Behavioral

An indicator showing that a clinical encounter represents a documented relapse to substance use or a return of significant behavioral health symptoms following a period of stability or remission, used in longitudinal outcomes tracking and relapse-prevention program effectiveness analysis.

An indicator showing that a physical restraint or seclusion intervention was used during a behavioral health inpatient stay, a heavily regulated event type subject to mandatory incident reporting and a key quality and safety metric in inpatient psychiatric facility oversight.

An indicator showing that a behavioral health service was delivered within a school-based setting, a growing service delivery channel for pediatric behavioral health that has distinct billing, consent, and confidentiality rules compared to clinic-based care.

An indicator showing that a behavioral health encounter or facility stay involved a serious reportable adverse event such as a completed suicide, serious self-harm, or significant safety incident, triggering mandatory root cause analysis and regulatory reporting obligations.

A flag identifying children or adolescents meeting the clinical criteria for serious emotional disturbance, a designation used to qualify youth for enhanced behavioral health services, wraparound care coordination, and certain federal and state funding streams targeted at pediatric mental health populations.

A flag identifying members meeting the clinical and functional criteria for serious mental illness, typically defined as a diagnosable mental disorder resulting in significant functional impairment that substantially interferes with major life activities. This population segment is used for targeted case management programs and certain state Medicaid eligibility categories.

The length of a single behavioral health treatment session expressed in minutes, used to validate that billed CPT codes for psychotherapy such as 90834 for 45 minutes or 90837 for 60 minutes align with the actual clinical time documented, supporting both billing accuracy and clinical workload analysis.

An indicator showing that a claim was processed under a single case agreement, a one-time contractual arrangement allowing an out-of-network behavioral health provider to be reimbursed at in-network rates for a specific member when no adequate in-network provider is available.

An indicator showing that a member transitioned from a higher level of behavioral health care to a lower less intensive level of care as part of a planned continuum of treatment, such as moving from inpatient to partial hospitalization or from residential to intensive outpatient.

A standardized code classifying the specific substance or class of substances driving a substance use disorder diagnosis, such as alcohol, opioid, stimulant, or polysubstance use. This classification supports targeted population health interventions, medication-assisted treatment eligibility determination, and regulatory reporting required under various state and federal substance use treatment programs.

A numeric or categorical score resulting from a standardized suicide risk assessment tool, such as the Columbia-Suicide Severity Rating Scale, administered during a behavioral health encounter. This field supports clinical decision support alerts, care escalation protocols, and population-level risk stratification for high-acuity case management programs.

A flag indicating whether a behavioral health encounter was delivered via telehealth, including synchronous audio-video, audio-only telephonic, or asynchronous formats, as distinct from in-person service delivery. This field is critical for tracking compliance with telehealth parity regulations and analyzing access patterns across rural and underserved populations.

The number of calendar days elapsed between a member's initial request for behavioral health services and their first scheduled appointment, a key access-to-care metric tracked against regulatory appointment availability standards and used in network performance scorecards.

An indicator showing that a behavioral health program or specific encounter follows a trauma-informed care model, which emphasizes safety, trustworthiness, and avoidance of re-traumatization in service delivery, used in program certification tracking and quality reporting.

A code identifying how a member's behavioral health treatment episode concluded, such as successful completion, clinician-initiated discharge, member-initiated dropout, or transfer to another level of care, used in episode-level outcomes analysis.

A code identifying the specific therapeutic approach or format used during a behavioral health session, such as individual therapy, group therapy, family therapy, cognitive behavioral therapy, dialectical behavior therapy, or medication management. This field allows data teams to analyze treatment patterns and outcomes by modality independent of the underlying diagnosis or level of care.

The date on which a member's behavioral health treatment plan was formally reviewed and updated by the treating clinician or treatment team, a documentation requirement under most state licensing regulations and accreditation standards used to verify ongoing clinical oversight of the treatment course.

A code reflecting the result of a urine drug screening test administered during substance use disorder treatment, indicating presence or absence of specific substances or substance classes. This field supports treatment plan adjustments and is documented separately from standard laboratory result tables due to its behavioral-health-specific clinical context.

An indicator showing that a member was transferred between behavioral health providers or levels of care through a direct real-time introduction rather than a passive referral, a practice associated with significantly higher rates of successful treatment engagement, particularly during care transitions from inpatient to outpatient settings.

A flag identifying whether a behavioral health encounter included medically supervised withdrawal management, commonly referred to as detoxification, for a member experiencing substance withdrawal symptoms. This indicator distinguishes acute stabilization services from ongoing rehabilitative treatment and is used in both clinical pathway analysis and facility staffing models.