Data Quality CAR Score Distribution by Level of Care: This report shows the number of times a score is reported in each of the nine domains on the

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1 Dear Provider, The PICIS/PA helpdesk is now scheduling a new training for those needing assistance in understanding and utilizing reports in PICIS. The training is approximately one hour in length and geared to both staff of agencies and LBHPs in private practice. The trainings will take place via phone and webinar in a one-on-one setting. The trainings will address the multiple reports available to providers in PICIS. Reports allow providers to improve data quality, look for areas of improvement in services, keep track of authorizations and CDC due dates, and look at aspects of financial billing and billing caps. Although the trainings have a set format/materials to address, all issues/questions related to PICIS reports and CDC data are welcomed, including a walkthrough of any reports. Please note the PICIS report training is completely optional for those who feel they need it, as it s simply a training tool that is available to providers. If you have any questions or would like to schedule training, please feel free to contact our helpdesk at or us at gethelp@odmhsas.org. Some examples of the reports covered are available at Authorization PA status & Expiration Dates for Open Customers: Report that allows providers/agencies to keep track of their open/admitted customer s prior authorizations, by status (active, expired, or no PA) and due dates. The report can further select prior authorizations by clinician (all authorizations submitted by a specific clinician), location (all authorizations submitted by a specific site), and/or PA group (ex. how many PG001s, PG042s, PG043s).

2 Overlapping PA: The overlapping report allows providers/agencies to identify behavioral health authorizations that have been submitted on their open customers with a PA by another provider/agency, creating overlapping authorizations. Providers/agencies will be able to better identify the possible need for a letter of collaboration or letter of termination, as well as engage in communication with the other provider/agency for best possible treatment/practices. Change in Prior Authorization: This report allows a provider to identify all customers that have at least two authorizations that are based on CAR levels and compare such authorizations in order to look for a decrease, increase, or no change in such level/authorization, possibly indicating if a customer s symptoms have improved, remained the same, or worsened. The provider can also look at the overall percentage of their customer s authorizations/levels decreasing, not changing, or increasing and compare such percentages to other providers.

3 Comparison on Open Authorization: This report shows the number of open authorizations by agency or Psychologist/LBHPs. A provider will be able to identify the number and percentage of specific authorizations they have, including the number and percentage of CAR/authorization levels, for example the provider below has 568 authorization/level 3s, accounting for 54.5% of their authorizations. Data Management Potential & Completed Administrative Discharges: When a client has had no activity (CDC or billed service) on their account in over 180 days, the system will complete a type 92 discharge, referred to as an administrative discharge. Administrative Discharges can have a negative impact on a provider's outcomes. This is because the data from the last CDC is copied to the discharge. If any positive changes had occurred, these will not be recorded if the provider does not do the discharge themselves. This process was created because of the large number of episodes which were mistakenly left open without a discharge. Using this report, a provider can identify who has been administratively discharged and delete such discharge in order to complete their own. Also a provider has the option to select the potential 92 tab, identifying who will be discharged in the future, and either completing their own discharge or completing an update on the customer.

4 Data Quality CAR Score Distribution by Level of Care: This report shows the number of times a score is reported in each of the nine domains on the CAR at admission. Included are totals, averages, and standard deviation for each of the domains. Also included are statewide counts, which might provide a reference for evaluating an agency's data. The statewide counts are for similar age groups and level of care (based on reported CDCs). This report can help a provider identify any tendencies to over use specific scores in CAR reporting and/or use as default scores.

5 Number of Paid Service by Place of Service: On most claims, place of services is a required field. It is also a field which if improperly reported, could lead to recoupment. Some providers report all services under 99 - OTHER UNLISTED FACILITY. Although this is possible for all, it might not be applicable in all situations.

6 Number of Repeated Car Scores on Last 42: This report is designed to aid providers in identifying if CAR scores are being repeated on subsequent updates (CDC 42). Although it is very common that many of the CAR domains may not change from one time period to the next, one might assume that if many CDC 42s had the same scores as the previous CDC for a customer, there might be a data quality issue.

