It should also be noted that one region in Washington State, Southwest, will be an “Early Adopter” region, combining the administration of Medicaid benefits for Mental Health, Substance Use Disorder and Medical. There will be an Administrative Services Office for Southwest and many providers in that area may be contracting with the existing Apple Health Plans (such as Molina, CHPW, etc.) instead of directly with their designated region. Washington State hopes to integrate all health services in this manner beginning in 2020.
The following is a brief summary of the Data Dictionary changes to being April 1, 2016:
All existing transactions will continue but will be renumbered due to changes in the new version. Some have been renamed and new transactions—identified by bold text—have been added:
- 020.06: Client Demographics (renamed from Consumer Demographics 020.05)
- 022.01: Client Address (new/MH, SUD & Pre-intake)
- 023.01: Authorization (new/MH & SUD)
- 030.01: ASAM Placement (new/SUD only)
- 035.08: Client Profile (renamed from Consumer Periodics 035.07)
- 036.01: Substance Use (new/SUD only)
- 060.03: Program Identification (was 060.02)
- 121.03: Co-occurring Disorder (was 121.02)
- 130.03: Cascade Merge (was 130.02)
- 160.03: DMHP Investigation (was 160.02)
- 161.03: ITA Hearing (was 161.02)
- 170.02: Service Episode (was 170.01)
- RSN ID has been redefined as “BHO ID” and could possibly be the ProviderOne ID—further State clarification is needed.
- Transactions that include a hospital or facility ID will now require a facility National Provider Identifier (NPI). This will replace Reporting Unit (RU) and the State will provide a list of facility NPIs with an RU cross-walk.
- All references to Consumer have been updated to Client.
- There are no transaction header changes.
Please note that 837 changes, identified in the BHO Service Encounter Reporting Instructions (SERI) do not include structure changes but define the service (CPT and HCPCS) codes that will be allowable.