CMBHS Access Request - Texas Health and Human Services



Clinical Management for Behavioral Health Services (CMBHS) Access Request

Employee Information:

Title:

First Name:      

Middle Name*:      

Last Name:      

Date of Birth:       (or) Employee /Contract Number:      

Office Phone:      

Email:      

Access Role(s):      

(Select one or more roles using the list on the second page as your guide. See page 2 for DSHS role descriptions. Do not leave blank.)

Report Roles:

|Check all that reports this person must access to fulfill their job responsibilities. |

| Client Reports (SA) | CMBHS Curriculum Reports (SA) |

| Dashboard Reports (SA) | Mental Health Reports (MH) |

| Billing Reports (SA) | NorthSTAR Reports (SA and MH) |

| Demographic Reports (SA) | DSHS MH YES Waiver Reports (MH) |

| Management Reports (SA) | YES Waiver Reports (MH) |

| Statewide Inpatient Care Waitlist | |

|I am familiar with the job duties of the individual identified on this form and I hereby approve the indicated access to CMBHS for this |

|individual. |

| |

|I agree to notify the CMBHS Team at teresa.cabral@dshs.state.tx.us and jackie.webster@dshs.state.tx.us if the listed employee/contractor’s job|

|duties change to no longer require access to CMBHS or upon the termination or departure of the listed employee/contractor. |

|(Must be signed by a DSHS/HHSC Manager) |

| | |

|Approved by:       |Date:       |

DESCRIPTION OF CMBHS SECURITY ROLES FOR DSHS

|ROLE |DESCRIPTION |ACCESS |DEFAULT PAGE |

|Roles |

|DSHS System |An individual designated by DSHo setup security and |Read/Write access to client records, sets up |Change Location |

|Administrator |ongoing maintenance of CMBHS. |organizations and staff on all levels | |

|DSHS Oversight |Quality Management, Contracts Management, Fiscal Auditors,|Read-only access to all organizations, client|Change Location |

| |Regulatory, Client Rights. |records and pages | |

|DSHS User Administrator |An individual designated by the DSHS to assist user with |Read/Write access to staff setup, user id and|Find/New Staff Page|

| |limited security functions such as user ids, passwords and|password maintenance for DSHS Staff. | |

| |adding new staff to the system. | | |

|DSHS Contracts |DSHS Contracts Management Unit Staff |Read-only access to administrative, financial|Change Location |

|Specialist | |and report functions. | |

|DSHS System Support |For CMBHS Help Line employee and others who provider |Read-Write accesses to set-up and other |Change Location |

| |training and technical assistance to users. |support pages; Read-only to client records. | |

|DSHS YES Authorized |Access needed to view and document CE and IPC |Read-Write access to YES Waiver CE and IPC. |Change Location |

|Reviewer |authorization decisions for YES Waiver Clients |Read-access to client records. | |

|DSHS IT Support |Access to needed functions and pages needed to develop and|Read-Write access to set-up, roles, client |Change Location |

| |test the application |and administrative functions | |

|Reports |

|ROLE |DESCRIPTION |ACCESS |

|Client Reports |Allows access to CMBHS Business Objects reports that relate to substance abuse (SA) |Available to DSHS & SA Providers |

| |clients, clinical documentation, and treatment services. | |

|Billing Reports |Gives access to an assortment of reports that relate to DSHS- substance abuse (SA) service|Available to DSHS & SA Providers |

| |billing activities, claims and payments. | |

|Demographic Reports |Allows access to CMBHS Business Objects that relate to general demographics of clients |Available to DSHS & SA Providers |

| |served by a substance abuse (SA) services business entity. | |

|Management Reports |Gives the user access to reports for oversight of employees, quality assurance, and |Available to DSHS & SA Providers |

| |performance data at substance abuse service locations. | |

|MH Reports |Allows access to an assortment of mental health (MH) reports |Available to DSHS & MH Providers |

|NorthSTAR Reports |Gives the user access to NorthSTAR MH and SA reports |Available to DSHS & NorthSTAR |

|DSHS SA Curriculum |Allows DSHS staff access to substance abuse curriculum reports |DSHS Only |

|Reports | | |

|DSHS MH YES Waiver |Gives the user access to YES Waiver DSHS only reports about all YES Waiver clients |DSHS Only |

|Reports | | |

|YES Waiver Reports |Allows YES LMHAs and provider managing agencies access to YES Waiver reports about their |Available to DSHS & YES Waiver |

| |clients only |Providers |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download