case cost information by: Individual client/patient (listed from high to low cost)

H

The system shall maintain Case cost information by: Family (listed from high to low cost of service)

H

The system shall maintain Case cost information by: Individual provider (both contract Network private providers and County employees)

H

The system shall maintain Case cost information by: Stratified case type (e.g. less intensive or more intensive)

H

The system shall maintain Case cost information by: Region of the County (e.g., ZIP code)

H

The system shall maintain Case cost information by: Facility or school location at which services are provided (site location table)

H

The system shall generate claims report that itemizes: Claims paid, Claims denied, and Claims suspended and reasons

H



No Comments

Generating Financial Reports:The system shall permit sorting claims report by provider, and by date range.

H

The system shall generate reports based on payer type to include: Medicare, Medicare, private pay, Healthy Families, and other payer types not yet identified.

H

The system shall itemize, extract, and report on costs by one or more of the following parameters: Service Location, Program, Provider, Service type, Case number, Funding Source, Date/Time (individual or range).

H

The system shall summarize non-billable activities by provider, by staff, and by service.

H

The system shall compile service units and charges into the Medicare and Medicare cost reporting categories to produce reports that will support the development of these annual cost reports.

H

The system shall generate appropriate reports as needed and on a timely basis (via paper forms, on-line screen, etc).

H

The system shall generate reports with summary-level data according to user-defined criteria, such as subtotals by payer, payer class, program, location, etc.

H

The system shall provide detailed aged accounts receivable reports with user-defined sort and subtotal criteria including payer, provider, client, program, location, etc.

H

The system shall report the total amount billed by: Case/client

H



No Comments

Generating Financial Reports:The system shall report the total amount billed by: Number of appointments

H

The system shall report the total amount billed by: 100% appointment / billing, (exception report of appointment not billed)

H

The system shall report the total amount billed by: The entire history of a client/patient account.

H

The system shall permit authorized staff to print or display Bills and re-bills to clients, patients and/or third-party payers (individually or batch).

H

The system shall permit authorized staff to print or display Notification to client/patient of provider claim approval.

H

The system shall generate a report on total amounts billed and total amounts received in a month.

H

The system shall generate an account-specific A/R aging report for claims over:30 days60 days90 days80 daysUser-defined time periods

H

The system shall generate A/R Aging Reports by client, by program/service, and by funding source that include: amount billed, amount received, amount adjusted.

H

The system shall generate a report of denied and/or rejected claims.

D

The system shall generate exception reports. D



No Comments

Generating Financial Reports:The system shall generate unbilled claims status report.

D

The system shall generate rejected claims status report.

D

The system shall generate a report that reflects payments received and credited to Client/Patient accounts by payer source and date or date range.

D

The system shall provide a report on all insurance billing and reimbursement activity for a specific Client/Patient.

D

The system shall provide reports showing the status of staff credentialing and licensing, including expiration dates.

D

Generating External (i.e., State) Reports:The system shall automatically generate State-required reports using prescribed data elements, formats, and frequencies

H

The system shall generate error reports to detect missing or incomplete data elements prior to electronic transmittal to include null fields

H

The system shall provide a consolidated report regarding client movement and discharge data reporting that complies with contract requirements.

D

The system shall generate State mandated reports on a 24-hour basis documenting total licensed staff working by staff classification and by shift for user-defined timeframes.

D

The system shall produce a Wisconsin Medicaid Cost Report.

D



No Comments

Complaints, Grievances, Appeals, Notice of Actions, State Hearings: Complaints, grievances, appeals, Notice of Actions, and State Hearings represent escalating levels of action available (depending on payer, program, and county policies and procedures) that can be taken when a client, provider, family member, or advocate contests a decision concerning denial of services or other issues deemed as unacceptable. Complaints are either informal verbal or formal, written expressions of dissatisfaction. DA/S requires that verbal complaints be put in writing. Grievances are formal, written expression of a complaint, typically initiated by a client against a provider or payer, concerning an alleged breach of agreement or an alleged injustice. Appeals are filed when a client disagrees with the adjudication of a grievance. A Notice of Action (NOA) is typically generated by a health plan, and constitutes notification to a client or other appropriate party regarding a denial, termination, reduction, or modification of requested services.

