Business Practices Committee

August 2014 review

All information contained in this document should be considered as recommendations and discussion only.

Credentialing/Enrollment

  • The BPC has been working on this process for approximately nine months. We have the info completed and ready to be presented to the Steering Committee (SC) on 8/26/14. The next step with this, once reviewed by the SC, will be to share the info with the AGs office for review and input. Goal is to standardize the information requested by MCOs for credentialing and enrollment.
  • Forms are to submitted to SC Co-Chairs on 8/26/14.

Contract

  • The MCO – provider contract was reviewed on two occasions by the BPC. A great deal of feedback was provided. The CEO forum of the NC Council has requested that the BPC step back from reviewing this at this time. Feedback received and provided to Lisa and Vince.
  • Question re: if LIP contract is still to be reviewed by BPC? Facilitator to review with Steering Committee on 8/26/14.

Incident Review Process

  • Task force has met on two occasions. Continuing to move forward with review and detail of recommendations around QM11, back up staffing treated as an incident, level 2 incidents, etc…
  • Next meeting is Sept 15. Representation is needed from the western partnership and from DMA.

NPI Issue

  • Team reviewed several NPI issues that were handed off from the IT committee: CABHA, rendering providers, and ICFs. In the BPC and in follow-up conversations with Lewis and Kevin, we feel these issues are resolved and that no further action is needed.
  • The issue of MCOs requiring each AFL to have a billing NPI appears to only be related to one MCO at this point and the BPC team feels that this issue should be reviewed with this MCO specifically rather than discussed by the BP Committee.
  • BPC chair or IT chair may wish to follow-up with MCO.

Outcomes

  • BPC has shared a concern with the SC of multiple groups focusing on outcomes with no clear overarching group reviewing. Outcomes are included in several MCO – provider contracts and there does not appear to be consistency between MCOs in the outcomes measured nor in the method of measuring.
  • MCO CEO forum met and this topic will be tabled as the MCOs partner with DHHS to determine next steps re: outcomes. Provider representation at that table will be crucial in standardization.

DSM 5 transition

  • Nothing significant to report. Transition seems to have gone fairly smoothly thus far.

Communication

  • Team had lengthy discussion around process and dissemination of information. Concern is that issues reviewed by BPC are: 1) getting to various stakeholder groups with inaccurate information, 2) not making it through all levels of various stakeholder entities, or 3) being shared as final decisions in various forums. Team is recommending that minute overviews (such as this) be shared with the Steering Committee, NC Council, CEO forum and provider associations on a monthly basis. We would like to discuss further at the SC.
  • Team continues to emphasize that the recommendations/discussions that come from the BPC group are NOT the final recommendation, do not have reflect conversations of all CEOs, and are to be shared only as conversation and recommendations only.