The language of
behavioral health software.
51+ definitions across clinical, compliance, operations, technology, and AI. Bookmark this; share it with new hires.
Clinical
Note formats, assessments, levels of care, and the documentation backbone of behavioral health.
Copy link ASAM Criteria
ASAM (American Society of Addiction Medicine) Criteria is the standard assessment framework for matching patients to the appropriate level of substance use treatment. Currently in its 4th Edition (published October 2023), which most commercial payers now reference in their medical-necessity policies. The criteria evaluate six dimensions including withdrawal risk, biomedical conditions, emotional/behavioral conditions, readiness for change, relapse potential, and recovery/living environment to recommend a level of care from outpatient through medically managed inpatient. ASAM-aware EMRs like Navix automate parts of this assessment and flag mismatches between documented dimensions and the assigned level of care.
View term page →Copy link BIRP Note
BIRP stands for Behavior, Intervention, Response, Plan — a behavioral-health note format that emphasizes the clinician's intervention and the client's response. Common in therapy, group counseling, and case management settings.
View term page →Copy link DAP Note
DAP is a behavioral-health-specific clinical note format: Data (objective and subjective information combined), Assessment (clinical interpretation), and Plan (next steps). Common in counseling and case management. NavixScribe supports DAP alongside SOAP, BIRP, GIRP, and SIRP.
View term page →Copy link GIRP Note
GIRP is a goal-oriented note format: Goal, Intervention, Response, Plan. Each session note ties back to a specific treatment-plan goal. Common in long-term programs where progress against goals matters.
View term page →Copy link LOCUS
LOCUS (Level of Care Utilization System) is the assessment framework for matching adults to mental health levels of care. Like ASAM for addiction, LOCUS uses six dimensions to determine the appropriate care intensity, from outpatient through medically managed residential. LOCUS scores are commonly required by payers for behavioral health prior authorization and continued-stay reviews.
View term page →Copy link MAT (Medication-Assisted Treatment)
MAT combines FDA-approved medications (methadone, buprenorphine, naltrexone) with counseling and behavioral therapies to treat substance use disorders. MAT is the evidence-based standard of care for opioid use disorder and is increasingly used for alcohol use disorder. EMRs supporting MAT must handle controlled-substance e-prescribing (EPCS) and integrate with state prescription drug monitoring programs.
View term page →Copy link SIRP Note
SIRP stands for Situation, Intervention, Response, Plan — a behavioral-health note format that begins with the situational context that brought the client to the session.
View term page →Copy link SOAP Note
SOAP is the most common clinical documentation format. It stands for Subjective (what the client reports), Objective (clinician observations), Assessment (clinical interpretation), and Plan (next steps). NavixScribe writes SOAP notes automatically from session audio.
View term page →Copy link Treatment Plan
A treatment plan is the formal clinical document specifying a client's goals, objectives, interventions, and timeframe for behavioral health treatment. Required for billing, accreditation, and continued-stay authorizations. Plans are typically reviewed every 30–90 days. Navix's Treatment Plan Generator drafts plans from chart context for clinician review and approval.
View term page →
Compliance
Regulations, accreditations, and certifications every behavioral health platform must answer to.
Copy link 42 CFR Part 2
42 CFR Part 2 is the federal regulation governing the confidentiality of substance use disorder patient records. Part 2 places stricter controls than HIPAA on disclosure of SUD records: written patient consent is generally required for any disclosure, and recipients are prohibited from re-disclosure. Behavioral health software handling addiction treatment records must implement Part 2 safeguards in addition to HIPAA.
View term page →Copy link CARF
CARF (Commission on Accreditation of Rehabilitation Facilities) is an international accreditation body widely used by behavioral health and rehabilitation programs. CARF emphasizes outcomes, quality, and consumer-focused services. Like JCAHO, accreditation is often required by payers and referral sources.
View term page →Copy link EPCS
EPCS (Electronic Prescribing of Controlled Substances) is the DEA-required certification for software that allows electronic prescribing of Schedule II–V controlled substances. Required in nearly all states. Navix EMR includes EPCS-certified e-prescribe.
