ESBD_357591_1714158778975_TPC RFP User Requirements Vendor Response.docx
DOCX document 174 KB Posted
- Attached to
- RFP-EHR
- Solicitation number
- 04262024
- Issued by
- Potter County, Amarillo City, Texas
About this file
This document is a Request for Proposal (RFP) issued by the Texas Panhandle Centers for Behavioral and Developmental Health (TPC) seeking proposals from vendors experienced in providing and implementing electronic health record (EHR) systems. TPC is accepting proposals for an EHR system to be used across its service area, which includes Potter County and the cities of Amarillo. Vendors interested in responding must submit an email indicating their intent to bid by May 17, 2024 at 4:00 p.m. CST, with all proposals due no later than June 7, 2024 at 4:00 p.m. CST.
The RFP outlines detailed functional and technical requirements for the EHR system, including client demographics, scheduling, clinical documentation, treatment plans, billing, and reporting capabilities. Vendors must provide responses addressing each requirement and indicate how their system meets or exceeds the needs of TPC. Pricing information, implementation timelines, and maintenance/support offerings are also required as part of the proposal submission. TPC reserves the right to accept or reject any proposals received and will award the contract in the best interest of the organization.
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Vendor Response to User Requirements Tables
Please complete this section in its entirety and include responses as part of the response to this RFP.
For each requirement, respond using the following scale:
1 = System meets this requirement fully without additional programming required by Center and the functionality described by this requirement will be provided to Center at “go live” at no cost.
2 = System can meet this requirement, but with modifications at an increased cost.
3 = System cannot meet this requirement.
4 = Requirement is not applicable based on the design of the system.
There is a notes field for each requirement that allows for clarifications to responses.
Administrative
| Reference |
| Administrative |
| Rating |
| AD-010 |
| Ability to extract patient insurance and billing data to load into Center’s financial system. |
Notes:
| AD-020 |
| Same data never keyed twice in system. Single entry of data is shared wherever needed throughout system. |
Notes:
| AD-030 |
| Ability to purge records in accordance with retention policies. Please describe the types of retention policies supported. |
Notes:
| AD-040 |
| Ability to merge client records when duplicates are identified. |
Notes:
| AD-050 |
| Ability to archive client records for inactive clients with the ability to re-activate if the client presents for services. |
· Please describe how inactive clients are determined for the purpose of archiving.
· If a client hasn’t been served for an amount of time that would justify archiving the client, but the client is continuing to make payments against an outstanding balance, would the client’s data be archived?
· Please describe what specific data is re-activated if an archived client is re-activated.
Notes:
| AD-060 |
| Ability to exclude specific clients from being accessed by specific staff. The staff are completely blocked from seeing any information regarding excluded clients on screens, reports, and any other system interfaces. |
Notes:
| AD-080 |
| Ability to either limit access or provide full access to client records for auditors and other types of external staff. Please describe methods available for limiting access to client records. |
Notes:
| AD-090 |
| Ability for staff to view their caseload’s payers along with effective dates for each of the caseload’s clients in one view. |
Notes:
| AD-100 |
| View Tracking can be enabled on a module-by-module basis to track whenever a user views data in that module. The client whose data was viewed is recorded with the View Tracking information (i.e., date/time viewed, user who viewed the client’s data, client data module name, etc.). |
Notes:
| AD-110 |
| A history of all changes to data is retained with the ability to view, through a user-friendly system interface, “before and after images” of changes including the date, time, and user that made a change. |
Notes:
| AD-120 |
| A user-friendly system interface provides the specific data that was changed between two versions of a single record. |
Notes:
| AD-130 |
| Deleted data isn’t physically deleted from the system until it has expired based on retention policy. |
Notes:
AD-140
Modification Reason requirement can be enabled on a module-by-module basis requiring the user to document a reason for changing the data in a record.
Notes:
| AD-150 |
| Forms can be saved as Draft and completed at a later time. If a user is changing an existing record and saves the new version of the record as a draft, please describe if the prior version of the record is treated as “live” until the draft is saved. |
Notes:
| AD-160 |
| Staff receive alerts that they have draft forms to complete. |
Notes:
| AD-170 |
| User and technical documentation is available. Please describe documentation and any other resources that are available to users and technical staff to help them understand the system. |
Notes:
| AD-175 |
| User and technical documentation provides “Quick Reference Guides” to provide users with short and concise instructions for common functions. |
Notes:
| AD-178 |
| User and technical documentation provides Frequently Asked Questions (FAQs) with answers to commonly asked questions about the system. |
Notes:
| AD-180 |
| Operating system clipboard can be used to copy information to and from fields within the system. For example, a user may want to copy information from a Word, Excel, or Adobe file into a text field within the system. |
Notes:
| AD-190 |
| Center can designate any forms in system to require electronic signature by staff and/or clients. |
Notes:
| AD-200 |
| Forms requiring electronic signature can be entered by data entry staff and later signed by appropriate staff. Please describe if the unsigned forms are treated as drafts until they are signed. |
Notes:
| AD-210 |
| Staff receive alerts when forms have been entered that require and are lacking electronic signature. |
Notes:
| AD-220 |
| Ability to enforce that electronically signed forms are converted to drafts and must be re-signed in the event that they are changed. |
Notes:
| AD-230 |
| Signature image capture for all applicable forms requiring client and/or family signatures. |
Notes:
| AD-240 |
| Ability to present or print any documents that require client signature in English and Spanish. |
Notes:
| AD-250 |
| To assist the user in multi-tasking in the system, ability to view or modify multiple different client records at the same. Please describe how this is accomplished. |
Notes:
| AD-260 |
| To assist the user in multi-tasking in the system, ability to view or modify multiple types of information for the same client at the same time. Please describe how this is accomplished. |
