Providers

Client Data Collection and Reporting

Monthly Reporting – Mental Health

Effective , all service authorizations reported on the Monthly Client Service Reports (610) with a start date on or later will need to use the ICD-10 diagnosis codes. Services authorizations that started prior to will use the ICD-9 diagnosis codes.

This is in response to the Centers for Medicare and Medicaid Services (CMS) mandate to implement the International Classification of Diseases, 10th Revision codes sets for diagnosis and procedure codes beginning on .

More information on the ICD-10 diagnosis codes may be found on the ForwardHealth web site at: www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/html/ICD10/ICD10Home.htm.spage

If you have any questions, please contact your DCDHS Contract Manager.

Monthly Client Services Report

Monthly Client Services Report – Mental Health (610 Form) version 4.4.7, revised 2014-12-18 (version 4.4.8 with no active code, uploaded 2015-01-08)
Monthly Client Services Report Instruction Manual

If required by their contract, service providers must use the Monthly Client Services Report (610 Form) to collect unit of service and opening and closing reason information on clients receiving publicly funded services. (For alcohol and other drug abuse programs, please refer to the AODA Monthly Client Report.)

Monthly reports are due on the tenth (10th) of the following month. Instructions for submitting the reports are included on page 18 of the Instruction Manual.

If you have questions about this report, please call your designated data entry contact.

Mental Health Episode (Supplemental) Form

Mental Health Episode Form

If a Mental Health service provider is required to submit monthly Client Service reports, they must also submit Mental Health Episode reports. These reports are used to collect qualitative information required by the State for people served through the public mental health system.

Data is to be collected at the beginning of an episode of services. Updates must be completed at six-month intervals thereafter for clients receiving ongoing comprehensive services.

These forms must be collected and mailed or faxed to the Department by the 10th of the following month. If mailed, please send them to:

Data Entry Contact
Department of Human Services
1202 Northport Drive
Madison WI 53704

Or please fax them to Designated Data Entry Contact at 608-242-6288.

If you have questions about this form, please call your designated entry contact.

In addition to the Mental Health Episode reports, Mental Health providers must submit monthly client services reports (610s).