Mental Health Data Alliance, LLC (MHData) May 17, 2018

Mental Health Data Alliance, LLC (MHData) May 17, 2018
DHCS CSI and DCR Data Quality Improvement Project FAQs and Out-of-County Reporting Mental Health Data Alliance, LLC (MHData) May 17, 2018

Project Goals Support the ability to submit good data to the current state CSI and DCR mental health data systems Close the feedback loop for counties to validate that they have good data in the CSI and DCR state mental health data systems Improve the value of state CSI and DCR mental health data systems for counties, the state and stakeholders

Approach Over 1.5 years: Provided counties with 2 reports which provide an overview of current data and errors for CSI and DCR Met with counties to review reports and identify potential causes of data patterns and inconsistencies Work with counties and DHCS to improve processes to submit data to DCR and CSI Provide counties with 2 reports which provide an overview of improved data for CSI and DCR

Frequently Asked Questions
Are the PowerPoint slide decks for these webinars available to Counties? PowerPoints for all Webinars is available on the MH Data Website at

Who needs to be reported to CSI? CSI system reflects Medi-Cal clients, non-Medi-Cal clients, and services provided in County, City/Mental Health Plan programs County-staffed providers: all clients & services must be reported Contract Providers: Clients & services provided in contract with County Mental Health Program must be reported. “All persons served in treatment programs must be reported to the CSI System. This includes both Medi-Cal and non-Medi-Cal clients, and persons served by the private practitioners that were formerly in the Fee- For-Service System” (MH-Ltr98-03). Exceptions: State Hospital and Conditional Release CONREP clients Phase I (Inpatient) Consolidation providers and services References: 10-Reporting Tips - Tip One - April 2016 (Technical Supplement F); MH-Ltr98-03

What needs to be reported to CSI? Client record information at first contact 24 Hour Services (Mode 05) Day Services (Mode 10) Outpatient Services (Mode 15) Periodic Records References: 10-Reporting Tips - Tip One - April 2016 (Technical Supplement F); MH-Ltr98-03

How invested are the vendors in this process? Have you spoken to any vendors? We are in contact with all vendors in this process. We will continue to engage with vendors during the project.

For those questions that need further review for an answer - will you be sending those questions and answers out to all Counties or to the participants of these meetings? Yes, we are reviewing FAQs today and have more detail in upcoming webinars on a additional FAQs which are still being researched.

If a Living arrangement changes frequently, say 6-7 times a year, do we or should we provide a periodic record for each move? Only one periodic record should be submitted each year, regardless of the number of moves Reference: See CLIENT AND SERVICE INFORMATION SYSTEM REPORTING TIPS; TIP FIVE: REPORTING PERIODIC RECORD DATA: “EXAMPLES OF INAPPROPRIATE PERIODIC DATA REPORTING: Reporting more than one (1) Periodic record for a client within a twelve (12) month period of time” (Page 3). Periodic records reports cross-sectional point in time status annually for clients Collected at first contact, annually, and at formal discharge

We don't formally "close" or discharge clients. We submit new period records with each time a client gets a service. Does this comply? This does not actually comply with the instructions for Periodic Records. Periodic records should be collected and reported at first contact, annually, and at formal discharge. Reference: See CLIENT AND SERVICE INFORMATION SYSTEM REPORTING TIPS; TIP FIVE: REPORTING PERIODIC RECORD DATA: “EXAMPLES OF INAPPROPRIATE PERIODIC DATA REPORTING: Reporting more than one (1) Periodic record for a client within a twelve (12) month period of time” (Page 3).

Previously error correction involved duplicate data entry in Avatar and on DHCS. What about now? We will discuss this in the May 31st webinar. Register here:

Did you indicate you have a document that lists services that are excluded from CSI? Services submitted to CSI include any type of service identified in CSI Data Dictionary described by the Service Function. Double click to open the Reporting Tips file embedded in this slide. Exceptions include: State Hospital and Conditional Release CONREP clients Phase I (Inpatient) Consolidation providers and services

Again regarding ICD-10 we have services that cannot be submitted due to the issue with CSI allowable ICD-10 - is there a way this can be address ASAP? The longer this issue is not resolved the number of unsubmitted records will grow. Please DHCS to register a ticket for the issue at

Will the provider file information be available on BHIS in the same way that it was on ITWS? The IT Team (EITS) is rewriting OPS (MHSD –Online Provider System) and in the near future (around end of July) access for OPS will be moved from ITWS to BHIS.

