Provider Monitoring Changes Made for Agencies and LIPs

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:

  1. Is there evidence the provider agency meets the access standards related to appointment availability (emergency, urgent and routine need)?
  2. Is there evidence the provider agency meets the access standards related to Office Wait Time (scheduled, walk-ins and emergency)?
  3. Is there evidence the provider agency provides physical access, reasonable accommodations, and accessible equipment for enrollees with physical or mental disabilities?
  4. 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 ajohndro@alliancebhc.org​



Page last modified: July 7, 2017