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Customer ServiceOne to Another

Developed by the NC DHHS-LME/MCO-Provider Collaboration Workgroup

February 2014

Revised 3-4-14

Presented by: Margaret MasonCOO, HomeCare Management CorporationRepresenting the NC Providers Council

Carol RobertsonQM Director, Sandhills Center for MH/DD/SASRepresenting the NC Council of Community Programs

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Customer Service One to Another

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Important Things to Remember:

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• Remain abreast of applicable policies, rules, regulations, standards and other information provided by the Division of MH/DD/SAS Administrative Publications and all other standards established by the Federal Government, State of NC or LME-MCO per contractual agreement.

• Comply with contractual obligations as denoted in individual contracts with respective LME-MCOs.

• Provide services as delineated in individual contracts with respective LME-MCOs.

• Use Provider Monitoring Tool for agency audits http://www.ncdhhs.gov/mhddsas/providers/providermonitoring/index.htm#tools

Providers

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• Develop and manage service benefit plans; coordinate and monitor services provided.

• Use DHHS Provider Monitoring Tools for agency audits http://www.ncdhhs.gov/mhddsas/providers/providermonitoring/index.htm#tools

• Also completes fiscal and billing audits (Post-

Payment Reviews).

• Reviews when complaints are received.

• Targeted/Focused Monitoring.

• Incident Report reviews.

Managed Care Organization (LME/MCO)

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General Monitoring Courtesies

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• Greet and welcome

• Make introductions

• Demonstrate respect

• Be professional

• Be calm and friendly

• Discuss openly when there is disagreement

Remember to:

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• Ask questions. • To share, without hesitation, if the

review becomes too disruptive for the participants.

• Demonstrate integrity throughout the process.

• Ensure transparency.

Remember to:

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• The process is not personal; it is a system – we all have shared accountability.

• Providers need to ensure preparedness, and LME-MCOs need to demonstrate patience, e.g. information may not be readily available and/or resources may be limited.

Other Reminders:

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• We must all work collaboratively.• Collaboration will ensure an effective,

efficient, and successful process.• Assume positive intent - monitoring is a

learning experience, not a punitive exercise.

• Be engaged in the information and dialogue.

Other Reminders:

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• Complete the survey as means to further improve the process.

• Most importantly, remember the primary objective is to ensure the health and safety of all the participants supported in the MH/I/DD/SAS system.

Other Reminders:

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• Ask questions when indicated.• Provide responses to questions.• Ensure responses are accurate and

to the point.• Stick to the question; do not talk

around it.

Asking and Answering Questions:

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• Responses should be referenced-based as needed.

• Make sure the question is understood in its entirety.

• Recognize the difference between “I think” and “I know.”

Asking and Answering Questions:

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•Efforts to resolve at the lowest possible level have proved ineffective.

•There is lack of professionalism.

•Actions are not in accordance with standard operating practices for the LME-MCO or Provider.

•There is continued disagreement concerning a particular issue.

•Additional support is warranted.

Seek Recourse When:

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Partners Making a Difference

Questions

If you have any questions about how the use the automated workbook and review tools, please send your questions to the Provider Monitoring mailbox:

provider.monitoring@dhhs.nc.gov

Please include in the Subject line the nature of your question.

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