Will CSI error correction involve duplicate data entry? Duplicate submitted client records will be overwritten. When a client record is submitted: If there is no Client record with the same Submitting County Code and CCN on the CSI Master database, the above record will be added. If there is a matching Client record it will be replaced with the above transaction record. Duplicate service records will be overwritten if submitting county code, CCN and RRN already exist in CSI. When a service record is submitted: If there is no Service record with the same Submitting County Code, CCN, and RRN on the CSI Master database, the above record will be added. If there is a matching Service record it will be replaced with the above transaction record.

Just wondering how many counties validate CSI data prior to sending it to the State? The County of Orange takes the Provider File and turns it into an Access Table that is used for validation. The provider file is pulled down each month prior to running the CSI job. Orange County use custom programming to turn the Provider File into a table that is used to validate CSI data.

In CALOMS corrected errors are picked up on the next submission. Will it be the same for CSI? Duplicate submitted client records will be overwritten. When a client record is submitted: If there is no Client record with the same Submitting County Code and CCN on the CSI Master database, the above record will be added. If there is a matching Client record it will be replaced with the above transaction record. Duplicate service records will be overwritten if submitting county code, CCN and RRN already exist in CSI. When a service record is submitted: If there is no Service record with the same Submitting County Code, CCN, and RRN on the CSI Master database, the above record will be added. If there is a matching Service record it will be replaced with the above transaction record. The issue is that the record needs to have the same record number (RRN) to be overwritten or deleted. The record number is often not kept in the EHR. When you submit a correction, you have to find and use the same record number.

What kind of membership do you need to access PRV/LE tab with the provider file instructions and forms? If the person doesn’t yet have an ITWS account, then they will need to follow the instructions listed under the link on the home page: Once they have an ITWS account, then they request additional memberships from the Utilities dropdown list. There they will select the PRV/LE membership for the counties they require data for.

How do I reach out to you to discuss my County’s data? MHDATA can meet with you to discuss specific challenging issues. Contact:

When you say that periodic data is "False" when it is repeatedly reported with an updated “Completed Date”, could the information be simply redundant? No, because the date completed is updated and the rest of the information in the record is not, the data is actually misrepresentational. Since the data is an inaccurate representation of the time point it is claiming, this could result in false results and statistics.

Which outcome measures are we talking about for subsequent periodic data collections? Can you please talk about the impact of inaccurate or incomplete periodic data reporting? If you can show an example of a report you are pulling and talk thru why the bad data is skewing the analysis that would be great. For example, children should be going up in grades each year unless they are held back. Bad data reporting suggests that 75% of children repeat grades each year.

Can CSI publish the most common problems that have been found with the CSI periodic record... such as inappropriate age for a student grade level? It is difficult to know when periodic records contain falsely reported status for a clients. False data is more recognizable for children who should be advancing grades, but it is nearly impossible to tell which information might be falsely reported for other types of clients.

What reports does CSI have that will help Counties identify issues like children too old for their grade? There are currently no reports for this purpose although this project is working to establish regular feedback reporting to counties.

Why can’t the Periodic record be reported more like the Client Record.... e.g. when something changes? DHCS documentation limits data reporting to one periodic record should be submitted each year, regardless of the number of changes: “EXAMPLES OF INAPPROPRIATE PERIODIC DATA REPORTING: Reporting more than one (1) Periodic record for a client within a twelve (12) month period of time” (CLIENT AND SERVICE INFORMATION SYSTEM REPORTING TIPS; TIP FIVE: REPORTING PERIODIC RECORD DATA , Page 3).

Is there a quick reference for 3 different types of CSI data submissions as to what they ought to be from state's point of view? Yes, the 06-Records Description-July 2007 (Technical Supplement B) describes the fields for each record. Double click on the icon below to open the file.

For Diagnosis Codes, can ICD 10 Z codes be used in 3, 4, or 5th diagnosis? Yes. Any valid ICD 10 code can be used in these fields.

