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Service Reporting Information
S
ERVICE
R
EPORTING
S
CREEN
H
OURLY
The following fields are required for completion of this screen.
Unit/Program
The valid unit and program number for the service that is reported. Each service is entered into DARTS using a unit number and program code. Therefore, before initially entering any data and whenever corrected
or updated software is received, all provider unit number and program codes should be verified to
reduce the incidence of data rejection. The Unit and Program number(s) are displayed in the
AProvider
Unit/Program File.
@ If services are delivered at multiple sites using the same unit number and program code, additional screens will be displayed listing the unique addresses, procedure codes and dedicated funding categories for each individual site. It is especially important to verify all site numbers by address for the current fiscal year as these may vary from to year-to-year. All addresses should match those specified on
DASA facility licenses and Medicaid certifications and enrollments. Failure to verify this information or to notify DASA immediately if errors are discovered may result in data errors and possible delays or holds in disbursement or reimbursement for rendered services.
Site Number
This field is required ONLY for billing of Assessment, Case Management, Early Intervention or Community
Intervention at more than one site.
DASA HELP
– E-MAIL:
– FAX: 217.558.4656
| July 2013
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Service Reporting Information
Staff ID
The unique nine-digit identification number for the staff member providing services.
Service Date
The date of service.
Funding Code
The funding code is what directs DARTS to the correct payment source for the service. The following codes are used:
DC - DARTS/Contract: A Service, which is supported in full or in part by DASA CONTRACT
(Non-Medicaid) funding
DM - DARTS/Medicaid: A Service, which is supported in full or in part by DASA MEDICAID funding. Services linked to a DM code are processed and forwarded on to the Department of Healthcare and Family Services (HFS) for reimbursement. HFS produces the Medicaid Remittance Report.
Unique Client/Patient Identifier
The 9-digit Unique Client/Patient Identifier must match the demographic record for the client/patient.
Service Type
There are three service types that can be used to report services that are paid hourly:
1. Individual
2. Group Service
3. Support (Includes Case Management, Community Intervention, HIV Counseling and Testing
Activity, HIV Early Intervention Training and Interpreter Referral, Donated Funds Initiative
(DFI))
Activity Code
Activity codes are mandatory and are used for identification of specific types of activity that relate to a general service. The activity code is three digits comprised of the specific type of service activity that was performed and the location as follows:
Location Codes
0 - Service at Provider Location
1 - Off Site
Assessment (Only allowed for use with Program Number
A48")
70 - Admission
71 - Discharge
72 - Gambling Assessment (only for use by providers with specific funding for gambling services)
Assessment should be used only for diagnosis and assessment of the six (6) ASAM dimensions in order to place the patient into a level of care.
Treatment or Early Intervention Service (Only allowed for use with Program Number
A42@, A43@
and
A44@)
01 - Individual Counseling
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Service Reporting Information
02 - Counseling Group
04 - Continued Stay Review and Discharge Planning
05 - Treatment Planning
06 - Didactic Group
07 - Recreation
08 - Telephonic
Psychiatric Review
11 - Psychiatric Evaluation
12 - Medication Monitoring
Case Management (Only allowed for use with Program Number
A41@)
22 - Intra-Agency Staffings
23 - Case Coordination
Case management services can be bundled and reported in larger increments of time. For example, a treatment patient
=s case is staffed 10 minutes each day on 24 different days during one
month. These minutes can be bundled into hour increments and reported once as four hours of case management. Services should be bundled by staff ID linked to each patient ID and the date of
service entered into DARTS should be the last date of service in the bundle.
Community Intervention (CIH) (Only allowed for use with Program Number
A42@ and a Service
Type of
A3@)
31 - In-reach
32 - Out-reach
33 - Case Finding
34 - Crisis Intervention
35 - Training (Can only be used by providers who are specifically funded to deliver or obtain training and to report such training to DARTS)
37 - Client/Patient Transportation
Community Intervention can be bundled and reported in larger increments of time. Services should be bundled by staff ID and the date of service entered into DARTS should be the last date of
service in the bundle.
Collateral (Only allowed for use with Program Number
A42@, A43@ and A44@ with a Service Type of
A1@ or A2@ )
41 - Family or Significant Other
42 - Other (Employer, Friend, Minister, etc.)