Data and Access:The system shall have the ability to limit access to client/member grievance records:Available to Client Rights Specialist(s) - CRSCRS’s Supervisor/BackupDirector Supervising Client/Member Grievance Process

H

The system shall have the ability record and maintain the following demographics in a client/member grievance record.NameAddressDate of BirthPhonePayer Type (needed to determine direction for appeal)Case manager/therapistID # (used for reports instead of name)Collateral Info (someone’s name who is supporting client/member)Parent’s name/contact info (if minor)Guardian’s name/contact info (if has legal guardian)

H

The system shall have the ability to enter and retain the Client Rights Specialist’s Name

H

The system shall have the ability to enter and retain the Grievance Program Director’s Name

H



No Comments

Data and Access: (continued)The system shall have the ability to enter and retain multiple TYPES of contact (could be more than one for each filing)General ComplaintInformal GrievanceFormal GrievanceCivil Rights/DiscriminationADA IssueRequest for AdvocacyTreatment Right QuestionOther

H

The system shall have the ability to enter and retain the DATE Contact Initiated

H

The system shall have the ability to enter and retain the DATE of CRS Completion

H

The system shall have the ability to enter and retain the Program or Programs Providing Services. Must have the ability to relate more than one program to any individual filing.

H

The system shall have the ability to enter and retain the Program or Programs Involved in the Complaint/Grievance/Request for Advocacy

H

The system shall have the ability to record and retain the Working Note Section to document contacts and CRS review. Including the Date of contact and the Author

H



No Comments

Data and Access: (continued) Ability to Identify the Treatment Right(s)

Involvedo Prompt/Adequate Treatmento Clean/Safe Environmento Adequate Treatment– Medso Adequate Treatment – Serviceso Confidentialityo No Harmo No Discriminationo Involvement in Treatment Planningo No unnecessary/excessive

medication/Treatmento Informed Consent Treatmento Informed Consent Medso Informed of Benefits/Side

Effects/Alternativeso Permission to Film/Recordo Financialo Informed of Costso Transfer of Serviceso Refuse Treatmento Rights Info Not Giveo Residential Treatment Righto Other Treatment Righto Civil Righto ADA Righto No Rights Involvedo Other

H



No Comments

Data and Access: (continued)The system shall have the ability to record and retain the Client Rights Specialist’s Disposition For Each Tx Right Involved and to retain at least the following data elements:FoundedUnfoundedUnable to SubstantiateNot GrievableNot ResolvableDismissed by CRSWithdrawn by client/memberNo Follow Through by client/memberNo Need for DispositionOther Disposition

H

The system shall have the ability to record and retain the Client Rights Specialist’s Resolution/Referral. Including at least the following data elements:Resolution – Change madeResolution – CompromiseResolution – No Change MadeResolution – Info/ClarificationResolution – Law/Rule InterpretationResolution - Reassurance/SupportResolution – OtherReferral – JMHC Clinician/TherapistReferral – JMHC Supervisor/ManagerReferral – JMHC DirectorReferral – Lawyer/CourtReferral - GuardianReferral - Other

H



No Comments

Data and Access: (continued)The system shall have the ability to produce and retain a copy of the Section for Correspondence Written by JMHC. Including:An Initial LetterA Finding ReportAn Appeal LettersAny Other Correspondence

H

The system shall have the ability to scan & add client/member’s complaint/grievance letter(s) and correspondence

H

The system shall have the ability to enter JMHC Financial Audits

H

The system shall have the ability to enter and retain JMHC Second Medical Opinions

H

The system shall have the ability to record and retain a Section to Identify Appeals with at least the following data elements:Level I JMHC Grievance Program DirectorLevel I JMHC CEOLevel I JMHC Medical DirectorLevel II County Grievance ExaminerLevel III State Grievance ExaminerLevel IV State AdministratorState Civil Rights/ADA OfficeFederal Civil Rights/ADA Office

H

The system shall have the ability to Scan & Add correspondence from county/state regarding appeals.