View term page →Copy link HIPAA
HIPAA (Health Insurance Portability and Accountability Act) is the US federal law governing the privacy and security of Protected Health Information (PHI). The Privacy Rule restricts uses and disclosures of PHI; the Security Rule mandates administrative, technical, and physical safeguards; the Breach Notification Rule requires notification when unsecured PHI is compromised. Software vendors that process PHI must sign Business Associate Agreements with covered entities. Navix is HIPAA compliant.
View term page →Copy link JCAHO / Joint Commission
The Joint Commission (formerly JCAHO) is a US accrediting body for healthcare organizations including behavioral health programs. Accreditation is voluntary but commonly required by payers. Surveys evaluate documentation, patient safety, infection control, leadership, and other domains. Navix's Compliance Agent helps facilities maintain ongoing audit readiness.
View term page →Copy link SOC 2
SOC 2 (Service Organization Control 2) is an audit framework that verifies a service organization's controls relevant to security, availability, processing integrity, confidentiality, and privacy. SOC 2 Type II reports cover an extended audit period (typically 6–12 months). Many enterprise behavioral health customers require SOC 2 certification before signing. Navix is SOC 2 certified.
View term page →Copy link TCPA
The TCPA (Telephone Consumer Protection Act) regulates SMS and automated telephone communications in the United States. Compliant SMS programs require explicit opt-in with full disclosure language, disclosed message frequency, and clear opt-out instructions (e.g., reply STOP). Navix's SMS program follows full TCPA compliance.
View term page →
Operations
Billing codes, revenue cycle, and the workflow vocabulary of admissions and front office.
Copy link CPT Codes
CPT (Current Procedural Terminology) codes are the standard medical-procedure codes used for billing. Behavioral health uses a specific subset including 90837 (60-minute psychotherapy), 90832 (30-minute), 90847 (family therapy with patient), 90853 (group therapy), and many more. Navix's AI Coding Suggestions flags the right CPT codes from session content.
View term page →Copy link ERA (Electronic Remittance Advice)
An ERA is the electronic version of a paper Explanation of Benefits (EOB) — payment information from a payer detailing how a claim was adjudicated. ERAs can be auto-posted into the EMR's accounts receivable, with discrepancies flagged for billing-team follow-up.
View term page →Copy link ICD-10
ICD-10 is the World Health Organization's classification of diseases used for diagnosis coding. F-codes cover mental, behavioral, and neurodevelopmental disorders. Navix's AI suggests ICD-10 diagnosis codes based on clinical documentation.
View term page →Copy link RCM (Revenue Cycle Management)
RCM is the end-to-end process of getting paid for healthcare services: insurance verification, charge capture, claims building, claims submission, payment posting, denial management, and patient billing. RCM software automates these steps. Navix's RCM Automation Platform uses AI agents to build claims from EMR data and run rejection analysis with minimal manual touches.
View term page →Copy link UR (Utilization Review)
UR is the process of justifying continued coverage of treatment to an insurance payer. UR reports include the client's clinical presentation, current treatment plan, level-of-care assessment (ASAM, LOCUS), progress since the last review, and clinical justification. Insurance companies use UR to authorize continued stay or step-down. Navix's Authorizations Assistant builds UR reports automatically from chart data.
View term page →Copy link VOB (Verification of Benefits)
VOB is the process of confirming a prospective patient's insurance coverage before treatment begins. It establishes whether the payer covers the proposed service, in-network or out-of-network status, deductible and co-insurance amounts, prior authorization requirements, and any coverage limits. Manual VOB historically takes 2–4 hours per patient. Navix's VOB Agent automates the lookup across payer portals.
View term page →
Technology
APIs, interoperability standards, and the plumbing connecting modern health systems.
Copy link API
An API (Application Programming Interface) is a defined way for software systems to talk to each other. Modern healthcare APIs are typically REST-based (HTTP + JSON) and use OAuth 2.0 for authentication. Navix's public API at api.navixhealth.com lets developers read and write charts, manage clients, fire automations, and subscribe to webhooks.
