Provider Monitoring
The Provider Monitoring process is designed for:
- Entry into the provider network
- The review of service providers in accordance with State and Federal Requirements.
The provider monitoring process is outlined in all the workbooks, and LME-MCO #J254 – Changes to the Agency Monitoring Process serves as the primary guidance moving forward.
Electronic communication provided on 7/31/2017 will provide information specific to the DHHS Provider Review Database Process.
Special Announcements
- 7/1/2019 – Communication with LME-MCO CEO and Waiver Contract Managers
- Update: Update to the Generic Tool and LIP Tool Guidelines – follow up to 4/22/2019 Clarification
- Effective: 4/22/2019 – Posted: 7/1/2019
- 4/22/2019 – Communication with LME-MCO CEO and Waiver Contract Managers
- Update: Clarification to Staff Qualification Worksheets and LIP Monitoring Tool effective 12/10/2018
- Effective: 4/22/2019 – Posted: 4/24/2019
- 11/30/2018 – Communication with LME-MCO CEOs and Waiver Contract Managers
- Update: Revision to LIP/Group Practices and Agencies Billing Outpatient Services Only (BH) – Guidelines and Workbook
- Effective: 12/10/2018 – Posted: 11/30/2018
- 6/25/2018 – LME-MCO Communication Bulletin #J292
- Changes to DHHS LIP/Agency Practice Provider Monitoring Review Process
- 5/2/2018 – Communication with LME-MCO CEOs and Waiver Contract Managers
- Update: Revisions to Provider Monitoring Tools
- 7/31/2017 – Communication with LME-MCO CEOs and Waiver Contract Managers
- Update: DHHS Provider Review Database Process, October 2015
- 6/17/2017 - LME-MCO Communication Bulletin #J254
- Changes to the Agency Monitoring Process
- Frequently Asked Questions
- Effective: 5/3/2018 – Posted: 5/2/2018
The revised Provider Monitoring Tools are effective as of April 22, 2019
- DHHS Monitoring Tools for Providers
- Effective: 4/22/2019 – Posted: 7/1/2019
- Guidelines revised.
- DHHS Review Tool for LIPs/ Group Practices and Agencies Billing Outpatient Services Only (BH)
- Effective: 4/22/2019 – Posted: 7/1/2019
- Guidelines revised
The revised Provider Monitoring Tools are effective as of May 3, 2018
- DHHS New Unlicensed Site Review Tool for Providers
- Effective: 5/3/2018 – Posted: 5/2/2018
- Clinical Coverage Policies updated May 3, 2018.
- DHHS Unlicensed AFL Review Tool for Providers
- Effective: 5/3/2018 – Posted: 5/2/2018
- Guidelines revised and Clinical Coverage Policies updated effective May 3, 2018.
Review Information and Tools
Monitoring Consists of the Following:
- For Licensed Independent Practitioners/Group Practices and Agencies Billing Outpatient Services Only (BH) – the Post Payment Tool will be utilized.
- For Unlicensed AFLs – the Unlicensed AFL Review Tool will be utilized.
- Providers that are Nationally Accredited – the appropriate Post Payment Tool will be utilized and is based on the combination of services included in the sample.
- For services that DHSR -MHL surveys on an annual basis only a post-payment review is done.
- Refer to the Instructions and Overview sections in each workbook for a detailed description of how the workbooks are organized and for more information on how all the component parts of the review fit together.
Contact
Email us at provider.monitoring@dhhs.nc.gov with questions or comments. Please include the issue in the subject line of the email.
Archived Documents
Frequently Asked Questions (2014)
- DHHS Monitoring Tool for Providers (retired: May 3, 2018)
- DHHS Unlicensed ALF Review Tool for Providers (retired: May 3, 2018)
- DHHS Review Tool for LIPs (retired: 7/1/2018)
- DHHS Review Tool for LIPs (retired: 12/10/2018)
- DHHS Review Tool for LIPs (retired: 7/1/2019)
- DHHS Monitoring Tools for Providers (retired: 7/1/2019)
The Provider Monitoring Webinar Project is a follow-up to workshops that were presented in February 2014 to introduce the new process and tools for routine provider monitoring that went live on March 1.
The webinars address important aspects of the process in greater detail than was possible during the statewide workshops. They will be used by LME-MCOs to train their review teams on how to use the tools. Provider agencies will also use the tools as part of their internal quality assurance process. The webinars can be used as a self-audit to ensure ongoing compliance with the regulatory requirements that are the focus of the routine review.
The webinars are broken into modules. Each module discusses a key component of the process. Presenting the webinars in modules allows the LME-MCOs and providers to select the topic they want to review at a specific point, whether for in-service training or as a personal refresher. A script is provided for each webinar.
Introduction to the New Routine Provider Monitoring Process
PowerPoint
Routine Review Tools – Agencies
PowerPoint
Using the Automated Workbook for the Provider Monitoring Tools
PowerPoint
Tips for Providers
PowerPoint
DHSR and LME-MCO Coordination
PowerPoint
Customer Service
PowerPoint
Transparency in the Provider Monitoring Process
PowerPoint
- September 2014 Status Update on Provider Monitoring
- NCIHMA Behavioral Health Conference
- NC Association of Rehab Facilities Conference
- NC TIDE Spring Conference
- An Introduction to Routine Monitoring of MH/IDD/SA Providers by LME-MCOs through Collaboration and Transparency
- Summary of Training Evaluations
- The Provider Review Database – effective as of August 10, 2016