As of July 3, 2017 the state of North Carolina has made changes to the provider monitoring process. As stated from the LME-MCO Communication Bulletin #J254, providers who are fully accredited by an accrediting body (CQI, COA, CARF, The Joint Commission) will no longer require a “Routine” monitoring. However, the every 2 year post-payment review will continue. As a result of this change some items were added to the post-payment review for ALL agencies (accredited and non-accredited) and licensed independent practitioners. Those items are:
- Is there evidence the provider agency meets the access standards related to appointment availability (emergency, urgent and routine need)?
- Is there evidence the provider agency meets the access standards related to Office Wait Time (scheduled, walk-ins and emergency)?
- Is there evidence the provider agency provides physical access, reasonable accommodations, and accessible equipment for enrollees with physical or mental disabilities?
- The question regarding coordination of care has been moved from the routine monitoring tool to the post-payment tab.
See guidelines for further clarification on these items. If you have any questions please contact Amy Johndro, Provider Network Evaluator Supervisor, at 919-651-8454 or email@example.com