HIV Early Intervention (Only allowed for use with program number
A95@)
51 - Test Decision - Initial Session
52 - Test Decision - Follow-up Session
53 - Post-test Session
54 - Community Intervention
55 - Case Management
56 - Phlebotomy Tracking
DASA HELP
– E-MAIL:
– FAX: 217.558.4656
| July 2013
29
Service Reporting Information
57 - HIV C and T Training
58 - Semiannual Training
HIV Early Intervention Training - (Only allowed for use with program number
A96.@ For use only
by providers who are specifically funded to deliver HIV early intervention training and to report
such training to DARTS.)
59 - Administration
60 - Workshop Delivery and Support
61 - Training Evaluation
Interpreter Referral - (Only allowed for use with program number
A64@)
62 - Interpreter Referral Services
Gambling - (Only allowed for use by providers with funded gambling services. Patient type must be
AT@, using program number A43", Service Type 2, with an AL@ dedicated funding tag and a
problem area of 1, 2 or 3.)
63 - Gambling
Donated Funds Initiative (DFI) - Use the hours field to enter the number of tokens. Numbers must be 1 through 9. (Only allowed for use with Program Number
A49" and service type A3")
66 - Case Management
67 - Round Trip Public Transportation
68 - One Way Trip Public Transportation
69 - Staff Transportation
Procedure Code
(Round trip or One Way Public Transportation can be bundled up to 9 tokens in the hour field)
This field is not entered by the user. When the date, unit/program, funding code and service type are entered, DARTS will check to assure that the user has been funded for the type of service entered and will automatically enter the procedure code. Procedure codes with their associated funding codes are as follows:
Funding Code
ADM@ or ADC@:
AAS - Assessment
OPI - Outpatient Individual
IOI - Intensive Outpatient Individual
OPG - Outpatient Group
IOG - Intensive Outpatient Group
PEV - Psychiatric Evaluation
Funding Code
ADC@ Only:
EII - Intervention Individual
EIG - Intervention Group
CMH - Case Management
CIH - Community Intervention
HIV - HIV Service
INT - Interpreter Referral
DFC - DFI Case Management
DFF - DFI Round Trip Public Transportation
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Service Reporting Information
DFH - DFI One Way Trip Public Transportation
DFS - DFI Staff Transportation
Group ID
The group ID should be a unique five-digit combination of numbers and/or letters that will distinguish the treatment counseling group from other such groups on the same date of service. This Group ID is used by
DASA for auditing purposes to determine the number of patients per counseling group. DASA will only reimburse for up to 16 patients (Medicaid or Contract funds) per counseling group.
Start Time
The time of day in which the service began, including
>A= for AM, or >P= for PM.
Length of Service
Hours of Service:
The number of hours the service was provided. Hours must be entered as whole numbers.
(For DFI, use this field to enter the number of transportation tokens.)
Minutes of Service:
Minutes of service should be rounded to the nearest quarter-hour increment based upon the actual number of minutes of delivered service (i.e., 1 hour, 45 minutes; 30 minutes; etc.). This field may be left blank, if there were
A00@ minutes.
E
XAMPLES OF
R
OUNDING
11 minutes = Rounded 15 minutes
20 minutes = Rounded 15 minutes
29 minutes = Rounded 30 minutes
Collateral ID
34 minutes = Rounded 30 minutes
40 minutes = Rounded 45 minutes
52 minutes = Rounded 45 minutes
When an activity code of 041 or 141, the collateral is a family member or significant other, a unique identifier shall be entered. There must be a demographic record in DARTS for client/patient in order to serve a collateral.
Video Counseling
Was this service delivered via video counseling? Enter
>Y= - Yes or >N= - No.
For program numbers „42‟ (Early Intervention), „43‟ (Level I) and „44‟ (Level II), the following Activity
Codes allowed for video counseling services:
01 - Individual
02 - Counseling Group
04 - Continued Stay Review and Discharge Planning
05 - Treatment Planning
06 - Didactic Group
11 - Psychiatric Evaluation
12 - Medication Monitoring
41 - Collateral – Family/Significant other
42 - Collateral – Other (Employer, friend, minister, etc.)
DASA HELP
– E-MAIL:
– FAX: 217.558.4656
| July 2013
31
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