Provider Monitoring

The Provider Monitoring process is designed for:

  • Entry into the provider network
  • The evaluation of service providers against quantitative and qualitative measures

The provider monitoring process is used to monitor both Medicaid and State-funded behavioral health services.

Special Announcements

The new Provider Monitoring Tools that will replace the current tools will go live on October 1. 

Providers please complete the Provider Survey after you receive your monitoring report.

Frequently Asked Questions

Review Information and Tools

Routine monitoring consists of a routine review and a post-payment review.

  • For Licensed Independent Professionals (LIPs) that includes the LIP Review Tool and the LIP Post-Payment Review Tool.
  • For provider agencies, the selection of tools is determined by the type services provided.
    • The Routine Monitoring Tool is used except when the agency provides Unlicensed AFL services, in which case the Unlicensed AFL Review Tool is used.
    • The specific post-payment review tool(s) to be used is based on the combination of services included in the sample.
    • For those services that DHSR-MHL surveys on an annual basis (i.e., residential services and opioid treatment services), 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.

Webinars

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
Webinar

Routine Review Tools – Agencies
PowerPoint
Webinar

Using the Automated Workbook for the Provider Monitoring Tools
PowerPoint
Webinar

Tips for Providers
PowerPoint
Webinar

DHSR and LME-MCO Coordination
PowerPoint
Webinar

Customer Service
PowerPoint
Webinar

Transparency in the Provider Monitoring Process
PowerPoint
Webinar

Workshops, Training and Conference Presentations

Contact

Email us questions or comments about the new tools or the provider monitoring process. Include the issue in the subject line.

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