H

The system shall have the ability to identify Appeal Findings

H



No Comments

Licensing/Credentialing: Credentialing is the administrative process of validating the qualifications of licensed professionals (including Health Agency staff, contract and network provider staff, organizational members or organizations) and checking their background and legitimacy. The agency outsources some licensing/credentialing activities to an outside credentialing organization and performs some activities in-house. Licensing/credentialing includes checking, certifying, and credentialing facility licenses.Obtaining and Verifying Data: Obtaining and verifying the required credentialing information [e.g., using credential verification organization or other external sources; obtaining DEA (Drug Enforcement Agency) certification with expiration, current malpractice insurance, response from National Practitioner Data Bank, lawsuits, and from the State].The system shall support the credentialing of individual clinicians (internal and external providers).

D

The system shall support the certification of provider facilities.

D

The system shall capture and maintain identification numbers and effective dates for provider license, Drug Enforcement Administration (DEA) number, professional liability insurance, etc.

H

The system shall capture and track NPI information (organizational provider, service facility, individual).

H

Communicating Result to Applicant: After reviewing all collected information, notifying the applicant clinician of the credentialing decision.The system shall automatically generate expiration letters to providers (e.g., expiration of licensure, Drug Enforcement Administration (DEA) number, professional liability insurance) according to user-defined number of days prior to expiration date.

H

Maintaining Credential Data: Credentialing information is stored and periodically updated in the system.The system shall track identification numbers and effective dates for provider license, Drug Enforcement Administration (DEA) number, professional liability insurance, etc.

H



No Comments

Maintaining Credential Data: (continued)The system shall automatically notify staff of providers who have not been re-credentialed by required date.

H

The system shall automatically prompt to verify providers are re-credentialed by the required date.

H

The system shall support Federal and State requirements related to professional and industry-specific licensing and credentialing.

D

The system shall provide the capability to track staff qualifications, including credentials, privileges, and licensure, and currency requirements for licensed/certified staff and contract providers.

D

The system shall provide the capability for an authorized user to review license, credential, and privilege expiration dates for licensed/certified staff and contracted individuals.

D

The system shall provide the capability for an authorized user to configure the time period prior to a specific expiration date when an alert is to be sent.

D

The system shall provide an alert to affected staff or contract provider when current license and/or credentials approach expiration deadlines.

D



No Comments

Performance Quality Improvement (PQI): Monitoring processes that affect the quality of client/patient care processes and/or outcomes. PQI identifies areas that need improvement, develops solutions to rectify deficiencies, optimizes resource utilization, and improves processes and outcomes. PQI efforts are integrated with staff training.Collecting, Aggregating, and Analyzing Data: Supporting the systematic capture, analysis, and reporting of data used in process improvement, outcome measurement, and trend analysis. Includes data captured in assessments, Treatment/Treatment/Care Plans, discharge summaries, and other areas of the electronic health record.The system shall permit the creation of a variety of outcome measurement instruments.

D

The system shall incorporate a variety of 3rd-party licensed instruments that have been authorized for use.

D

The system shall support Locally-defined scoring protocols that can be used to summarize outcome instrument data.

D

The system shall permit Clinical review of outcome score trends over time (e.g., through on-line queries).

D

The system shall capture Outcome data elements. HThe system shall capture and track age group specific (e.g., adult, child, elder, family) Outcome data (e.g., beginning and ending Outcomes).

H

The system shall support data mining, data analysis, data validation, reporting, queries, and billing.

H



No Comments

Community Education and Outreach: Community Education and Outreach involves initiating communication and contact with the public, and disseminating information to the public, for the purpose of providing health education, health promotion/disease prevention, training and/or skill building, activities, health related screenings, educationally-based early intervention, and awareness of community services and resources.Prevention: Designed to produce optimal behavioral health outcomes in a cost-effective manner through various approaches (population-based, proactive, disease-specific) in delivering the services. Preventative behavioral health places strong emphasis on new education measures, practitioners, common outpatient procedures, and adherence to prescription drug regimens.The system shall capture and track prevention, early intervention, and outreach activities.

H

The system shall capture and track demographics (recipients, viewers, attendees) depending on activity.

H

The system shall capture and track non-demographics (e.g., brochures and materials at health care meetings, environmental campaigns, mass media).