View term page →Copy link EMR vs EHR
An EMR (Electronic Medical Record) is the digital chart maintained by a single practice or facility — used internally for that organization's patients. An EHR (Electronic Health Record) is broader: designed to share patient records across multiple providers, hospitals, and care settings. The terms are often used interchangeably; in behavioral health, most platforms (including Navix) function as an EMR for the host organization with EHR-style structured data exchange where needed.
View term page →Copy link FHIR
FHIR (Fast Healthcare Interoperability Resources) is the modern standard for exchanging healthcare data between systems. FHIR is RESTful, JSON-based, and built on web standards. Resources include Patient, Encounter, Observation, MedicationRequest, ServiceRequest, DiagnosticReport, and many more. FHIR is the foundation for modern lab integrations, EHR-to-EHR data exchange, and patient apps. Navix supports FHIR R4 across its lab and integration surface.
View term page →Copy link HL7 v2
HL7 v2 is the older but still ubiquitous healthcare data exchange standard. It uses pipe-delimited segments (ORM for orders, ORU for results, ADT for admit-discharge-transfer) over MLLP or file-based transport. While FHIR is the future, most US labs and many older systems still operate on HL7 v2. Navix supports both.
View term page →Copy link PHI (Protected Health Information)
PHI is any individually identifiable health information that is created, received, or transmitted by a HIPAA-covered entity. PHI includes names, addresses, dates, medical record numbers, email addresses, biometric identifiers, photographs, and any other identifier when combined with health information. Software handling PHI must implement HIPAA's required safeguards.
View term page →Copy link Webhook
A webhook is an HTTP callback — when an event happens in one system, that system pushes a payload to a configured URL. Navix supports webhooks for chart events, status changes, automation fires, and more. Webhooks enable real-time integration without polling.
View term page →
AI
The vocabulary behind AI scribes, agentic workflows, and the new clinical operating layer.
Copy link Agentic AI
Agentic AI refers to AI systems that don't just answer questions or generate content — they autonomously execute multi-step workflows. Where traditional AI features are reactive, agentic AI is proactive: a VOB Agent verifies benefits across payer portals, an alumni follow-up agent reaches out post-discharge, an authorizations assistant builds UR reports from chart data. Each agent is a specific named capability rather than a generic chat interface.
View term page →Copy link AI Scribe
An AI scribe is an AI-powered tool that listens to a clinical session — either in real time or from an uploaded audio file — and automatically produces a structured clinical note. Modern AI scribes go beyond raw transcription: they identify section structure (subjective, objective, assessment, plan), generate notes in chosen formats, and integrate directly into the EMR. NavixScribe is a behavioral-health-specific AI scribe.
View term page →Copy link De-identification
De-identification is the process of removing identifiers from health data so it cannot be linked back to a specific individual. HIPAA's Safe Harbor standard (45 CFR 164.514(b)(2)) lists 18 identifier categories that must be removed (names, dates, account numbers, biometrics, etc.). De-identified data is no longer PHI and can be used for research, analytics, and AI training without HIPAA restrictions. Navix's AI training uses de-identified data only.
View term page →Copy link LLM (Large Language Model)
An LLM is a foundation AI model trained on massive text data, capable of understanding and generating human language. GPT-4, Claude, Gemini, and Llama are LLMs. In healthcare, LLMs power AI scribes, chart summarization, and agentic workflows. The leading clinical AI platforms tune general-purpose LLMs against clinical data to improve accuracy in medical contexts.
View term page →Copy link MCP (Model Context Protocol)
MCP is the emerging open standard for connecting AI agents to systems and data sources. Created by Anthropic, MCP is being adopted by Claude, ChatGPT, Cursor, and other AI tools. An MCP server exposes capabilities (read data, take actions) to any compatible AI client. Navix exposes its capabilities as MCP servers — meaning any AI agent can read Navix data and execute Navix actions through a single secure protocol.
