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OCA details claims‑code set for behavioral‑health spending measurement, including screening and pharmacy rules
Summary
OCA proposed a claims‑based definition that would include claims with a primary behavioral‑health diagnosis, screening/assessment service codes regardless of diagnosis, place‑of‑service categorization and an NDC list to flag behavioral‑health drugs. Staff shared the draft code counts and sought input on how to capture screenings across settings.
The Office of Health Care Affordability on Oct. 9 presented a draft claims‑based methodology for identifying behavioral‑health spending in payer data, proposing a multi‑step process that uses diagnosis, service, place‑of‑service/revenue and national drug codes.
The proposal: include primary‑diagnosis behavioral‑health claims and screening/assessment service codes
Mary Jo Condon, principal consultant with Friedman Healthcare, outlined OCA’s high‑level rule: if a claim lists a behavioral‑health diagnosis in the primary diagnosis field it will be included in behavioral‑health spending totals; separate service codes for mental‑health or substance‑use screening and assessment would also be counted even when the claim’s primary diagnosis is not behavioral health. "All claims with behavioral health diagnosis, a primary behavioral health diagnosis will be…
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