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 FAQ - Frequently Asked Questions Frequently Asked Questions (2014) DHHS Monitoring Tools - retired 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) Webinars - retired (2014) 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 ProcessPowerPoint Routine Review Tools – AgenciesPowerPoint Using the Automated Workbook for the Provider Monitoring ToolsPowerPoint Tips for ProvidersPowerPoint DHSR and LME-MCO CoordinationPowerPoint Customer ServicePowerPoint Transparency in the Provider Monitoring ProcessPowerPoint Workshops, Training and Conference Presentations - retired (2014) 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 Other Documents The Provider Review Database – effective as of August 10, 2016 DHHS Provider Review Database – effective October, 2015 – rev. 8-10-16 Files DHHS Unlicensed AFL Review Tool for Providers 7-3-17.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 847.87 KB - June 28, 2017 DHHS Monitoring Tools for Providers 8-7-17 FINAL.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.3 MB - August 07, 2017 7 31 2017 Communication LME.pdf PDF • 231.62 KB - May 02, 2018 FAQ For Changes to Agency Monitoring Final Rev 6d May 3 2018.pdf PDF • 226.98 KB - May 01, 2018 DHHS Monitoring Tools for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.88 MB - May 01, 2018 DHHS New Unlicensed Site Review Tool for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 760.56 KB - May 01, 2018 DHHS Review Tools for LIPs FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1.1 MB - May 01, 2018 DHHS Unlicensed AFL Review Tool for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 900.68 KB - May 01, 2018 5 2 2018 Communication LME.pdf PDF • 149.04 KB - May 02, 2018 DHHS-Review-Tool-for-LIPs-Group-Practices-and-Agencies-Billing-Outpatient-Services-Only--BH--7-1-18-FINAL.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 992.2 KB - June 26, 2018 DHHS-Review-Tool-for-LIPs-Grp-Practices-and-Agencies-Billing-Outpatient-Services-Only-BH-11-30-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1.01 MB - November 30, 2018 11302018-Communication-LME.pdf PDF • 154.07 KB - December 01, 2018 providermonitoringfaqs.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 87.3 KB - April 24, 2019 Website-4-22-2019-Communication-as-forwarded-to-LME.pdf PDF • 191.68 KB - April 24, 2019 DHHS-Monitoring-Tools-for-Providers-FINAL-7-1-19.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.35 MB - July 01, 2019 DHHS-Review-Tool-for-LIPs-Grp-Practices-Agencies-Billing-Outpatient-Svcs-Only-BH-7-1-19-FINAL--003-.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1003.65 KB - July 01, 2019 Communication-as-forwarded-to-LME-July-1-2019-PM.pdf PDF • 190.69 KB - July 01, 2019
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 FAQ - Frequently Asked Questions Frequently Asked Questions (2014) DHHS Monitoring Tools - retired 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) Webinars - retired (2014) 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 ProcessPowerPoint Routine Review Tools – AgenciesPowerPoint Using the Automated Workbook for the Provider Monitoring ToolsPowerPoint Tips for ProvidersPowerPoint DHSR and LME-MCO CoordinationPowerPoint Customer ServicePowerPoint Transparency in the Provider Monitoring ProcessPowerPoint Workshops, Training and Conference Presentations - retired (2014) 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 Other Documents The Provider Review Database – effective as of August 10, 2016 DHHS Provider Review Database – effective October, 2015 – rev. 8-10-16 Files DHHS Unlicensed AFL Review Tool for Providers 7-3-17.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 847.87 KB - June 28, 2017 DHHS Monitoring Tools for Providers 8-7-17 FINAL.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.3 MB - August 07, 2017 7 31 2017 Communication LME.pdf PDF • 231.62 KB - May 02, 2018 FAQ For Changes to Agency Monitoring Final Rev 6d May 3 2018.pdf PDF • 226.98 KB - May 01, 2018 DHHS Monitoring Tools for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.88 MB - May 01, 2018 DHHS New Unlicensed Site Review Tool for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 760.56 KB - May 01, 2018 DHHS Review Tools for LIPs FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1.1 MB - May 01, 2018 DHHS Unlicensed AFL Review Tool for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 900.68 KB - May 01, 2018 5 2 2018 Communication LME.pdf PDF • 149.04 KB - May 02, 2018 DHHS-Review-Tool-for-LIPs-Group-Practices-and-Agencies-Billing-Outpatient-Services-Only--BH--7-1-18-FINAL.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 992.2 KB - June 26, 2018 DHHS-Review-Tool-for-LIPs-Grp-Practices-and-Agencies-Billing-Outpatient-Services-Only-BH-11-30-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1.01 MB - November 30, 2018 11302018-Communication-LME.pdf PDF • 154.07 KB - December 01, 2018 providermonitoringfaqs.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 87.3 KB - April 24, 2019 Website-4-22-2019-Communication-as-forwarded-to-LME.pdf PDF • 191.68 KB - April 24, 2019 DHHS-Monitoring-Tools-for-Providers-FINAL-7-1-19.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.35 MB - July 01, 2019 DHHS-Review-Tool-for-LIPs-Grp-Practices-Agencies-Billing-Outpatient-Svcs-Only-BH-7-1-19-FINAL--003-.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1003.65 KB - July 01, 2019 Communication-as-forwarded-to-LME-July-1-2019-PM.pdf PDF • 190.69 KB - July 01, 2019
DHHS Unlicensed AFL Review Tool for Providers 7-3-17.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 847.87 KB - June 28, 2017
DHHS Monitoring Tools for Providers 8-7-17 FINAL.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.3 MB - August 07, 2017
DHHS Monitoring Tools for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.88 MB - May 01, 2018
DHHS New Unlicensed Site Review Tool for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 760.56 KB - May 01, 2018
DHHS Review Tools for LIPs FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1.1 MB - May 01, 2018
DHHS Unlicensed AFL Review Tool for Providers FINAL 5-3-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 900.68 KB - May 01, 2018
DHHS-Review-Tool-for-LIPs-Group-Practices-and-Agencies-Billing-Outpatient-Services-Only--BH--7-1-18-FINAL.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 992.2 KB - June 26, 2018
DHHS-Review-Tool-for-LIPs-Grp-Practices-and-Agencies-Billing-Outpatient-Services-Only-BH-11-30-18.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1.01 MB - November 30, 2018
providermonitoringfaqs.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 87.3 KB - April 24, 2019
DHHS-Monitoring-Tools-for-Providers-FINAL-7-1-19.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 2.35 MB - July 01, 2019
DHHS-Review-Tool-for-LIPs-Grp-Practices-Agencies-Billing-Outpatient-Svcs-Only-BH-7-1-19-FINAL--003-.xlsx application/vnd.openxmlformats-officedocument.spreadsheetml.sheet • 1003.65 KB - July 01, 2019