Internal Workplan for Monitoring Network Operations Review request for sanctions and Quarterly QM Staff 6 sanctions, 1 appealed, 1 upheld response to request for trends. Data Integrity for NC TOPPS. Quarterly QM Staff Completed and providers contacted to make corrections Internal Workplan for Monitoring Health Call Center/Customer Services Review random sample of Emergent Quarterly QM staff All in sample were seen within 2 hours clients to ensure they are seen within 2 hrs of the contact/STR. Review IRR reports for outliers and Quarterly QM Director and No issues identified ensure corrective action taken when Customer Services needed. Director Internal Workplan for Monitoring Care Coordination Review and trend management reports Quarterly QM Director and Details below by section including IRR fidelity to policies and Care Coordination procedures and corrective action taken Director when required. Review random sample of care Quarterly QM Director and MH Care Coordination Director and QM coordination to ensure documentation is Care Coordination Director reviewed. Utilizing new tools occurring as required, including Director results: 94% compliance rate. integrated care scripts are being used.
Internal Workplan for Monitoring Network Operations Review request for sanctions and response to request for trends. Quarterly QM Staff 6 sanctions, 1 appealed, 1 upheld Data Integrity for NC TOPPS. Quarterly QM Staff Completed and providers contacted to make corrections Internal Workplan for Monitoring Health Call Center/Customer Services Review random sample of Emergent clients to ensure they are seen within 2 hrs of the contact/STR. Quarterly QM staff All in sample were seen within 2 hours Review IRR reports for outliers and ensure corrective action taken when needed. Quarterly QM Director and Customer Services Director No issues identified Internal Workplan for Monitoring Care Coordination Review and trend management reports including IRR fidelity to policies and procedures and corrective action taken when required. Quarterly QM Director and Care Coordination Director Details below by section Review random sample of care coordination to ensure documentation is occurring as required, including integrated care scripts are being used. Quarterly QM Director and Care Coordination Director MH Care Coordination Director and QM Director reviewed. Utilizing new tools results: 94% compliance rate.
QMC-Exec-Summary-3rd-Qtr-jan-march-Copy.docx