Notes:
| AD-270 |
| System contains scanning functionality that allows scanned documents to be part of client record without the use of a third party application. |
Notes:
| AD-280 |
| Scanning functionality works with well-known hardware and doesn’t require specific manufacturers or models of scanners. |
Notes:
| AD-290 |
| Scanned documents have indexes that contain the type of document and key identifying information about the document. |
Notes:
| AD-300 |
| System provides intelligent routing of scanned documents to appropriate client medical records. |
Notes:
| AD-310 |
| System is able to perform bulk scanning of documents that can be routed to different medical records. |
Notes:
| AD-320 |
| Pictures can be scanned, identified with indexes, and attached to a client’s medical record. |
Notes:
| AD-330 |
| Live help desk support is available Monday through Friday from 8 – 5 CST. Please describe how this type of support would be accessed by the Center. |
Notes:
| AD-340 |
| Off hours support is available 24 hours per day, 7 days per week, 365 days per year for designated users. Please describe how this type of support would be accessed by the Center. |
Notes:
Form Requirements
| Reference |
| Form Requirements |
| Rating |
| FR-010 |
| Please indicate whether the following forms are pre-defined in the system. If the system contains an alternate form that closely resembles the following form, please include a copy of this form. See the Form Samples section for copies of the following forms. |
| N/A |
Notes:
| FR-010.010 |
| Consent for Treatment with Psychoactive Medications |
Notes:
| FR-010.020 |
| Spanish version of Consent for Treatment with Psychoactive Medications (see FR-010.010) |
Notes:
| FR-010.030 |
| Patient Consent for Telemedicine and Telehealth Services - Revised |
| N/A |
Notes:
| FR-010.040 |
| Spanish version of Patient Consent for Telemedicine and Telehealth Services (see FR-010.030) |
Notes:
| FR-010.050 |
| Client Infection Reporting Form |
Notes:
| FR-010.060 |
| Authorization for Treatment/Application for Services |
Notes:
| FR-010.070 |
| Financial Assessment - Revised |
| N/A |
Notes:
| FR-010.080 |
| Abnormal Involuntary Movement Scale |
Notes:
| FR-010.090 |
| Client Agreement - Revised |
| N/A |
Notes:
| FR-010.100 |
| Medical Information Survey |
Notes:
| FR-010.110 |
| Crisis Intake Assessment and Recovery Plan Progress Note Template - Revised |
| N/A |
Notes:
| FR-010.120 |
| Peer Support Progress Note |
Notes:
| FR-010.130 |
| Patient Health Questionnaire (PHQ-9) |
Notes:
| FR-010.140 |
| BMI Adult Screening and Follow-up Progress Note Template - Revised |
| N/A |
Notes:
| FR-010.150 |
| Child/Adolescent Weight Assessment and Counseling Progress Note Template - Revised |
| N/A |
Notes:
| FR-010.160 |
| Colombia Suicide Severity Rating Scale Screening with Triage Points |
Notes:
| FR-010.170 |
| Tobacco Use: Screening and Cessation - Revised |
| N/A |
Notes:
| FR-010.180 |
| Physician Progress Note |
Notes:
| FR-010.190 |
| Physician New Patient Diagnostic Interview Progress Note |
Notes:
| FR-010.200 |
| Physician Diagnostic Interview Progress Note |
Notes:
| FR-010.210 |
| Safety Plan |
Notes:
| FR-010.220 |
| Brief Bipolar Disorder Symptom Scale |
Notes:
| FR-010.230 |
| Brief Negative Symptom Assessment |
Notes:
| FR-010.240 |
| Quick Inventory of Depressive Symptomatology |
Notes:
| FR-010.250 |
| Initial Plan of Care – Child/Adolescent Services |
Notes:
| FR-010.260 |
| Wraparound Recovery Plan – Child/Adolescent Services - Revised |
| N/A |
Notes:
| FR-010.270 |
| Youth Recovery Plan - Revised |
| N/A |
Notes:
| FR-010.280 |
| Adult Recovery Plan - Revised |
| N/A |
Notes:
| FR-010.290 |
| Discharge Summary |
Notes:
| FR-010.300 |
| Nursing Tasks Screening Tool |
Notes:
| FR-010.310 |
| Comprehensive Nursing Assessment - Revised |
| N/A |
Notes:
| FR-010.320 |
| IDD Person-Directed Plan |
Notes:
| FR-010.330 |
| IDD Implementation Plan |
Notes:
| FR-010.340 |
| Initial Plan of Care (IPC) for HCS/CFC - Revised |
| N/A |
Notes:
| FR-010.350 |
| Initial Plan of Care (IPC) for TxHmL/CFC - Revised |
| N/A |
Notes:
Scheduler
| Reference |
| Scheduler |
| Rating |
| SC-010 |
| At the time of scheduling an appointment or appointments, ability to limit this scheduling based on the following factors: |
| N/A |
Notes:
| SC-010.020 |
| Only schedule covered services based on client’s payers |
Notes:
| SC-010.030 |
| For clients with payers that require authorizations for all services or specific services, ensure that there is a current authorization for the date and type of service. |
Notes:
| SC-020 |
| When scheduling appointments for clients, notify staff if there are the following types of forms due “as of” the scheduled appointment date: |
| N/A |
Notes:
| SC-020.010 |
| Demographic data updates |
Notes:
| SC-020.020 |
| Financial Assessment (including payer updates) |
Notes:
| SC-020.030 |
| Insurance authorizations |
Notes:
| SC-020.040 |
| Treatment Plans |
Notes:
| SC-020.050 |
| Assessments |
Notes:
| SC-020.060 |
| Release of Information |
Notes:
| SC-020.070 |
| Medication Consents |
Notes:
| SC-020.080 |
| Consent to Treat |
Notes:
| SC-020.090 |
| Proof of residency |
Notes:
| SC-020.100 |
| Guardianship Paperwork |
Notes:
| SC-020.110 |
| Please list any other types of “due forms” that can be verified when scheduling appointments. |
| N/A |
Notes:
| SC-020.120 |
| Ability to indicate in the scheduled appointment which of the above forms should be completed for the client. |
Notes:
| SC-030 |
| When scheduling appointments, provide error messages if the client’s time overlaps other scheduled appointments. Please describe recommended approach for allowing and preventing client appointment overlaps. |
Notes:
| SC-040 |
| When scheduling appointments, provide warning messages if staff time overlaps other scheduled appointments. Please describe recommended approach for allowing and preventing staff appointment overlaps. |
Notes:
| SC-050 |
| Schedules for staff that work in different locations are recognized by the Scheduler so that staff appointments are only scheduled in these locations during the times that staff are present in them. |
Notes:
| SC-060 |
| Ability to grant certain staff access to the scheduler and restrict other staff from accessing the scheduler. |
Notes:
| SC-070 |
| Ability to create appointment records for: |
| N/A |
Notes:
| SC-070.010 |
| One or many clients |
Notes:
| SC-070.020 |
| One or many staff |
Notes:
| SC-070.030 |
| A group of clients contained on a Group Roster. The appointment is scheduled for the Group and all of the individual clients on the Group Roster are scheduled. |
Notes:
| SC-070.040 |
| One or many types of services |
Notes:
| SC-070.050 |
| One or many Center-defined resources such as equipment, conference rooms, etc. |
Notes:
| SC-080 |
| If a Group Roster is scheduled, individual clients assigned to the Group Roster are tested for appointment overlaps. |
