BFD SAMHSA Filtering

BFD SAMHSA Filtering

This page describes SAMHSA data and how BFD filters this data.

What is SAMHSA and SAMHSA data?

SAMHSA is the Substance Abuse and Mental Health Services Administration, which as described oversees public health efforts relating to mental health and substance abuse. Specific types of patient diagnosis are categorized as SAMHSA data. Per federal law, this data has special confidentiality rules about who is authorized to view it.

How Does BFD Apply Filtering?

In accordance with Federal Law Regarding Drug and Mental Health Diagnosis Confidentiality (particularly CFR Title 42: Parts 2 and 51), BFD has the capability to filter claims which have SAMHSA data for requesters who do not have clearance to view them.

BFD applies SAMHSA filtering on both the adjudicated ExplanationOfBenefit endpoint as well as the partially adjudicated Claim and ClaimResponse endpoints by looking for the excludeSAMHSA parameter. If the value of excludeSAMHSA is true on the request, BFD will search specific fields for any SAMHSA related codes and exclude all claims which have those codes in them.

If excludeSAMHSA is passed as false or the parameter is not included, BFD will include all SAMHSA data in the response.

For adjudicated claims, BFD checks for SAMHSA data in six locations:

• DRG codes
• CPT (HCPCS) codes
• ICD9 diagnosis codes
• ICD10 diagnosis codes
• ICD9 procedure codes
• ICD10 procedure codes

For partially adjudicated claims, BFD checks for SAMHSA data in four locations:

• ICD9 diagnosis codes
• ICD10 diagnosis codes
• ICD9 procedure codes
• ICD10 procedure codes

The list of SAMHSA codes that BFD matches on can be found here: https://github.com/CMSgov/beneficiary-fhir-data/tree/master/apps/bfd-server/bfd-server-war/src/main/resources/samhsa-related-codes