During the implementation of the new ICD-10 CSI requirements, the documentation indication only the "F" code series would be allowed for Primary diagnosis - Is this still the case? Some of the documents you showed did not indicate that. Yes, the primary and secondary need to ICD 10 F code series. Any other codes need to be other codes are added into other sections DHCS originally did not allow “R69” (Illness, unspecified) and “Z0389” (Encounter for observation for other suspected diseases and conditions ruled out) but are now valid codes. They had previously accepted “ ” (DIAGNOSIS DEFERRED) and “ ” (NO DIAGNOSIS), respectively.

We also had duplicate records entered when we were trying to correct errors. Is there anyway we can get a download of our data so we can see our service duplicates? Please submit a ticket to or

When there are T or V codes in the 3rd, 4th, 5th diagnoses, do these need to be changed to or ? Any valid ICD-10 code can be used in these fields, including T and V series codes.

Is there an expectation that ALL ICD-10 errors will be corrected, or if we fall below 5% are we okay? High rate ICD-10 codes are targeted for each county. Please attend the May 31st data correction webinar if your county has diagnosis related errors to correct. Register here:

Will z03.89 be allowed as a valid code, now that the state accepts that as a valid code. DHCS has relaxed codes; this is accepted.

Is there support phone number? Best to contact through at or

What counties have the lowest IDC-10 error count? This cannot be determined because many records which would otherwise have errors are suspended and never submitted to the state.

Where can we find the data on historical errors that you had in these slides so we can get a good visual and identify where we need to concentrate? County data can be found in error reports. Error reports are cumulative. This project provided a report which contained a complete history of error counts by error code, record type, and for service records, service type. If you cannot locate the report provided to your county in the spring of 2017, please contact

Can any ICD10 code be used as a substance abuse dx code? This field requires a valid ICD 10 F10-F19 substance abuse diagnosis need to be used

Where are the Fiscally Responsible vs. Rendering Service Numbers listed? Can this re-published in case some of us are confused? There are two county elements in the CSI submission service record submission files. One field identifies the county submitting the service. The other field identifies the county who is fiscally responsible for the service. Most often, these identifiers are the same. When a county serves a client from an outside county and that outside county pays for those services, then these two fields will contain different values as the county who provided the services will report the service as the submitting county on behalf of the outside county which would be identified as the fiscally responsible county H-01.0 COUNTY/CITY/MENTAL HEALTH PLAN SUBMITTING RECORD (SUBMITTING COUNTY CODE) S-14.0 COUNTY/CITY/MENTAL HEALTH PLAN WITH FISCAL RESPONSIBILITY FOR CLIENT The County/City/Mental Health Plan With Fiscal Responsibility for Client FISCALLY-RESP-COUNTY Identifies the county/city/mental health plan responsible for directly or indirectly paying for the client’s services.

Fiscally Responsible County

In the report mocks, what does "SN" mean in the table? Small number, any cell with 10 or less observations is redacted and replaced with the term “SN”.

How does the data reported in the planned Feedback Summary Reports relate to the Submission Update Report? The submission update report displays whether or not a file was submitted in a certain timeframe. The regular feedback reports will display the counts of clients and services reported for a timeframe.

Are the recordings and documents from this webinar which will be available for future reference? Yes recordings and webinar materials are posted on the MHDATA website

Just to confirm, "New Clients" in the planned Summary Reports means new to the county not if they are "new" to a particular program within the county. Is that correct? New clients represent a count of client records submitted that period.

If "Provider" level data is reported in the Summary Reports, will it be based on the 4 digit "Provider Number" listed on the DHCS website? Yes, it will.

Are these planned Summary Reports that we can download from DHCS website? The Summary reports will be available for download from BHIS website once implemented. The Statewide Summary report will be posted on the public website, but the County Specific Reports will be available for secure download within BHIS for users with the appropriate authorization.

If the county disagrees with the percentages in the Summary Reports, what is the process to discuss? If there are suspected discrepancies with the data, please register a ticket with DHCS at to report the discrepancies.

Can we receive county reports quarterly or monthly? Currently, quarterly reports are planned. Depending on the level of effort to produce the reports, this may change.

Where is the repository of those NetSmart (or other vendor) filtered errors, so some one can work those errors so the data finally gets submitted? As part of this project, each county received a report of counts of errors by error type and record type. Contact NetSmart counties to review their reports.

I'm not aware of Grade Level being part of CSI. I don't think we collect this in our system. Are all other counties collecting this? Highest grade of education completed is collected as part of the Periodic Records of CSI.