7 Potential CDC Problems: This report shows potential data quality problems on admission CDCs. Categories appearing in this report indicate areas in which the quality of data being reported should be examined and do not necessarily mean there is a problem. Criteria for categories appearing in the report are listed below. Number of Days Absent from School (Ages 6-17) 99 10% or more 00 90% or more Number of Days Suspended from School (Ages 6-17) 99 10% or more 00 90% or more Number of Days Self Harm (Ages 0-17) 00 95% or more Number of Days Restrictive Placement (Ages 0-17) 00 95% or more Number of Days No Return to Day Care (Ages 0-5) 99 10% or more 00 95% or more Tobacco Use (Ages 18 and up) 99 25% or more 00 75% or more Drug of Choice (Ages 18 and up) 01 None 97% or more Primary Referral 01 Self 75% or more Legal Status If listed, legal status on CDC may not be allowed for your agency or provider type. 03, 05, 09, 12, 13, 20, 21 Must be state operated facility or ODMHSAS contract CMHC. Service Focus If listed, service focus on CDC is not allowed for your agency or provider type. 03 Must be drug court agency 09, 15, 16, 17, 18, 22, 26, 27 Must be DMH contracted agency 12 Must be PACT agency 23 Must be day school agency Education (Ages 8 and up) 00 More than 0% In School (Ages 7 17) No 20% or more Presenting Problem 100 Other Non-BH Problem more than 25% Level of Care CI, CL, HA, SC, SN Must be DMH contracted agency SMI (Ages 18 and up) No More than 25% SED (Ages 6-17) No More than 25% Number of Days Self Help/Support Group 99 More than 0% 00 More than 99% Number of Days Arrested Last 30 Days 99 More than 0% Number of Days Arrested Last 12 Months 99 More than 0%

8 Demographic Demographic/CDC Extract Report: This report will show the number and percent of admitted, discharged or open customers based on different demographic variables available on the ODMHSAS/OHCA CDC form. This report can be used for performance improvement to: 1) track and make internal comparisons against expectations/standards, 2) identify opportunities for improvement, and 3) monitor the impact of improvement actions such as training or process/procedure changes.

9 Financial Over Monthly Rehab: For the rehabilitation service code (H2017), monthly limits have been put into place for clients who have a PA group of PG042, PG043 or PG044. Although the billing system cannot prevent a provider from overbilling the system, this report can show a provider which clients they have billed more than the allotted amount. Providers are expected to keep within these limits. If they do not, they may be subject to review and audit. This report shows only the month where limits have been exceeded. All rehab services billed during the month are shown and claims which have exceeded the limit are highlighted. Only rehab services provided on or after 1/15/2013 are included. If a rehab service was incorrectly paid for a client under six years old, those claims will also appear on this report. Other Provider & Access to PICIS information: This report is an administrative tool for agencies to use in identifying staff that may or may not need access to PICIS. When a provider adds a staff member in the enrollment process, an is sent to the staff at the address provided. After receiving the , the staff must then follow the enrollment instructions in the in order to gain access.

10 Provider Performance, Comparison & Change Number of Days with Paid Claims and Amount of Paid Claims by Rendering Provider: This report has four main sections with two subsections. Main Sections 1. Days with Paid Claims System Wide: This shows the number of days and weekend days with paid claims for all rendering providers, and provides a ranking among all behavioral health providers within the entire state system. Sorting is possible on Days, Weekend Days and Rank. If you click on a rendering provider ID, a calendar will appear. 2. Days with Paid Claims Within Provider: This shows the number of days and weekend days with paid claims for all rendering providers, and provides a ranking among all behavioral health providers within the provider (if more than one). Sorting is possible on Days, Weekend Days and Rank. If you click on a rendering provider ID, a calendar will appear. 3. Amount of Paid Claims System Wide: This shows the amount of paid claims for all rendering providers, and provides a ranking among all behavioral health providers within the entire state system. Sorting is possible on Rank. If you click on a rendering provider ID, a calendar will appear. 4. Amount of Paid Claims Within Provider: This shows the amount of paid claims for all rendering providers, and provides a ranking among all behavioral health providers within the provider (if more than one). Sorting is possible on Rank. If you click on a rendering provider ID, a calendar will appear. Subsections 1. Calendar: Number of Clients, Amount Paid, and Number of Claims in a Calendar View. Clicking on a date or the month will show all the detail claims. 2. Details: Paid Claims for Month or Individual Day.

11 PPMR: The intent of the Provider Performance Management Report (PPMR) is for providers to quickly identify areas of achievement and areas for improvement. By comparing their score to the state score or their previous year's score, providers are able to determine which outcomes and/or performance measures may need additional work.