Notes:
| SC-090 |
| Ability to schedule multiple staff/resources in one entry across locations when the client will be receiving multiple types of services consecutively. |
Notes:
| SC-100 |
| Recurring Appointment functionality allows for multiple appointment records to be created through a single entry based on the type of recurrence entered by the user. |
Notes:
| SC-110 |
| Ability to perform “first available” appointment scheduling. |
Notes:
| SC-120 |
| “First available” appointment scheduling based on the following criteria: |
| N/A |
Notes:
| SC-120.010 |
| Target Date Range |
Notes:
| SC-120.020 |
| Time of Day |
Notes:
| SC-120.030 |
| Specific staff |
Notes:
| SC-120.040 |
| Provider Type such as LPC, LPHA, QMRP, etc. |
Notes:
| SC-120.050 |
| Location of Clinic |
Notes:
| SC-120.060 |
| Based on the planned service entered on the appointment screen, staff qualified to provide this service |
Notes:
| SC-120.070 |
| Staff with credentials required by the client’s payers |
Notes:
| SC-130 |
| Bulk appointment transfer capability to transfer multiple appointments from one staff to another. |
Notes:
| SC-140 |
| Ability for staff with appropriate security privileges to perform centralized scheduling across locations and programs. |
Notes:
| SC-150 |
| Scheduler security ensures that users can only see and/or modify appointments for other users to whom they’ve been provided access. |
Notes:
| SC-160 |
| Ability to generate appointment reminders for clients based on scheduled appointments. |
Notes:
| SC-170 |
| Ability to send text messages as appointment reminders based on the client’s permission to use text messages. Please include any costs associated with sending text messages to clients in the Pricing section of RFP response. |
Notes:
| SC-180 |
| Ability to accept a response to a text message to indicate client’s plan to attend an appointment. |
Notes:
| SC-190 |
| Ability to send automatic phone messages as appointment reminders based on the client’s permission to use phone messages. |
Notes:
| SC-200 |
| Ability to accept a response to a phone message to indicate client’s plan to attend an appointment. |
Notes:
| SC-210 |
| Ability to send email messages as appointment reminders based on the client’s permission to use email messages. |
Notes:
| SC-220 |
| Ability to accept a response to an email to indicate client’s plan to attend an appointment. |
Notes:
| SC-230 |
| Ability to record external provider appointments in scheduler with the ability to document the activity or results of that appointment in a field or fields in the appointment record. |
Notes:
Clinical
| Reference |
| Clinical |
| Rating |
| CL-010 |
| Ability to create a client record with limited demographic information with the ability to correct and add additional information later. Please list minimum fields necessary to build a client record. |
Notes:
| CL-020 |
| In client demographics, ability to record different gender types other than male and female. Please list additional gender types supported. |
Notes:
| CL-025 |
| Ability to track a complete history of a client’s county of residence changes along with the date of the change. |
Notes:
| CL-030 |
| Name aliases are collected in case the same client provides different names for him/herself. |
Notes:
| CL-040 |
| Name searches in the system search alias records in addition to names recorded on the Client Demographic screen to help prevent duplicate client records. |
Notes:
| CL-050 |
| Fuzzy name searches are used to identify potential duplicate clients that may be spelled differently than what the user enters. |
Notes:
| CL-060 |
| Allow for the following additional search fields when searching for potential duplicate client records: |
| N/A |
Notes:
| CL-060.010 |
| Social Security Number |
Notes:
| CL-060.020 |
| Birth Date |
Notes:
| CL-060.030 |
| Ethnicity |
Notes:
| CL-060.040 |
| Gender |
Notes:
| CL-070 |
| An interface exists in the system to allow patients to check themselves in for a service and verify that their demographics are current. |
Notes:
| CL-080 |
| A roster of one or many staff that are assigned to a client’s Care Team is maintained by the system. |
Notes:
| CL-090 |
| A complete history of staff assignments to a client’s Care Team, including the begin and end date of the assignment, is maintained by the system. |
Notes:
| CL-100 |
| A staff person’s assignment to a client’s Care Team enables this staff person to receive alerts regarding the client. |
Notes:
| CL-110 |
| A staff person’s assignment to a client’s Care Team triggers the client to show on the staff person’s caseload reports. |
Notes:
| CL-120 |
| One person on the Care Team can be identified as the Primary Care Team Member. Validations in the system only allow one person at any given time to serve in this role. |
Notes:
| CL-130 |
| Messaging capability between staff includes the ability to send messages to a client’s Care Team. Please describe the method for doing “Care Team” messaging. |
Notes:
| CL-140 |
| A view of a staff person’s caseload lists all clients for whom the staff person is assigned as a Care Team Member. |
Notes:
| CL-150 |
| Bulk transfers of clients to another staff person’s caseload can be performed in a single operation. |
Notes:
| CL-160 |
| Bulk ends of clients on a staff person’s caseload can be accomplished in a single operation. |
Notes:
| CL-170 |
| Bulk copies of a staff person’s caseload to another staff person can be accomplished in a single operation. |
Notes:
| CL-180 |
| Tracks individuals or organizations that are granted access to the client’s Protected Health Information. |
Notes:
| CL-190 |
| Each release of Protected Health Information to an authorized individual or organization is tracked along with the type of Protected Health Information that was released. |
Notes:
| CL-200 |
| Lab orders can be electronically sent to labs. |
Notes:
| CL-210 |
| Lab results can be electronically imported into system. In the Pricing section of the RFP response, please describe costs associated with sending electronic lab orders, acquiring electronic lab order results, and lab interface creation costs. |
Notes:
| CL-220 |
| Lab alerts are generated based on no timely results of lab request. Please describe who would be recipient of these alerts. |
Notes:
| CL-230 |
| Lab alerts are generated based on results that are outside of normal limits. Please describe who would be recipient of these alerts. |
Notes:
| CL-250 |
| Integrated ePrescribing that doesn’t require a separate login. |
Notes:
| CL-260 |
| ePrescribing functionality doesn’t require duplicate entry of information. |
Notes:
| CL-270 |
| Based on system security, ability for non-prescriber medical support staff to enter and save medications into ePrescribing system for subsequent prescriber signature and electronic transmission to pharmacy. |
Notes:
| CL-280 |
| Ability for ePrescribing system to store more than one pharmacy for each client. |
