Affiliation Error Checking Software: A program written by CEI to use specifically with DCH required reports for Encounter and Demographic data.

Authorized Service: Specialty Mental Health Services that are required by the Michigan Mental Health Code, Chapter III of the Medicaid Bulletin and under contract with the Michigan Department of Community Mental Health, which receive written approval to be provided.

Business Hours: The official hours per board, Monday through Friday. These hours may vary and total hours are included in the indicator.

Communication: The effective transmission of messages using spoken language, Braille, American Sign Language, or available technology, as necessary.

Concurrent review: The review of a person’s current level of service for the purpose of authorizing continued treatment.

Connected: Receiving a login, password and access to those portions of the data system determined to be appropriate.

Credentialing: The process of reviewing and verifying the credentials of contract service providers and staff to include licensure, registration and/or certification conveyed by legal authority, academic record and degree, specific clinical training and/or experience, and professional affiliation.

Data files: Electronic files required per contractual obligations with the Department of Community Health Demographic Data: The individual consumer demographic elements for which data is required. These elements are specified in the Department of Community Health Reporting Requirements Contract.

Demographic Files: The individual consumer demographic elements for which data is required. These elements are specified in the Department of Community Health Reporting Requirements Contract.

Disabilities: For the purpose of this procedure, disabilities include mental illness, developmental disabilities, serious emotional disturbances and substance abuse disorders.

Encounter Data: The individual services or encounters per consumer collected, regardless of payment source or funding stream. Encounters are defined in the Department of Community Health Reporting Requirements Contract.

Encounter Files: The individual services or encounters per consumer collected, regardless of payment source or funding stream. Encounters are defined in the Department of Community Health Reporting Requirements Contract.

External Source: The person or organization authorized, or identified in a reporting contract, to receive the data/information files from the mental health agency.

Facility: A hospital, institution or program that has entered into an agreement as an independent contractor with the agency to provide direct services.

Hub staff: Staff employed by CMH of Clinton, Eaton and Ingham Counties whose responsibilities include Affiliation related duties.

Information/Billing System: The network of computers and other hardware and software used to categorize, store, retrieve, copy, protect, and manipulate data on behalf of the organization and its clinical and administrative operations.

Intensity of Service: The setting of care, usually corresponding to the types and frequency, duration, restrictiveness, and level of support needed to treat the consumer.

Interpretation: The transmittal of a message from one language to another (including sign language), considering dialect, culture and nuance.

Limited English Proficient (LEP): An LEP individual is a person who is unable to speak, read, write or understand the English language at a level that permits them to interact effectively with health care providers and social service agencies. For the purposes of this policy, LEP will also apply to individuals whose primary form of communication is something other than the oral English language.

Medical Necessity: The determination that a specific health care service is medically necessary and appropriate in meeting a persons needs, is consistent with the persons diagnosis, the most cost effective option and consistent with clinical standards of care.

Performance Indicator Reports: Documents containing the quality improvement or monitoring measures as defined in the Department of Community Health Reporting Requirements Contract.

Person-Centered Planning: The on-going process for planning and supporting individuals receiving services based on their capacity to engage in activities that promote community life and honor individual choice, preference and ability. The process involves support from family, friends and professional as chosen by the individual.

Population/Service Area: Includes any county resident who may potentially receive services from a member of the Affiliation, excluding prison populations.

Privileging: The process of granting permission to individuals to perform certain professional duties within a defined scope of service, based on a determination of competency and verification of credentials.

Proposal Evaluation Committee: A committee comprised of representatives from various functional CMH areas, as well as stakeholders, family members and/or consumers as appropriate, whose purpose is to review and evaluate proposals submitted in response to an RFP or RFQ.

Qualifications: The individual’s knowledge, training, experience, education and applicable licensure, registration, and/or certification in relation to a specific responsibility and/or function.

Quality Improvement: Practices designed to support continuous scrutiny and improvement of the daily practices, systems and overall quality of efforts in which an organization is engaged.

Quality Indicators: The data that is studied in order to measure the strength of the service that the IS department provides internally to the staff and programs.

Request for Proposal (RFP): A bid process utilized by the agency to solicit competitive proposals from community providers to address a specific service need. The bidder is requested to provide a proposed set of activities addressing the need, the price for providing the services, information

Request for Quote (RFQ): A competitive bid process utilized by the agency to procure the purchase of services, which includes requesting information from prospective bidders about their ability to provide services and the price of those services.

Retrospective review: The review of a person’s treatment after discharge for the purpose of authorizing past treatment.

Self-determination: The ability of individuals to control their lives, to achieve self-defined goals and to participate fully in society. Self-determination describes a set of beliefs and behaviors adopted by individuals seeking improvement in their lives and by those who support them. Self-determination giving people the opportunity to control a fixed sum of supports they will purchase from whom and under what circumstances.

Service pattern reviews: The review of aggregate service data for the identification of patterns of over-utilization, underutilization, or other factors.

Severity of Illness: The nature and severity of the signs, symptoms, functional impairments and risk potential related to the consumer’s disorder.

Steering Committee:  Group comprised of 5 members, including the CEO, from each affiliated CMH.

Sub-Element Cost Report: Document containing consumer totals and costs as defined in the Department of Community Health Reporting Requirements Contract. These totals and costs typically relate to the Encounter Files / Data.

Timely reports: Those received by the external source on or before the specified due date. Sufficient mailing time must be allowed in order to be timely.

Training: Education or instruction designed for staff that is developed and/or presented by members of the IS Department.

Translation: The written interpretation of a message from one language to another, conveying the original meaning of the text with linguistic precision.

Utilization Review: The process of using criteria in examining the necessity and appropriateness of a service.

Vital Documents: Documents containing information about or otherwise related to a client’s rights as a mental health consumer. These may include, but are not limited to applications, consent forms, releases of information, important information regarding participation in a program, notices pertaining to the reduction, denial, or termination of services or benefits, notice of the right to appeal such actions or that require a response from beneficiaries, notices advising LEP persons of the availability of free language assistance, and other outreach materials.

837 Format: The specific transaction set required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. HIPAA requires all electronic transactions sent to Prepaid Health Plans or Coordinating Agencies from providers to be in a HIPAA compliant format. The 837 format is one of the approved transactions to be used for some Demographic and all Encounter and Children’s Waiver data.

Common Acronyms

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