IT Requirements Regarding the BHS Program Eligibility Database. The client population for the BHS Program includes low income and indigent mentally ill and/or substance abusing adults and children, participating in both inpatient and outpatient County programs. Eligibility is based on an interview process where BHS Program staff interviews the client to evaluate economic ability to pay, non-eligibility of client in other county or state programs (i.e. Medi-Cal), and if client is not covered, makes the BHS Program the payer of last resort by indicating the appropriate healthplan in the BHS Program Integrated Records Information System (IRIS). County’s Health Care Agency (HCA) Information Technology Staff pull the required data from IRIS and submit an eligibility file to Contractor as well as the contracted pharmacy consultant/quality assurance/auditor. This eligibility file is currently transmitted weekly, however, HCA is in the process of evaluating its capabilities to pull and send this data on a daily basis. Contractor agrees to accept the eligibility file at either a weekly or daily frequency as determined by the BHS Program. Contractor must submit 100% of all claims supporting documentation to the County- contracted pharmacy consultant/quality assurance/auditor as well as any reports detailing any edits or prior authorizations.
IT Requirements Regarding the BHS Program Eligibility Database. The client population for the BHS Program includes low income and indigent mentally ill and/or substance abusing adults and children, participating in both inpatient and outpatient County programs. Eligibility is based on an interview process where BHS Program staff interviews the client to evaluate economic ability to pay, non-eligibility of client in other county or state programs (i.e. Medi-Cal), and if client is not covered, makes the BHS Program the payer of last resort by indicating the appropriate healthplan in the BHS Program Integrated Records Information System (IRIS). County’s Health Care Agency (HCA) Information Technology Staff pull the required data from IRIS and submit an eligibility file to Contractor as well as the contracted pharmacy consultant/quality assurance/auditor. This eligibility file is currently transmitted weekly, however, HCA is in the process of evaluating its capabilities to pull and send this data on a daily basis. Contractor agrees to accept the eligibility file at either a weekly or daily frequency as determined by the BHS Program.