Notes:
| CL-290 |
| Ability for ePrescribing system to designate one pharmacy as the “preferred” pharmacy for the client. |
Notes:
| CL-300 |
| Lab and prescription documents received electronically through e-fax or an electronic interface without an identifiable matching client record are queued for follow-up in a dashboard area or some other type of system interface. |
Notes:
| CL-310 |
| Ability to access a payer-specific medication formulary based on the client’s payer. |
Notes:
| CL-320 |
| Ability to print a list of a client’s prescribed medications for a specified time frame. |
Notes:
| CL-330 |
| Ability to maintain a Center inventory of medications. |
Notes:
| CL-340 |
| Ability to prescribe medication from the Center’s inventory. |
Notes:
| CL-350 |
| Ability to track client forms by due date with automatic alerts sent to appropriate staff. Automatic alerts provide Center-defined lead times on a form-by-form basis for staff to complete forms on or before the due date. Please describe who would be recipient of these alerts. Assuming that these alerts exist, please list client data forms that are tracked by date that wouldn’t have this capability. |
Notes:
| CL-360 |
| Ability to automatically identify specific types of forms required for different client populations. Please describe method of defining types of forms for these different client populations. |
Notes:
| CL-370 |
| Ability for Center to define a hierarchical structure of Programs (organizational/reporting units). |
Notes:
| CL-380 |
| Ability to assign clients to multiple concurrent Programs based on services that the clients are receiving. |
Notes:
| CL-390 |
| Ability to indicate which of a client’s Program Assignments is the primary one. |
Notes:
| CL-400 |
| System tracks complete history of client assignments to Center-defined Programs. Begin and end dates track clients’ membership in these Programs. |
Notes:
| CL-410 |
| Ability to identify, at a glance, the programs where clients are being served. Please describe the method for doing this. |
Notes:
| CL-420 |
| Center-defined follow-up timeframes trigger messages to staff regarding multiple follow-ups for different Center-defined reasons regarding clients’ assignment to the Program. Center-defined follow-up messages need to be generated for reasons other than the client being opened and closed in a program. |
Notes:
| CL-430 |
| Ability to identify individuals that have not received a specific service in a specified time period. |
Notes:
| CL-440 |
| Ability to map diagnosis codes to other diagnosis codes required by payers or funding sources for claims and/or reporting requirements. |
Notes:
| CL-450 |
| Maintain a complete history of diagnosis reviews performed by staff. These diagnosis reviews are saved by diagnosis date and diagnosis time. |
Notes:
| CL-460 |
| Ability to save diagnoses performed by external staff. |
Notes:
| CL-470 |
| Allows diagnoses to be recorded using DSM-IV, ICD-9, DSM-5, and ICD-10 code sets. |
Notes:
| CL-480 |
| Supports SNOMED code sets. |
Notes:
| CL-490 |
| On a no-axis DSM-5 diagnosis, a “primary diagnosis” must be reported to the Texas Health and Human Service’s CARE system’s Diagnosis transaction. System has a method to determine this primary diagnosis even if it’s not recorded as the first occurrence on the no-axis DSM-5 diagnosis record. |
Notes:
| CL-500 |
| Vendor provides annual ICD-10 and DSM-5 updates that can be automatically uploaded into system. |
| N/A |
Notes:
| CL-510 |
| Collects details for State Facility Admissions, Absences, Discharges, and State-required follow-ups. |
Notes:
| CL-520 |
| Collects data necessary to batch the “Follow-up Contact” transaction to the Texas Health and Human Service Commission’s CARE system. |
Notes:
| CL-530 |
| Ability to record Medication Administration Records. |
Notes:
| CL-540 |
| Ability to import medication orders into Medication Administration Records. |
Notes:
| CL-545 |
| Ability to record Injection Administration Records. |
Notes:
| CL-560 |
| Ability to track arrival date and time of client in order to meet required assessment and service delivery timeframes for programs such as the Crisis Center. |
Notes:
| CL-570 |
| Ability to record a client’s warrant status with the appropriate authority (ex. Police). |
Notes:
| CL-580 |
| System tracks complete history of client assignments to Center-defined residential locations for bed-day counts. Begin and end dates track clients’ membership in these residential locations. |
Notes:
| CL-590 |
| Center-defined follow-up timeframes trigger messages to staff regarding follow-ups required after the client’s discharge from the residential location. |
Notes:
| CL-600 |
| For residential clients, documents client bed days and provides a means to suppress billing when these clients have temporary absences from these residential assignments to avoid inappropriate billing for the duration of the absence. |
Notes:
| CL-610 |
| Ability to support the following residential bed day requirements: |
| N/A |
Notes:
| CL-610.010 |
| Bed board functionality showing clients in beds and status of all beds |
Notes:
| CL-610.020 |
| Bed board functionality showing documentation of routine checks |
Notes:
| CL-610.030 |
| Bed board functionality showing medication orders |
Notes:
| CL-610.040 |
| Bed board functionality showing medication administration |
Notes:
| CL-610.045 |
| Bed board functionality showing injection administration |
Notes:
| CL-610.050 |
| Specific data field(s) identified for recording an inventory of client’s possessions upon arrival. |
Notes:
| CL-620 |
| Ability to create and manage stored phrases that can be used in various system interfaces. These stored phrases can be managed at the Center level and individual staff level. |
Notes:
| CL-630 |
| Ability to save and electronically sign the following types of consents: |
| N/A |
Notes:
| CL-630.010 |
| Release of Information |
Notes:
| CL-630.020 |
| Medication Consent |
Notes:
| CL-630.030 |
| Consent to Treatment |
Notes:
| CL-630.040 |
| CFR42 Part 2 Substance Abuse Disclosure |
Notes:
| CL-640 |
| Ability to record Medical Power of Attorney and Guardianship and include on Client Data Overview and Client Demographic interfaces. |
Notes:
| CL-650 |
| System support for the following care coordination activities: |
| N/A |
Notes:
| CL-650.010 |
| Ability to record referrals to and from internal Programs and external entities with time-based follow-ups that automatically generate alerts for staff. Please describe who would be recipient of these alerts. |
Notes:
| CL-650.020 |
| Ability to record tasks for internal Programs and external entities with time-based follow-ups that automatically generate alerts for staff. Please describe who would be recipient of these alerts. |
Notes:
| CL-650.030 |
| Ability for the Center to define automatic referrals based on events recorded in the system. For example: If a client is identified as having a substance use issue, then a referral could be automatically generated to an internal substance use department. |