Does anyone know if the single contact issue has been addressed for Cerner Anasazi? Cerner reported that it has been updated but is pending delivery, but it has not been rolled out yet. It should be able to be rolled out in a patch update soon.

What is the service function code assigned to collateral services? In the data dictionary, it is identified as Outpatient Services/Mode 15 Service Function Service Function 19 represents Professional Inpatient Visit – Collateral.

For Cerner Anasazi, I see that we can ignore suspended code, if we check-mark this will it cause the records to unsuspend? Cerner reported that there is a global set-up to turn suspense off. It will allow you to choose what gets suspended. If a record has a suspense code on it and the suspense code does not make sense, please contact Cerner.

Substance use disorders are not mental health diagnosis? DHCS requires the Substance Abuse/Dependencies codes to be a valid ICD-10 Substance Abuse diagnosis code (F10-19).

In the county reports which were provided to each county as part of this project, where the clients are served numbers coming from? This is coming from the amount of unique clients served in a month from CSI. DHCS wants to create regular reports so that counties can keep track of these unique individuals served.

Are there standardized reporting codes for court/legal status? Whenever that changes for the client, does it need to get reported? Periodic records are reported as an annual status. Changes in status during the year are not reported, until the end of the year. Only the final status is reported. The valid codes are listed in the CSI Data Dictionary as identified in the following figure.

Can you please advise about this warning 'Axis I Primary and Axis II Primary can both be N only if Axis I Diagnosis and Axis II Diagnosis are coded to V7109:N (S-32.0 Axis II Primary)? This is an error that relates to ICD-9 reporting, you should have not received this error since the switch to ICD-10 reporting, after October 2015. If this error code is still being reported for you, please register a ticket with DHCS at

I’m curious about client columns with different modes in the planned Summary Reports? Are modes related the services they had? 05 = 24 Hour Services 10 Day Services 15 Outpatient Services

Do the “services” in the Summary Reports including non-billable services? They include all CSI reported services. CSI services should include any services provided by the county, regardless of funder, including those which are Medi-Cal non-billable services.

Any thought to creating reports like the ones presented by EQRO such as penetration? Not at this time. We want to get to a point where we think the data in the CSI is representative of the population we serve before looking at things like penetration. We are just describing the data but we encourage folks to get there

Is there an average the goal that the state is supposed to reach with regard to Summary Report Outcomes? No, we aren’t really setting goals now. The Summary Reports are not a goal-oriented. They are designed to describing the system at this point so that we can identify how to establish benchmarks. No benchmarks have been established at this time.

Additional Questions DHCS staff are researching. More information will be provided on these soon. Why is there a separate CalOMS reporting system for reporting drug related services? CalOMS corrected errors are included in the next batch upload and corrected. Does the CSI DHCS resolve duplicate data entry? Several years ago, we were getting letters from Dept. of MH that stated we were not reporting bed day services for an ISP. It was because we were reporting the same facility as a PHF. We no longer receive those letters, and still report it as a PHF (a State classification) rather than as a PHF (a national class). How do we determine if we should report a PHF, or report as an IMD? Is there an update on when Provider File will be available on BHIS? Could the provider file could be available to Counties via .csv file? How long do updates for Provider file changes? Please clarify for me: For Periodic Records, if my staff does not collect at first contact should they enter the information when they do collect it later (say within a month or two) and report that as an intake collection or is it better to report as unknown or not collected until the annual mark. I was told that for Acute Inpatient CSI got the billable services from SDMC. Is that incorrect? Has the State evaluated whether the drop in Collateral services was related to individual services vs. group services? CSI gets information from the SDMC for MediCal funded 05 clients, correct? We thought CSI got that information from SDMC. Do we need to report MediCal funded 05 clients, correct to CSI? The State Short/Doyle billing system allows additional ICD-10 codes not in the "F" codes series for the Primary Code. Is the allowed Short/Doyle billing ICD-10 codes going to be added to the ICD-10 master file so the CSI data is in synch with the allowable Primary and second diagnosis codes that includes more than the "F" code series? If the Short/Doyle ICD-10 allowable codes will not be allowed will an Info Notice be sent to the Counties so our Vendors can make the necessary programing changes to their systems.

