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NCDHHS »   Providers »   Provider Info »   Mental Health, Development Disabilities and Substance Abuse Services »   Provider Monitoring

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 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

      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

      Mental Health, Development Disabilities and Substance Abuse Services

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      • NC-SNAP (NC Support Needs Assessment Profile)
      • NCTracks
      • Pharmacology
      • Plan(s) of Correction
      • Printable Interview Forms
      • Problem Gambling
      • Provider Monitoring
      • Records Management
      • Reporting Requirements
      • Service Definitions
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      • Training Information
      • Treatment Accountability for Safer Communities (TASC)

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