Behavioral Health Integration Collaborative Care Documentation Template

Documentation form for collaborative care management activities, including behavioral health care manager time, psychiatric consultation, and registry tracking to support CoCM billing and audit readiness.

Submission Notice

• Documentation Period
  Select the month or date range this collaborative care entry covers.
• Entry Type
  Choose the type of documentation being completed.
• Patient consent for collaborative care obtained?
  Document whether consent or disclosure required by your workflow has been completed.
• Consent Date
  Enter the date consent was obtained if applicable.
• Patient Identifier
  Use your organization’s approved identifier only if needed for registry linkage. Avoid collecting unnecessary PII.

Patient and Program Eligibility

• Care Setting
• Primary Behavioral Health Concern
• Registry Status
• Treatment Goal Summary
  Briefly summarize the current care goals, using only the minimum necessary detail.

Care Manager Time and Activities

• Behavioral Health Care Manager Minutes
  Enter the total minutes spent on CoCM activities during the billing period.
• Number of Care Coordination Contacts
  Count patient, family, or care team contacts related to collaborative care.
• Activities Completed
  Select all collaborative care activities completed during this period.
• Care Manager Notes
  Document clinically relevant coordination details, using minimum necessary information.

Psychiatric Consultation

• Psychiatric consultation completed?
• Consultation Date
• Consultant Recommendation Summary
  Summarize recommendations, medication guidance, or care plan changes.
• Recommendation implemented?

Registry Tracking and Billing Support

• Registry Review Date
• Symptom Measure Used
  Select the measure used for registry tracking if applicable.
• Current Measure Score
• Billing Code
• Billing Rationale
  Briefly explain how the documented activities support the selected billing code.

Attestation and Audit Trail

• Documented By
  Enter the role or name of the staff member completing this form, per organizational policy.
• Attestation
• Follow-up needed?
• Follow-up Details
  Describe the next action, owner, and due date if follow-up is needed.