Behavioral

An indicator showing that a member has a documented intellectual or developmental disability, a population segment that frequently requires specialized behavioral health benefit carve-outs, distinct service authorization rules, and dedicated provider networks in most state Medicaid programs.

An indicator showing that a member's inpatient psychiatric admission was initiated under involuntary commitment statutes due to assessed danger to self or others, as distinct from a voluntary admission, a field with significant legal documentation and reporting requirements.

An indicator showing that a behavioral health provider is systematically administering standardized outcome measures at regular intervals and using the results to guide treatment decisions, a practice associated with improved clinical outcomes and increasingly required under value-based behavioral health contracts.

A binary indicator showing whether a member's substance use disorder treatment plan includes medication-assisted treatment, such as buprenorphine, methadone, or naltrexone, in combination with behavioral therapy. This flag is used in quality measure reporting and population health dashboards tracking access to evidence-based opioid use disorder treatment.

An indicator showing that a clinical medication reconciliation review was completed during a behavioral health encounter, comparing currently prescribed psychiatric medications against what the member is actually taking, a key safety practice tracked at care transition points.

An indicator derived from member-reported outcome data showing clinically meaningful improvement on a validated symptom or functioning measure between treatment intake and a defined follow-up point, used in value-based behavioral health outcome reporting.

An indicator showing that a member on long-term antipsychotic medication received recommended metabolic monitoring, such as weight, glucose, and lipid screening, addressing the elevated cardiometabolic risk associated with certain psychiatric medication classes.

An indicator showing that a mobile crisis team was dispatched to respond to a member experiencing a behavioral health emergency in the community, rather than the member presenting to a fixed-location emergency department, used to measure community-based crisis response capacity and effectiveness.

An indicator showing that a member with an opioid use disorder diagnosis or known opioid risk factors has an active prescription for naloxone, an opioid overdose reversal medication. This flag supports overdose prevention quality programs and harm reduction outreach targeting.

A code identifying the outcome of a clinical peer-to-peer review conducted between a treating behavioral health provider and a payer's medical director, such as authorization upheld, authorization modified, or denial upheld, used in appeals and grievance tracking.

An indicator showing that a behavioral health encounter was delivered in whole or in part by a certified peer support specialist, an individual with lived experience of mental illness or substance use recovery who provides non-clinical support services. This service type is increasingly reimbursable under Medicaid behavioral health benefits and is tracked separately from licensed clinical encounters.

An indicator showing that a member is concurrently prescribed multiple psychiatric medications meeting a defined polypharmacy threshold, used in medication safety monitoring programs that identify members at elevated risk of adverse drug interactions or side effect burden.

An indicator showing that a postpartum patient was screened for depression using a validated instrument such as the Edinburgh Postnatal Depression Scale, supporting maternal behavioral health quality measures increasingly required in perinatal care quality programs.

The principal ICD-10-CM diagnosis code reflecting the primary behavioral health or substance use condition being treated during an encounter, such as major depressive disorder, generalized anxiety disorder, or substance use disorder. This field drives clinical grouping logic, level-of-care determination, and payer medical necessity review, and must be distinguished from secondary or comorbid diagnosis codes which provide additional clinical context but do not represent the chief reason for treatment.

A binary flag indicating whether a psychiatric case, treatment episode, or service record is currently active within the behavioral health system. Used to filter active mental health cases from closed or historical records in care management workflows and utilization reporting.

A categorical value representing the operational state of a psychiatric service, episode, or authorization record, such as active, inactive, suspended, or terminated. Used in behavioral health management systems to track the current lifecycle stage of mental health treatment episodes.

The physical location text associated with a mental health provider, facility, or patient record in EHR and claims systems. Used to route psychiatric referrals, validate provider directories, and support geographic network analysis for behavioral health services.

The dollar value of financial modifications applied to a psychiatric service claim or payment record, including contractual adjustments, write-offs, or corrections. Used in behavioral health billing to reconcile the difference between billed charges and final reimbursement amounts.

The patient's age in years at the time of a psychiatric encounter, admission, or assessment. Used in behavioral health analytics to stratify mental health service utilization, support age-appropriate treatment planning, and comply with reporting requirements for child, adolescent, and geriatric psychiatric programs.

The maximum dollar amount a payer will reimburse for a psychiatric service based on fee schedules or contractual agreements. Used in behavioral health claims processing to determine plan liability and calculate member cost-sharing obligations for mental health services under parity regulations.