H

The system shall permit but not require the maintaining of a roster associated with an activity.

H

Client Satisfaction Surveys: Generate client satisfaction survey letters with pre-printed address labels to random samples, user-defined populations, or all clients. Capture interview online when client comes in for follow-up and E-mail results back to appropriate department.The system shall provide tools for conducting client/customer satisfaction surveys, both on-line and through hardcopy collection means.

H

Analysis: Capture trends, analyzes and disseminates results of client satisfaction surveys.The system shall have robust analysis and reporting capability (e.g., comparing pre- and post-test data).

H

The system shall support the ability to chart outcome data (e.g., pre- post- data entry).

H

The system shall visually present data for analysis and reporting.

H



No Comments

Portal: Maintaining a website that offers a range of capabilities that support accessing Health Agency services or promoting a client's well-being, such as e-mail, chat boards, search engines, and content.Client Application/ Enrollment): Enabling the public to register or apply for services online.The system shall support online completion and submission of various forms, including but not limited to application, enrollment, and registration forms and customer satisfaction surveys.

H

The system shall automatically populate appropriate forms (e.g., intake assessment) from data entered online.

H

Client Appointments: Supports online requests by clients for an appointment with specific clinician(s).The system shall permit active and prospective clients to request an appointment.

H

The system shall capture requests for various appointment types, including drug testing, intake assessment, appointment with assigned counselor/therapist for active clients, etc.

H

The system shall support: online viewing of scheduled appointments by active clients.

D

The system shall enable active clients to request changes to, or cancellation of, one or more previously scheduled appointments

D

Client Account Checking and Bill Payment: Client checking status of their account; making payments for services received.The system shall support online bill payments by active clients.

D

The system shall permit active clients to view the status of their account (e.g., balance).

D

Communication: Active clients sending secure messages to their clinician.The system shall support chat rooms and/or forums for active clients.

D

The system shall enable an active client to send a secure message to their assigned counselor or therapist.

D



No Comments

Service Provider Data Submission: Health Agency, Community-Based Organizations, and Network Providers submitting State-mandated data.The system shall enable the exchange of data with service providers.

H

The system shall support financial reporting with service providers.

H

The system shall support the sharing of outcomes data among authorized users

H

The system shall support online viewing of lab results for contract physicians, other contract service providers, and staff.

D

The system shall support online exchange of data with service providers for contract physicians, other contract service providers, and staff.

D

The system shall support online creation of service plans for contract physicians, other contract service providers, and staff.

D

The system shall support financial reporting with service providers for contract physicians, other contract service providers, and staff.

D

For Service providers and CBOs, the system shall permit: online viewing a client's drug test results

D

For Service providers and CBOs, the system shall permit: online sharing of outcome data

D

For Service providers and CBOs, the system shall permit: online access to client record

D

For Service providers and CBOs, the system shall permit the online viewing of laboratory results.

D

For Service providers and CBOs, the system shall permit: online monthly billing and annual cost reports [need clarification]

D



No Comments

Service Provider Treatment/Service Planning: Supports online completion of service plans.The system shall permit the online creation of service plans by authorized clinicians for clients on their caseload.

D

The system shall permit direct entry and submission of CSI data by authorized users.

H

Drug Testing: Service provider and active clients accessing drug testing schedules and results, as appropriate.The system shall permit authorized individuals to view drug test schedule via mobile phone

D

The system shall permit authorized individuals (e.g., active clients, clinicians, network providers, CBOs, etc.) to view lab test results.

D

Chart Access: Service provider and client accessing a client's chart, as appropriate.The system shall provide authorized users access to authorized sections of a client's record.

H

Information and Education: Provides information, including downloadable documents, that may be of interest to the general public, active or prospective clients (e.g., what to expect during an inpatient PHF stay).The system shall permit the posting of public information/ education for prospective PHF, MHS, and D/AS clients (e.g., education and prevention, services, programs, locations, hours of operation, and contact information).

D

The system shall permit the posting of documents that may be downloaded in pdf format (e.g., applications and satisfaction surveys).

D

The system shall support electronically sending/receiving referral packets.

D
