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

The revised Provider Monitoring Tool is effective as of July 1, 2018 

The revised Provider Monitoring Tools are effective as of 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

    FAQ - Frequently Asked Questions

    Frequently Asked Questions (2014)

    DHHS Monitoring Tools - retired

    DHHS Monitoring Tools - retired

    Webinars - retired (2014)

    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
    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 - retired (2014) Other Documents

    Other Documents