all provider meeting june 20 , 2018 1:00pm – 3:00pm 4600 … · 2018-11-12 · insurance...

All Provider MeetingJune 20 , 2018

1:00pm – 3:00pm4600 Emperor

Boulevard, Durham, NC Rooms 104-105

AGENDA

Welcome and Introductions (Cathy Estes Downs)APAC Update( Ali Swiller)Alliance UpdatesLegislative Updates(Brian Perkins/Sara Wilson)Budget Updates- (Beth Melcher)Needs and Gaps Survey 2018-( Carlyle Johnson)Network Adequacy Survey-(Carlyle Johnson)CURES Grant update (Carlyle Johnson) Provider Network Updates(Cathy Estes Downs)(review of site change, NCTracks issues and implications for authorization and billing, requirements for Insurance Attestations, Network needs, Contract Renewal update) Accreditation Portal-(Tracylee Cicero)Provider Satisfaction and ECHO Survey Results-(Wes Knepper)IDD Updates(Jarret Stone)

Powerpoint will be posted on the Alliance Website by June 27https://www.alliancebhc.org/providers/provider-resources/all-provider-meetings/

Next meeting: Wednesday, September 19, 2018

https://www.alliancebhc.org/providers/provider-resources/all-provider-meetings/

Legislative Updates

Alliance All Provider MeetingJune 20, 2018

FY2018-19 Single Stream Cuts•System-wide

o Additional $438K recurring cuto Additional $16.6M nonrecurring cut

•Allianceo Recurring cut reduced by $2.9Mo Nonrecurring cut increased by $8.4M

Service Maintenance of Effort •Each LME/MCO shall offer at least the same level of single-stream service utilization as during FY2014-15 across the LME/MCO's catchment areao “Single-stream” added in this legislation

•After a comparison of the cash balance and solvency range of each LME/MCO on December 1 DHHS may adjust the specified recurring and nonrecurring reductions among the LME/MCOs

FY2018-19 Single Stream Cuts

LME/MCO Solvency Ranges• Calculates a solvency range for each LME/MCO by

calculating several financial components

• DHHS to compare the cash balance of each LME/MCO to its solvency range

• If an LME/MCO's cash balance is more than (+) or (-) 5% of the solvency range figure, DHHS and the LME/MCO will develop corrective action plan to bring the cash balance within the solvency range

H403- Medicaid Transformation• Eliminates the 4 year language by establishing Tailored

Plans to be operated by LME/MCOs that meet a readiness review as determined by DHHS.

• Includes provisions for the services and populations to be covered by Standard Plans (SPs) and Tailored Plans (TPs)

• Moves the “mild/moderate” population to the SPs to receive coverage

• Establishes Integrated Care for SP and TP enrollees

Medicaid Transformation Timeline• Jointly established by H403 and H156

• Standard Plans “go-live” no later than 18 months from the date the 1115 waiver is approved.

• Tailored Plans “go-live” 1 year after the implementation of the Standard Plan contracts and will have a contract term of 4 years.

H156-PHP Licensure• Requires all Prepaid Health Plans (PHPs) to be licensed

by the NC Department of Insurance (DOI)

• Adds additional provisions to NCGS Chapter 58 (Insurance) outlining additional requirements that PHPs must adhere to.

S630-Involuntary Commitment • Requires LME/MCOs to develop and adopt a community

crisis services plan.

• This crisis plan must:• Identify facilities responsible for completing a first examination

in conjunction with a health screening in the same location.

• Identify the law enforcement agencies and/or other groups responsible for custody and transport, including training needs for these groups.

FY19 Budget

• Total Budget - $500,329,015• Revenue Sources

• Medicaid – 82.3%, $411,402,305• State – 9.73%, $48,661,565• Local – 8.06%, $40,265,144

• Decrease of $39M from FY18 budget due to:

• Retroactive Medicaid to come later• Additional state allocations received during the year

•Monitoring Medicaid lives closely due to decreasing trend

Total Budget Highlights

• Board Budget Retreat in March• Strategy for short and long term management

• Reduce reliance of fund balance for ongoing operations

• Focus on alternative funding sources

• Maintain affordable Medicaid spend

Non-Medicaid Budget Highlights

• Alliance Base Benefit Plan - $23,685,217• ACTT, Community Support Team, Developmental Therapy, Outpatient,

Residential Services, Substance Use Treatment, etc.

• Alliance Community Funds - $3,298,300• ADVP, Assertive Engagement, Day Activity, Intensive In Home, PSR, MST,

etc.

• Funding is managed at Alliance level not individual counties


• County funds from Cumberland, Durham, and Wake• Investments in:

• Crisis continuum

• Outpatient

• Behavioral Health Urgent Care

• Inpatient

• Total – over $40M


2018 Community Needs AssessmentAll-Provider Meeting

June 20, 2018

2018 Community Needs Assessment• Change in breadth and focus of assessment

• New CMS rules for network adequacy• NC Medicaid transformation• Preparation for standard and tailored plans

• Examples of DHHS change in emphasis• DHHS feedback about 2017 Community Needs

Assessment• DHHS Concept Paper: Network Adequacy &

Accessibility Standards• Name change of report: 2018 Network Adequacy

and Accessibility Analysis Report

DHHS Concept Paper• Access to Care: historically measured by sufficiency /

number of providers and geographic access (choice of providers within 30 minutes/miles)

• Shift to multifaceted approach:• Availability: number of providers, willingness to accept

new referrals, ability to offer timely appointments• Accessibility: geographic accessibility, physical access

(e.g., handicapped accessible), non-English access• Accommodation: operating hours, appointment policies,

language and cultural competency• Realized Access: actual use of services by enrollees

Network Adequacy Questions• Are there enough providers of each service type?• Does the network have enough providers within a

reasonable distance who are accepting referrals?