Notes:
| CL-650.040 |
| Collects the date and time that a Referral is closed to indicate its completion. |
Notes:
| CL-670 |
| CANS 3-5, CANS 6-17, and ANSA assessments built in system with the business rules, level of care calculation, and validations defined by the Texas Health and Human Services Commission. |
Notes:
| CL-680 |
| Provide alerts when the next section of a CANS 3-5, CANS 6-17, or ANSA is due based on the completion of a prior section. |
Notes:
| CL-690 |
| Messaging capabilities that are linked to specific CANS 3-5, CANS 6-17, and ANSA assessments allow for messaging between the provider(s) and the authorizer. |
Notes:
| CL-700 |
| For clients receiving Texas Resilience and Recovery (TRR) services, validations in the system ensure that a TRR Discharge Assessment is recorded before these clients are discharged from the Center. |
Notes:
| CL-710 |
| For questions on assessments, the system’s interface provides descriptions of the criteria that are defined for the answers to these questions. |
Notes:
| CL-720 |
| System tracks complete history of client assignments to Center-defined Special Populations. Begin and end dates track clients’ membership in these Special Populations. |
Notes:
| CL-730 |
| System tracks complete history of client assignments to a Waiting List for Center-defined Programs. Begin and end dates track clients’ membership on these Waiting Lists. |
Notes:
| CL-740 |
| In the Waiting List, ability to record a ranking of the clients’ need for the Program which allows for slots in the Program to be filled based on this need. |
Notes:
| CL-750 |
| Follow-up messages can be sent to staff based on a Follow-up date recorded on the Waiting List record. |
Notes:
| CL-760 |
| System has validations to ensure that all episodic information is ended prior to discharge from the Center. Examples of episodic information are Treatment Plans, Program Assignments, Waiting Lists, etc. |
Notes:
| CL-770 |
| Collects and tracks history of clients’ Vital Signs information. |
Notes:
| CL-780 |
| Vital Signs collected include the following: |
| N/A |
Notes:
| CL-780.010 |
| First Sitting or Standing blood pressure |
Notes:
| CL-780.020 |
| Second Sitting or Standing blood pressure |
Notes:
| CL-780.030 |
| Official Blood Pressure Reading (user indicates whether to use the First or Second Sitting or Standing blood pressure reading as the “official” one). |
Notes:
| CL-780.040 |
| Height |
Notes:
| CL-780.050 |
| Weight |
Notes:
| CL-780.060 |
| Temperature |
Notes:
| CL-780.070 |
| Pulse Rate |
Notes:
| CL-780.080 |
| Respiration |
Notes:
| CL-780.090 |
| Glucose Level |
Notes:
| CL-780.100 |
| Adult BMI |
Notes:
| CL-780.110 |
| Computes Adult BMI Indicator which describes whether BMI is abnormal. |
Notes:
| CL-780.120 |
| Child BMI |
Notes:
| CL-780.130 |
| Computes Child BMI Indicator which describes whether BMI is abnormal. |
Notes:
| CL-790 |
| Single interface exists in system that indicates a client’s status in the service delivery process (ex. Intake process, crisis stabilization, ongoing service delivery, etc.). Please provide a brief description of this interface. |
Notes:
| CL-800 |
| Incident reporting module exists that allows staff to report incidents such as illness, behaviors, accidents, and medication errors. |
Notes:
| CL-810 |
| When viewing a client’s information in the system, there is a “forms due” interface that notifies the user that the following types of forms are due: |
| N/A |
Notes:
| CL-810.010 |
| Demographic data updates |
Notes:
| CL-810.020 |
| Financial Assessment (including payer updates) |
Notes:
| CL-810.030 |
| Insurance authorizations |
Notes:
| CL-810.040 |
| Treatment Plans |
Notes:
| CL-810.050 |
| Assessments |
Notes:
| CL-810.060 |
| Release of Information |
Notes:
| CL-810.070 |
| Medication Consents |
Notes:
| CL-810.080 |
| Consent to Treat |
Notes:
| CL-810.090 |
| Proof of residency |
Notes:
| CL-810.100 |
| Guardianship Paperwork |
Notes:
| CL-810.110 |
| Please list any other types of “due forms” that this interface lists. |
| N/A |
Notes:
| CL-820 |
| Forms Tracker – For forms that the Center doesn’t want to record specific data in the system, ability to create Center-defined Form Types with accompanying frequencies. Collects when the Form is completed and generates alerts when a Form becomes due. For each Form Type, lead times can be recorded to provide a Center-defined amount of time for staff to complete the Form. |
Notes:
| CL-830 |
| Ability to track and report on Patient Assistance Program efforts in acquiring free or low cost medications from pharmaceutical companies. |
| N/A |
Notes:
Treatment Plan
| Reference |
| Treatment Plan |
| Rating |
| TP-010 |
| Ability for Center to build custom treatment plan formats utilizing differing terminologies, differing fields, differing review periods, and differing numbers of hierarchical levels for different program areas within the Center. |
Notes:
| TP-020 |
| Ability to enter free-form text into treatment plans to allow for client developed (in their own words) content. |
Notes:
| TP-030 |
| Behavioral Health Person Centered Recovery Plan pre-defined and provided with system. |
Notes:
| TP-040 |
| Ability to record an IDD Person-Directed Plan (PDP) (see Form Samples section) and track that it is created/updated annually. Automatic alerts provide Center-defined lead times to complete this IDD Person-Directed Plan on or before the due date. |
Notes:
| TP-050 |
| Ability to track, through progress notes, progress toward the Outcomes defined in the PDP for each individual client. Please describe how the Outcomes tracked through progress notes would be linked to the PDP. |
Notes:
| TP-060 |
| IDD Person-Directed Plan prints in a format that mimics the layout of the form included in the Form Samples section. |
Notes:
| TP-070 |
| Ability to record an IDD HCS/CFC Individual Plan of Care (see Form Samples section) which would contain units and dollars assigned by service. Track, through dashboards and reports, utilization of both the units and dollars for each service by individual client. This is a subset population of clients, only waiver clients would need this function. |
Notes:
| TP-080 |
| Ability to track that the IDD HCS/CFC Individual Plan of Care is created/updated annually. Automatic alerts provide Center-defined lead times to complete this IDD HCS/CFC Individual Plan of Care on or before the due date. |
Notes:
| TP-084 |
| Ability to record an IDD TxHmL/CFC Individual Plan of Care (see Form Samples section) which would contain units and dollars assigned by service. Track, through dashboards and reports, utilization of both the units and dollars for each service by individual client. This is a subset population of clients, only waiver clients would need this function. |
Notes:
| TP-087 |
