Provider Alerts

Healthcare Effectiveness Data and information Set (HEDIS)
For Measurement Year 2023

Behavioral Health Emergency Department Follow up Care:
FUM – Follow-up After Emergency Department (ED) Visit for Mental Illness – Patients 6 years and older who visited the ED and had a diagnosis of mental illness or intentional harm and any diagnosis of a mental disorder.
FUA – Follow-up after Emergency Department (ED) Visit for Substance Use– Patients 13 years and older who visited the ED and had a diagnosis of substance use disorder (SUD) or ANY diagnosis of drug overdose.
• Patients discharged from the ED meeting any of the above criteria should receive a follow up care visit with a PCP or Behavioral Health (BH) provider within 7 days of discharge from the ED.
• If for any reason patient is unable to be seen within 7 days of discharge, patients should receive a follow up care visit with a PCP or BH Specialist within 30 days of discharge from the ED.
Recommended Best Practices:
• Encourage patients to bring their discharge paperwork to appointments
• Educate patients on the importance of follow up care and adhering to recommended treatments
• Coordinate care with the patients BH provider including sharing notes and updates as needed
• Reach out to patients who cancel appointments and reschedule as soon as possible
• Other services and care can be rendered during the follow up visit, but principal reason for visit should be ED follow up care in documentation and billing.

For additional information on Behavioral Health benefits and services from HPSJ visit:
https://www.hpsj.com/behavioral-health-services/

If you have questions or need assistance, please call our Provider Services team at (209) 942-6340. You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.