View term page →Copy link RAG (Retrieval-Augmented Generation)
RAG is an AI architecture pattern where a language model retrieves relevant data from a knowledge base before generating a response. In healthcare, RAG lets AI answer questions grounded in the actual chart rather than hallucinating. Navix Intelligence (chart-chat) uses RAG over Navix data so answers reference real clinical content.
View term page →
Medi-Cal & Medicaid Systems
County and state behavioral health data systems, reporting models, and the acronyms operators must navigate to get paid.
Copy link 245G
Minnesota Statutes chapter 245G is the licensing chapter for substance use disorder treatment programs, governing assessment, treatment planning, staff qualifications, documentation, and service delivery; withdrawal management programs are licensed separately under chapter 245F. Minnesota's 2025 legislation amended 245G.07 to restructure SUD services around ASAM criteria, replacing the old treatment-service structure with ASAM-aligned service types, effective July 1, 2026 or upon federal approval, with a DHS operational go-live of August 1, 2026.
View term page →Copy link BHASO
A Behavioral Health Administrative Service Organization is a Colorado Behavioral Health Administration-contracted regional entity that builds and manages the provider network for non-Medicaid, safety-net behavioral health, handling contracting, payment, care coordination, and data collection. Four regions went live July 1, 2025: Rocky Mountain Health Plans serves Region 1 and Signal Behavioral Health Network serves Regions 2 through 4. BHASOs are distinct from the Medicaid RAEs, though they share the same four-region map.
View term page →Copy link CalOMS Tx
CalOMS Treatment is California's data collection and outcomes reporting system for publicly funded substance use disorder treatment. Any provider receiving public funding for SUD services, and all opioid treatment programs, must report CalOMS Tx for every client at admission, discharge, and an annual update for clients in treatment over 12 months, submitted to the county at least monthly. County SUD systems such as San Diego's SmartCare collect and transmit CalOMS Tx data to the state.
View term page →Copy link CCBHC / PPS-1
A Certified Community Behavioral Health Clinic (CCBHC) is a clinic model that provides a comprehensive set of behavioral health services and, under the Medicaid demonstration, is paid a clinic-specific daily Prospective Payment System rate (PPS-1) for all CCBHC services furnished to a person on a given day, rather than fee-for-service per procedure. The rate is cost-based and set per clinic, and CCBHCs carry heavy quality, cost-report, and staffing obligations. Michigan operates one of the largest CCBHC demonstrations.
View term page →Copy link CMHSP
A Community Mental Health Services Program is a county-based public entity in Michigan that delivers behavioral health services within a Prepaid Inpatient Health Plan's regional network. PIHPs hold the Medicaid risk and manage the network; CMHSPs deliver the services under the PIHP. Providers on the specialty behavioral health track enroll and bill through Michigan's CHAMPS system.
View term page →Copy link CoBHRM
The Colorado Behavioral Health Reporting Model is the state's unified behavioral health data-reporting model, launched July 1, 2026 by the Behavioral Health Administration. It consolidates five legacy data sets — CCAR, DACODS, ACT, FEP, and the Special Connections pregnancy and postpartum screening — into a single client-centric framework submitted through the Treatment Management System (TMS), eliminating duplicative data for clients with both mental health and SUD needs. BHASO-contracted providers get submission specifications from their BHASO.
View term page →Copy link DAANES
The Drug and Alcohol Abuse Normative Evaluation System is Minnesota's SUD treatment data system. Providers must enroll and participate in DAANES, and every SUD client must be entered for each admission episode regardless of funding source. A provider does not receive reimbursement as a SUD treatment provider unless DAANES requirements are met. Data is collected at admission, a six-month review for opioid treatment clients, and discharge.
View term page →Copy link DMC-ODS
The Drug Medi-Cal Organized Delivery System is California's Medicaid model for substance use disorder treatment. Participating counties administer it as prepaid inpatient health plans, organizing care around ASAM levels and controlling access, authorization, and claims for Drug Medi-Cal services. Providers contract with the county rather than the state directly. Los Angeles runs DMC-ODS through SAPC and the Sage system; other counties use their own information systems such as IRIS in Orange County and SmartCare in San Diego. See dhcs.ca.gov.