Out-of-County Reported Services
If a county contracts with another county to provide services to their out-of-county clients, the county providing the services should report the service on behalf of the county paying for the service. The county paying for the services is reported in the S COUNTY/CITY/MENTAL HEALTH PLAN WITH FISCAL RESPONSIBILITY FOR CLIENT data field. The county providing the service is reported in the H COUNTY/CITY/MENTAL HEALTH PLAN SUBMITTING RECORD (SUBMITTING COUNTY CODE)

Types of services which occur out of county Counts of clients who receive this service in one county when another county is fiscally responsible.

Example of Services which were Funded by Contra Costa and were Provided by another County (Out of County)

Example of Services which were Funded by Placer and were Provided by another County (Out of County)

Example of Services which were Funded by San Bernardino and were Provided by another County (Out of County)

Who Reported for Whom? How often are your clients served out of county? Who often do you serve clients whose services are payed by other counties? What is the data quality of Out of County reported services?

Example of Clients which were Funded by Alameda and were Provided by another County (OOC=Out of County)

Example of Clients which were Funded by Sacramento and were Provided by another County (OOC=Out of County)

Example of Clients which were Funded by Los Angeles and were Provided by another County (OOC=Out of County)

Clients Served on Your Behalf by Other Counties
Clients Served on Your Behalf by Other Counties Clients You Served on Behalf of Other Counties County/MHP FY_1415 FY_1516 FY_1617 Alameda 895 947 922 1502 1922 1824 Alpine 26 15 12 7 5 4 Amador 52 56 57 89 100 Berkeley City 19 13 9 Butte 303 238 246 42 33 Calaveras 127 112 102 103 78 Colusa 31 22 45 113 82 58 Contra Costa 645 704 689 1424 1489 1441 Del Norte 50 49 41 54 80 79 El Dorado 130 141 114 104 140 147 Fresno 415 401 388 597 733 765 Glenn 39 27 70 71 47 Humboldt 121 111 126 177 187 150 Imperial 125 109 66 81 65 74 Inyo 14 11 Kern 267 251 278 709 831 903 Kings 143 145 124 106 Lake 108 91 136 Lassen 40 30 Los Angeles 2738 2361 2359 Madera 157 154 229 175 212 Marin 119 120 115 Mariposa 23 Mendocino 34 Merced 219 263 283 317 315 Modoc 8 Mono Monterey 128 122 131 73 Napa 84 94 98 169 201 161 Nevada 144 158 282 260 Clients Served on Your Behalf by Other Counties Clients You Served on Behalf of Other Counties County/MHP FY_1415 FY_1516 FY_1617 Alameda 895 947 922 1502 1922 1824 Alpine 26 15 12 7 5 4 Amador 52 56 57 89 100 Berkeley City 19 13 9 Butte 303 238 246 42 33 Calaveras 127 112 102 103 78 Colusa 31 22 45 113 82 58 Contra Costa 645 704 689 1424 1489 1441 Del Norte 50 49 41 54 80 79 El Dorado 130 141 114 104 140 147 Fresno 415 401 388 597 733 765 Glenn 39 27 70 71 47 Humboldt 121 111 126 177 187 150 Imperial 125 109 66 81 65 74 Inyo 14 11 Kern 267 251 278 709 831 903 Kings 143 145 124 106 Lake 108 91 136 Lassen 40 30 Los Angeles 2738 2361 2359 Madera 157 154 229 175 212 Marin 119 120 115 Mariposa 23 Mendocino 34 Merced 219 263 283 317 315 Modoc 8 Mono Monterey 128 122 131 73 Napa 84 94 98 169 201 161 Nevada 144 158 282 260

Out of County Service Data Quality
It is likely that not all out of county services are being reports on behalf of paying counties There are some counties with years of data in which no services were reported on behalf of other paying counties (peach colored rows in prior two slides)

Out of County Services Next Steps
County specific reports have been created Which show counties report on your behalf Which services are reported on your behalf Counties should review processes to ensure services are being reported correctly on behalf of other counties when other counties are fiscally responsible for that client MHDATA will follow up with counties who do not seem to be reporting serving clients on behalf of other counties to identify potential data reporting issues

Discussion Other issues? Comments? Next Steps? Email Support
DHCS: MHData:

DHCS CSI and DCR Data Quality Improvement Project
Mental Health Data Alliance, LLC (MHData)

Mental Health Data Alliance, LLC (MHData) May 17, 2018

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Mental Health Data Alliance, LLC (MHData) May 17, 2018

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