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 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 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 Specifications PRI MU RESP Included Add'l Cost 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 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 immediately update and report client/patient financial accounts to include H The system shall immediately update and report client/patient financial accounts to include 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 automatically calculate sliding fees. H Generating 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 Specifications PRI MU RESP Included Add'l Cost 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
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 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 Specifications PRI MU RESP Included Add'l Cost 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 Specifications PRI MU RESP Included Add'l Cost No Comments
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 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 Specifications PRI MU RESP Included Add'l Cost 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 H
Specifications PRI MU RESP Included Add'l Cost 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 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. H The 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 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
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 meet co-occurring disorders (dual diagnosis) data access requirements. The system shall permit configurable Clinical history screens. H The system electronically restrict access to and secure all client records. H Specifications PRI MU RESP Included Add'l Cost No Comments Managing the Record: (continued)
The system 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 integrate attendance records for scheduled sessions with client notes. H Specifications PRI MU RESP Included Add'l Cost 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 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 Specifications PRI MU RESP Included Add'l Cost No Comments
The system shall flag contraindications when a medication is ordered, including allergies, food-drug, or drug-drug interactions. D The system 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 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 support medication-specific, 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 Specifications PRI MU RESP Included Add'l Cost 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 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 Specifications PRI MU RESP Included Add'l Cost 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 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 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 assign and maintain a unique identifier for each program. H The system shall support per program fees. H The system shall support per session fees. H The system shall support drug testing fees. H The system shall support miscellaneous fees. H The system shall permit adjustments to Client accounts at any point in the billing process. H Specifications PRI MU RESP Included Add'l Cost 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 D
Specifications PRI MU RESP Included Add'l Cost 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 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 Specifications PRI MU RESP Included Add'l Cost No Comments Maintaining All HIPAA-Compliant Transactions: (continued) The system shall support standard encounter formats, either proprietary or industry-standard (837P). H
counting the day entering placement, but not counting the day of discharge. 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 outcome information related to special populations such as Homeless and CSOC consumers. H Specifications PRI MU RESP Included Add'l Cost 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 provide an alert to affected staff or contract provider when current license and/or credentials approach expiration deadlines. D Specifications PRI MU RESP Included Add'l Cost 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 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 capture Outcome data elements. H The 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