View term page →Copy link IRIS (Orange County)
IRIS (Integrated Records Information System) is the Orange County Health Care Agency's billing system for all Behavioral Health Services county and contract mental health and SUD programs, and the documentation platform for county-operated programs. Contract providers enter services into IRIS and the county's IT and EDI unit submits the resulting Medi-Cal claim; there is no documented path for a contract provider to submit its own 837 directly to the county. OCHCA issued a 2025 Request for Information exploring EHR-system replacement.
View term page →Copy link MichiCANS
The Michigan Child and Adolescent Needs and Strengths (MichiCANS) Screener is the state-designated standardized mental health assessment for enrollees birth through 18. Under the Mental Health Framework, providers serving Medicaid Health Plan enrollees must incorporate MichiCANS, and LOCUS for adults, for dates of service on and after October 1, 2025. Per Bulletin MMP 26-01, the MichiCANS Screener bills as HCPCS H0002 with modifier 7Y and LOCUS as H0031 with modifier WX.
View term page →Copy link PIHP
A Prepaid Inpatient Health Plan is a regional Medicaid managed-care entity that administers a state's specialty behavioral health benefit. In Michigan, MDHHS contracts with 10 regional PIHPs for the specialty behavioral health benefit — serious mental illness, serious emotional disturbance, intellectual and developmental disabilities, and SUD — and the PIHPs contract with county Community Mental Health Services Programs (CMHSPs) as their provider network. Mild-to-moderate outpatient mental health is instead the responsibility of the enrollee's Medicaid Health Plan.
View term page →Copy link ProviderConnect NX
ProviderConnect NX (PCNX) is the web interface LA County uses for its behavioral health information systems, communicating in real time with the county's underlying record. For the Department of Mental Health, PCNX writes through to Avatar NX and is the mandatory interface for contracted Legal Entity providers to submit admissions, financial eligibility, diagnosis, authorizations, and concurrent review. It is also the platform Sage runs on for the SUD side.
View term page →Copy link RAE (Regional Accountable Entity)
A Regional Accountable Entity is a Colorado Medicaid (Health First Colorado) entity that administers the capitated behavioral health benefit for members in its region under the Accountable Care Collaborative Phase III, which launched July 1, 2025. To bill Medicaid behavioral health in Colorado, a provider must enroll with HCPF and contract and credential directly with the RAE for its region. RAEs are HCPF's Medicaid entities, separate from the BHA's non-Medicaid BHASOs.
View term page →Copy link Sage (LA County SAPC)
Sage is the substance use information system for Los Angeles County's Substance Abuse Prevention and Control division (SAPC), running on the ProviderConnect NX platform. All SUD providers contracted with LA County must use Sage, either as Primary Users, where Sage is their EHR, or as Secondary Users, who run their own EHR and submit 837P/837I claim files to Sage built to SAPC's companion guides.
View term page →Copy link Sage Secondary User
A Sage Secondary User is an LA County SAPC-contracted SUD provider that runs its own electronic health record instead of using Sage as its EHR, and submits claims to Sage as 837P or 837I files formatted to SAPC's companion guides. Providers convert from Primary to Secondary during an annual window: the request is due by January 31, 837 testing begins by March 31 and completes by June 30, and the agency must reach an 80% adjudication approval rate. Withdrawal Management 3.7 and 4.0 use the 837I guide; all other services use 837P.
View term page →Copy link SmartCare (behavioral health)
SmartCare is a semi-statewide electronic health record offered through the California Mental Health Services Authority (CalMHSA). In San Diego County it replaced SanWITS on September 1, 2024 as the county record for the SUD System of Care, and it is the county EHR for the mental health system as well. Providers running their own EHR are not exempt; the county requires dual entry of client data, state reporting, and billing into SmartCare.
View term page →
We expand this glossary as the field evolves.
Send us a term you want defined. Operators, clinicians, and engineers shape this list — write to connect@navixhealth.com or call 855-490-1982.
- Edition2026 · Updated quarterly
- DomainsClinical · Compliance · Ops · Tech · AI
- Open toClinicians · Operators · Engineers