AFL 1 1 1 3 Total 66 Total Number of 20 day POC Reviews Type of Monitoring January February March Total Routine 5 7 2 14 Post-Payment 1 1 2 4 IR 0 1 0 0 Complaint 0 1 0 1 QOC 0 0 1 1 Health & Safety 0 1 0 1 AFL 0 0 1 1 Total 22 Total Number of Pre-Sanction Reviews Type of Monitoring January February March Total Routine 1 1 0 2 Total 2 Total for All 387 Top Significant Accomplishments Identified Accomplishment Factors That Supported Success Documented MD initial credentialing information that thoroughly assisted in Re-Credentialing Mailing Notification: the re-credentialing process. Timely mailing and improved process of determining clean and flagged applications. Enhanced oversight process with Network manager, MD and QM Identified Interim Clinical Monitoring Manager. Team collaboration with QM QM Monitoring transitioned to Network team during transition. B3 Services Implementation: Respite, Community Guide, Peer Support, SE/MH, SE/IDD, Personal Care, Physician Network Development support and collaboration with SHC departments Consult and community stakeholders/providers Non Innovations Pending: One Time Transitional Cost Standardized process for releasing letters in timely manner. LIPS can 94% Re-Credentialing Completed access CAQH as applicable to their enrollment. Collaboration with QM QOC process and MD approval. Identified Areas of Need and Possible Solutions Item/Area of Need Identified Recommended Solutions Re-Credentialing and Shaping the Network: Establish billing requirement and/or evaluate current contract Providers who decline to haven’t billed. But requirements. voluntarily terminate or amend their Data reports that identify actual needs per catchment zip code contract.
AFL 1 1 1 3 Total 66 Total Number of 20 day POC Reviews Type of Monitoring January February March Total Routine 5 7 2 14 Post-Payment 1 1 2 4 IR 0 1 0 0 Complaint 0 1 0 1 QOC 0 0 1 1 Health & Safety 0 1 0 1 AFL 0 0 1 1 Total 22 Total Number of Pre-Sanction Reviews Type of Monitoring January February March Total Routine 1 1 0 2 Total 2 Total for All 387 Top Significant Accomplishments Identified Accomplishment Factors That Supported Success Re-Credentialing Mailing Notification: Timely mailing and improved process of determining clean and flagged applications. Documented MD initial credentialing information that thoroughly assisted in the re-credentialing process. Enhanced oversight process with Network manager, MD and QM QM Monitoring transitioned to Network Identified Interim Clinical Monitoring Manager. Team collaboration with QM team during transition. B3 Services Implementation: Respite, Community Guide, Peer Support, SE/MH, SE/IDD, Personal Care, Physician Consult Non Innovations Pending: One Time Transitional Cost Network Development support and collaboration with SHC departments and community stakeholders/providers 94% Re-Credentialing Completed Standardized process for releasing letters in timely manner. LIPS can access CAQH as applicable to their enrollment. Collaboration with QM QOC process and MD approval. Identified Areas of Need and Possible Solutions Item/Area of Need Identified Recommended Solutions Re-Credentialing and Shaping the Network: Providers who haven’t billed. But decline to voluntarily terminate or amend their contract. Establish billing requirement and/or evaluate current contract requirements. Data reports that identify actual needs per catchment zip code
QMC-Exec-Summary-3rd-Qtr-jan-march-Copy.docx