| Ability to track that the IDD TxHmL/CFC Individual Plan of Care is created/updated annually. Automatic alerts provide Center-defined lead times to complete this IDD TxHmL/CFC Individual Plan of Care on or before the due date. |
Notes:
| TP-090 |
| Ability to record an IDD Implementation Plan (see Form Samples section) which would show strategies by the provider agency to meet outcomes associated with the PDP for each individual client. It would also contain units and dollars assigned by service. This would be applicable for HCS, TxHmL, PASSR, and GR (General Revenue) clients. |
Notes:
| TP-100 |
| Ability to track that the IDD Implementation Plan is created/updated annually based on the date of the IDD HCS/TxHmL Individual Plan of Care or the date of the IDD TxHmL/CFC Individual Plan of Care. Automatic alerts provide Center-defined lead times to complete this IDD Implementation Plan on or before the due date. |
Notes:
| TP-120 |
| Ability to record an IDD Comprehensive Nursing Assessment (see Form Samples section) and track that it is created annually based on the date of the IDD HCS/CFC Individual Plan of Care or the date of the IDD TxHmL/CFC Individual Plan of Care. Automatic alerts provide Center-defined lead times to complete this IDD Comprehensive Nursing Assessment on or before the due date. |
Notes:
| TP-160 |
| Complete history of Treatment Plan reviews is tracked by system. These reviews track the date of the review, client participants, and staff participants. |
Notes:
| TP-170 |
| Licensed Professional of Healing Arts (LPHA) signature is tracked when required on Treatment Plan reviews. |
Notes:
| TP-180 |
| Physician signature is tracked when required on Treatment Plan reviews. |
Notes:
| TP-190 |
| Center-defined staff types can be created that are required to sign Treatment Plans. |
Notes:
| TP-200 |
| Client and/or family signatures are tracked on Treatment Plan reviews. |
Notes:
| TP-210 |
| System provides tools so that services to be delivered under a Texas Resilience and Recovery (TRR) level of care can be imported into the Behavioral Health Person Centered Recovery Plan. Please describe these tools. |
Notes:
| TP-220 |
| System provides tools so that issues identified in assessments can be imported into Treatment Plans. Please describe these tools. |
Notes:
| TP-230 |
| Linkages exist between assessments and Treatment Plans to identify the specific assessment from which issues were imported into the Treatment Plan. |
Notes:
Service Data Collection
| Reference |
| Service Data Collection |
| Rating |
| SV-010 |
| Ability for Center to define progress note templates that display based on the service being delivered. These progress note templates collect details specific to the type of service being delivered that are in addition to the “billing strip” details (date, start time, stop time, service, service modality, staff providing service, etc.). |
Notes:
| SV-020 |
| Ability for Center-defined progress note templates to have validations such as required/optional, picklists, presence of specific terms or phrases, and allowable ranges. |
Notes:
| SV-030 |
| Ability to designate fields on Center-defined progress note templates that will default data from the same field on the most recent entered template that is the same type for the same client. |
Notes:
| SV-040 |
| Ability for Center-defined progress note templates to have a validation that text fields have a minimum number of words. |
Notes:
| SV-050 |
| Ability for Center-defined progress note templates to print as part of printing the service record. |
Notes:
| SV-060 |
| Ability to automatically push diagnosis fields from E&M progress notes to the Diagnosis Form. |
Notes:
| SV-070 |
| Ability to automatically push medications from E&M progress notes to the ePrescribing module. |
Notes:
| SV-080 |
| Service collection module for individual services based on a start and stop time between a client and a staff person. |
Notes:
| SV-090 |
| Service collection module for ancillary services that are non-time-based such as rent, injection administration, medications, etc. |
Notes:
| SV-100 |
| Service collection module for group services for more than one client being provided time-based services by one or more staff. Staff time and client time are recorded separately to ensure that no duplication occurs. |
Notes:
| SV-110 |
| For individual or group services that require a supervisory or ordering provider, this provider can be collected on the service screen. |
Notes:
| SV-120 |
| For individual or group services that require a referring provider, this provider can be collected on the service screen. |
Notes:
| SV-130 |
| Services can be linked to specific treatment plan interventions that are being addressed in the service. These links are stored along with the service. |
Notes:
| SV-140 |
| The diagnosis that is being primarily addressed by the service is collected on the service screen. |
Notes:
| SV-150 |
| Services that have had claims generated for them can’t have fields that were used to generate the claim modified. |
Notes:
| SV-160 |
| Based on a user’s security, progress notes can be changed for services that have had claims generated for them. |
Notes:
| SV-170 |
| Services that have had claims generated for them can’t be deleted. |
Notes:
| SV-175 |
| Services can be entered in any program for a client without this client having to be assigned to any programs. |
Notes:
| SV-180 |
| Services can be mapped to HHSC Service Encounter Services based on the following fields: |
| N/A |
Notes:
| SV-180.010 |
| Client Type (child or adult) |
Notes:
| SV-180.020 |
| Program where service is delivered |
Notes:
| SV-180.030 |
| Staff credential of staff providing service |
Notes:
| SV-180.040 |
| Setting where service is provided (ex. office, home, other, external health facility, etc.) |
Notes:
| SV-180.050 |
| Recipient of service (ex. Client, client and collateral, collateral only, etc.) |
Notes:
| SV-180.060 |
| Appointment Code for service (ex. Scheduled, non-scheduled, client cancel, staff cancel, etc.) |
Notes:
| SV-180.070 |
| Mode of service (ex. Face-to-face, phone, telehealth, etc.) |
Notes:
| SV-180.080 |
| Crisis indicator of service |
Notes:
| SV-185 |
| There is a “user-friendly interface” built into the system that allows non-technical users to enter the mapping of the Center’s services to the HHSC Service Encounter Services based on fields identified in SV-180.010 through SV-180.080. |
Notes:
| SV-190 |
| Telehealth is an option for mode of service delivery without having to create separate service codes to indicate this mode of service for billing or other purposes. |
Notes:
| SV-200 |
| Ability to correctly suggest the proper evaluation and management (E & M) service codes for services based on entry of E&M required information. |
Notes:
| SV-210 |
| Services that are provided in settings away from the Center’s offices/clinics have location information recorded that maps to Texas Health and Human Services Commission defined location codes. |
Notes:
| SV-220 |
| The following fields are collected in service modules: |
| N/A |
Notes:
| SV-220.010 |
| Setting (ex. Office, home, other, external health facility, etc.) |
Notes:
| SV-220.020 |
| Recipient (ex. Client, client and collateral, collateral only, etc.) |
Notes:
| SV-220.030 |
| Appointment (ex. Scheduled, Non-scheduled, Client Cancel, Staff Cancel, etc.) |
Notes:
| SV-220.040 |
| Mode (ex. Face-to-face, Phone, Telehealth, etc.) |
Notes:
| SV-220.050 |
| Crisis Indicator |
Notes:
| SV-220.060 |
| COPSD indicator |
Notes:
| SV-230 |
| Ability to control the entry of service codes that can be entered in service screens based on any combination of the following criteria: |
| N/A |
Notes:
| SV-230-010 |
| Program |
Notes:
| SV-230-020 |
| Staff Credential |
Notes:
| SV-230-030 |
| Setting (ex. Office, home, other, external health facility, etc.) |
Notes:
| SV-230-040 |
| Recipient (ex. Client, client and collateral, collateral only, etc.) |
Notes:
| SV-230-050 |
| Appointment Code (ex. Scheduled, Non-scheduled, Client Cancel, Staff Cancel, etc.) |
Notes:
| SV-230-060 |
| Mode (ex. Face-to-face, Phone, Telehealth, etc.) |
Notes:
| SV-230-070 |
| Crisis Indicator |
Notes:
| SV-240 |
| Validations can be activated to warn the user of the following when a service is entered: |
| N/A |
Notes:
| SV-240.010 |
| Service needs a payer authorization and an authorization doesn’t exist |
Notes:
| SV-240.020 |
| Service must show on an active Treatment Plan |
Notes:
| SV-240.030 |
| None of the client’s payers will pay for the service |
Notes:
| SV-240.040 |
| Client’s age is not within certain limits defined for the specific service |
Notes:
| SV-240.050 |
| Service duration must be longer than a Center-defined minimum |
Notes:
| SV-240.060 |
| Service duration cannot exceed 12 hours |
Notes:
| SV-240.070 |
| For client time, certain services can be defined that can overlap with a defined set of other services. A warning message is provided if an overlap occurs. |
Notes:
| SV-240.080 |
| For client time, certain services can be defined that can’t overlap with any other service. A warning message is provided if an overlap occurs. |
Notes:
| SV-240.090 |
| For client time, certain services can be defined that can overlap with any other service. |
Notes:
| SV-240.100 |
| For staff time, a service can’t overlap with any other service. A warning message is provided if an overlap occurs. |
Notes:
Billing
| Reference |
| Billing |
| Rating |
| BL-010 |
| Ability to collect payments and copays from the client at the point of service and provide a receipt to the client. |
Notes:
| BL-020 |
| Ability to print a client statement that show a client's billed services, payments, and adjustments applied towards those services and any unapplied payments. The statement includes Payer related transactions as well as Client related transactions. |
| N/A |
Notes:
| BL-030 |
| Ability to customize the appearance of client statements. |
Notes:
| BL-040 |
| Ability to print a standard HCFA claim form that includes a provider's Medicaid TPI as well as the provider's NPI. |
Notes:
| BL-050 |
| Ability to define “Usual and Customary” charges that serve as the Centers “standard charges” for its services. |
Notes:
| BL-060 |
| Ability to vary charges for services based on any combination of the following criteria: |
| N/A |
Notes:
| BL-060.010 |
| Payer |
Notes:
| BL-060.020 |
| Service Code |
Notes:
| BL-060.030 |
| Program |
Notes:
| BL-060.040 |
| Staff Credential |
Notes:
| BL-060.050 |
| Setting (ex. Office, home, other, external health facility, etc.) |
Notes:
| BL-060.060 |
| Recipient (ex. Client, client and collateral, collateral only, etc.) |
Notes:
| BL-060.070 |
| Appointment Code (ex. Scheduled, Non-scheduled, Client Cancel, Staff Cancel, etc.) |
Notes:
| BL-060.080 |
| Mode (ex. Face-to-face, Phone, Telehealth, etc.) |
Notes:
| BL-060.090 |
| Crisis Indicator |
Notes:
| BL-070 |
| Ability to vary procedure, modifier, and place of service codes for services based on any combination of the following criteria: |
| N/A |
Notes:
| BL-070.010 |
| Payer |
Notes:
| BL-070.020 |
| Service Code |
Notes:
| BL-070.030 |
| Program |
Notes:
| BL-070.040 |
| Staff Credential |
Notes:
| BL-070.050 |
| Setting (ex. Office, home, other, external health facility, etc.) |
Notes:
| BL-070.060 |
| Recipient (ex. Client, client and collateral, collateral only, etc.) |
Notes:
| BL-070.070 |
| Appointment Code (ex. Scheduled, Non-scheduled, Client Cancel, Staff Cancel, etc.) |
Notes:
| BL-070.080 |
| Mode (ex. Face-to-face, Phone, Telehealth, etc.) |
Notes:
| BL-070.090 |
| Crisis Indicator |
Notes:
| BL-080 |
| Ability to vary payer-specific procedure codes, modifiers, and place of service codes based on the calculated number of units for the service to be billed. |
Notes:
| BL-090 |
| When performing third party payer billing, confirm that a client has a Financial Assessment that is dated on or before a service date. Exceptions to this are reported to billing staff. |
Notes:
| BL-100 |
| Prior to billing a payer for a service, confirm that the client has an Assignment of Benefits on file that is dated on or before the service date. Exceptions to this are reported to billing staff. |
Notes:
| BL-110 |
| If there are no active payers for a client for a given service date, this exception is reported to billing staff. |
Notes:
| BL-130 |
| For specific psychotherapy claims, provide the appropriate 30 minute, 45 minute or 60 minute procedure code based on the duration of the service without having to enter different service codes for the different durations. When entering the service, staff would simply select the psychotherapy service and then based on the duration, the appropriate procedure code would be sent on the claim. |
Notes:
| BL-140 |
| If a payer is active for a given service date, but the service code/program/staff credential/setting/recipient/appointment code/mode/crisis indicator isn’t defined for the payer for the given service, this exception is reported to billing staff. |
Notes:
| BL-150 |
| Ability to bill for a no-show where the date, planned service description, and an indicator of a no-show fee are reflected in the charge. |
Notes:
| BL-160 |
| Ability to bill a fixed amount based on an event or procedure. |
Notes:
| BL-170 |
| Ability to bill based on per diems. |
Notes:
| BL-180 |
| Ability to bill based on a monthly case rate (i.e., value based payment). |
Notes:
| BL-190 |
| Ability to bill based on a computed number of units that are computed based on the duration of a service. |
Notes:
| BL-200 |
| For computing units to be billed to a specific payer for a specific service, support the following rounding methods: |
| N/A |
Notes:
| BL-200.010 |
| Round Up - A minute over the defined minutes per unit round up to the next unit |
Notes:
| BL-200.020 |
| Round Down - Units round down to the nearest unit |
Notes:
| BL-200.030 |
| No rounding - no rounding, fractions of a unit are recorded |
Notes:
| BL-200.040 |
| Half Up - Round up to the nearest unit when at least half-way between units; otherwise round down |
Notes:
| BL-200.050 |
| Half Down - Round down to the nearest unit up through the half-way point between units; otherwise round up |
Notes:
| BL-210 |
| Collect and post information to client’s financial assessment screen(s) from the magnetic strip of insurance and benefit cards. |
Notes:
| BL-220 |
| For families in which multiple family members are being served, these multiple family members are linked together so that Financial Assessment information is recorded for the family rather than each separate family member. |
Notes:
| BL-230 |
| A billing alias with different demographic information can be recorded for a client to match a payer’s demographic information when required by the payer. |
Notes:
| BL-240 |
| Payer assigned to clients can be flagged as a Contractor, Local Funds Payer, and OBRA so that these fields can be used to determine the First Billed Payer in the HHSC Service Encounter Extract. |
Notes:
| BL-250 |
| Referring provider details can be recorded for clients so that these details can be reported to payers in claims. |
Notes:
| BL-260 |
| For payers that are linked to clients, system provides automated assistance in ordering payers in the order in which they should be billed (ex. Medicare should be billed before Medicaid). |
Notes:
| BL-270 |
| Ability to do an overall “hold” for billings for a specific staff person for reasons other than credential verification (credentialing verification requirement listed in next requirement). Removing the “hold” from the staff person enables any services that were held during the duration of the staff person’s “billing hold” to be subsequently billed. |
Notes:
| BL-280 |
| Collect clinician credentials and privilege dates and don’t bill for services that require a credential that isn’t active. Billing exceptions caused by inactive credentials are reported to billing staff. |
Notes:
| BL-280.010 |
| Collect the unique combination of credentials that different staff may have at any point in time. |
Notes:
| BL-290 |
| Collect payer specific identifiers (e.g., benefit codes) for clinicians that are included in claims based on payer requirements. |
Notes:
| BL-300 |
| Allow for authorizations that control whether services can be billed based on the following methods: |
| N/A |
Notes:
| BL-300.010 |
| Specific Center service codes |
Notes:
| BL-300.020 |
| Service classes composed of multiple Center service codes |
Notes:
| BL-300.030 |
| Center service codes and durations based on Texas Resilience and Recovery (TRR) levels of care that are automatically sent to the authorization module |
Notes:
| BL-300.040 |
| Center service codes and durations defined on Treatment Plans that are automatically sent to the authorization module |
Notes:
| BL-300.050 |
| Payer procedure codes |
Notes:
| BL-310 |
| Allow for authorizations to be defined based on the following methods: |
| N/A |
Notes:
| BL-310.010 |
| Number of procedures |
Notes:
| BL-310.020 |
| Number of per diems |
Notes:
| BL-310.030 |
| Number of units |
Notes:
| BL-310.040 |
| Monthly case rate |
Notes:
| BL-310.050 |
| Date range |
Notes:
| BL-310.060 |
| Dollar amounts |
Notes:
| BL-320 |
| Ability to define payer classes that contain more than one payer to simplify authorizations for groups of planned services that will be billed to these multiple payers. For example, a group of planned services that result from a Texas Resilience and Recovery (TRR) Level of Care may be billed to different payers that can be grouped into a payer class. |
Notes:
| BL-330 |
| Authorization requests to the payer and grants from the payer are tracked separately to preserve the specific set of services requested by the Center and those that are actually granted by the payer. |
Notes:
| BL-335 |
| Ability to print an authorization request that is made to a payer for a set of services for a specific client. |
Notes:
| BL-340 |
| An “on demand” overview is available to the user which shows remaining services for a given authorization. |
Notes:
| BL-350 |
| Single online interface in the system that provides a client’s financial overview that includes payers, copays paid, insurance payments for specific charges, client payments, pending insurance charges, pending client payments, and overall balance. |
Notes:
| BL-360 |
| Ability to bill for staff time divided proportionally between recipients of the service. HCS Transportation is an example of this type of billing. |
Notes:
| BL-370 |
| Ability to activate payer-specific billing validations based on the following criteria: |
| N/A |
Notes:
| BL-370.010 |
| Allowable service codes that can be billed. Exceptions are reported to billing staff. |
Notes:
| BL-370.020 |
| Allowable Programs where billed service can be provided. Exceptions are reported to billing staff. |
Notes:
| BL-370.030 |
| Allowable Staff Credentials for specific services. Exceptions are reported to billing staff. |
Notes:
| BL-370.040 |
| Allowable Settings (ex. Office, home, other, external health facility, etc.) where billed service can be provided. Exceptions are reported to billing staff. |
Notes:
| BL-370.050 |
| Allowable Recipients (ex. Client, client and collateral, collateral only, etc.) who received the service to be billed. Exceptions are reported to billing staff. |
Notes:
| BL-370.060 |
| Allowable Appointment Codes (ex. Scheduled, Non-scheduled, Client Cancel, Staff Cancel, etc.) for the service to be billed. Exceptions are reported to billing staff. |
Notes:
| BL-370.070 |
| Allowable Modes (ex. Face-to-face, Phone, Telehealth, etc.) for the service to be billed. Exceptions are reported to billing staff. |
Notes:
| BL-370.080 |
| Allowable Crisis Indicators for the service to be billed. Exceptions are reported to billing staff. |
Notes:
| BL-370.090 |
| For the purpose of Medicaid Rehab and Service Coordination, ability to confirm that a service doesn’t exceed the number of daily and/or monthly maximum units before billing. Exceptions are reported to billing staff. |
Notes:
| BL-370.100 |
| For the purpose of billing Medicaid and Medicaid Managed Care Organizations, ability to confirm that Rehab and Service Coordination service dates fall within the client’s Texas Resilience and Recovery (TRR) Assessment Authorization Period. Exceptions are reported to billing staff. |
Notes:
| BL-370.110 |
| For the purpose of billing CCP Medicaid, confirm that the service’s selected diagnosis code’s Diagnostic Group is a “physical diagnosis”. Exceptions to this are reported to billing staff. |
| N/A |
Notes:
| BL-370.130 |
| For Medicaid Rehab, MH Service Coordination, and IDD Service Coordination, ability to confirm that the service’s selected diagnosis is a member of the appropriate Diagnosis Group and the diagnosis is dated within the Medicaid-required number of days of the service before generating the claim for the service. Exceptions are reported to billing staff. |
Notes:
| BL-370.140 |
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