• Are appointments available in a timely manner?• Does the MCO address the needs of all beneficiaries,

including those with limited English proficiency or literacy.

• Are services culturally competent for those with:• Diverse cultural and ethnic backgrounds• Disabilities• Diversity in gender, sexual orientation or gender identity

Request for Provider Input and Assistance• APAC feedback about service gaps • Provider response to on-line surveys

• Survey of providers, stakeholders, consumers, staff by 7/6/18

• Community ‘focus groups’ feedback• Provider capacity and accessibility

survey (one response per provider) by 7/26/18

• Assistance with distribution of surveys for consumers and families

Alliance Opioid Treatment Expansion GrantSTR/Cures Year 1 Report

May 22, 2018

21st Century Cures Grant• Federal funding from SAMHSA to DMHDDSA: State

Targeted Response to the Opioid Crisis• NC has received over $31M for FY18 and FY19• New target population added to benefit plan

(ASOUD) for reimbursement and tracking• New funds for service expansion, and MCOs must

demonstrate maintenance of prior funding commitment to Opioid Treatment (maintenance of effort, or MOE)

• Must adhere to MCO-specific benchmarks for service expansion (additional number served and “person months”)

Opioid Treatment Expansion• Added State contracts for OTP for five clinics• Implemented Peer Support Aftercare and

Discharge in Wake and Durham• Implemented Peer Support in OTPs (Durham,

Wake)• Added Office-Based Opioid Treatment

(OBOT) for uninsured• Social Determinants of Health Pilot with OTPs• Planning for ED initiation of opioid treatment

with peer support engagement supports

FY18 OTP Expenditures

$-

$50,000.00

$100,000.00

$150,000.00

$200,000.00

$250,000.00

$300,000.00

$350,000.00

$400,000.00

Jul Aug Sep Oct Nov Dec Jan Feb Mar

OTP BHO

Next Steps• New referrals currently on hold pending receipt of FY19

funding allocations• Additional funding possible through State and Federal

budgets• Numerous initiatives focused on local response to

opioid epidemic• Continuing expansion of Office-Based Opioid

Treatment (OBOT) for Medicaid• Development of funding model for State-funded OBOT• Review of State-funded Peer Support impact• Review of Social Determinants Pilot• Other suggestions and discussion

PROVIDER NETWORK UPDATES

In addition to DMA Clinical Coverage Policy 8C requirements

Alliance Behavioral Healthcare requires that Psychiatric Nurse Practitioners, Nurse Practitioners

and Physicians Assistants who are credentialed with Alliance have a supervision agreement with a licensed

Psychiatrist.Alliance maintains this and other credentialing

requirements to help ensure that our providers have the appropriate experience and psychiatric oversight

to best serve our enrollees.

Alliance credentialing requirements for Nurse Practitioners, Psychiatric Nurse Practitioners and Physician Assistants

Provider Network RemindersSite changes- all site changes require a minimum of a 30 day notification using the Notice of Change form. All new sites will need to be enrolled in NCTracks prior to being entered in Alpha. The effective date will be the date indicated on the Notice of Change(the actual date of the move) or the NCTracks effective date- whichever comes last. Previous sites will be end dated on the date the provider is no longer providing services from that site.

Please ensure your enrollment of any new site in NCTracks has an effective date that will not cause a gap as it may result in a gap in contract end and start dates which will result in payment denials.

Provider Network Reminders

• Important: There will be a suspension in a providers ability to be paid and receive authorizations for site changes that are not yet enrolled in NCTracks.

• Please note any services billed from a site that the provider has indicated they have moved from may result in a recoupment and a compliance referral.

Provider Network Reminders

Licensed Practitioners and Provider Agencies- please ensure that you stay current with your NCTracks enrollment. If your Medicaid Health Plan is terminated in NCTracks your enrollment with Alliance is suspended until you are reinstated in NCTracks.Effective dates once a suspension is lifted for current providers will mirror the NCTracks effective dates. If you are paid by Alliance for services when your NCTracks enrollment is terminated or if there is a gap in the reinstatement period you are at risk for recoupment for that time period.

Notification from DMA re: reverification

• Effective July 1, 2018, Medicaid and NC Health Choice Behavioral Health Providers who were added to NCTracks via the Local Management Entity/Managed Care Organization (LME/MCO) Provider Upload process must complete reverification. DMA identified 474 Behavioral Health providers as needing to complete reverification. Providers identified are being notified of their reverification due date via NC Tracks communication to the Office Administrator on record.

• Providers who do not respond by the July 1, 2018 reverification due date, will be subject to claims payment suspension. Providers must submit either a reverification application or a full Managed Change Request to NCTracks for a claims payment suspension to be removed.

• NOTE: A list of providers scheduled for re-credentialing is available on the provider enrollment page of the North Carolina Medicaid website under the “Re-credentialing” header.

https://dma.ncdhhs.gov/providers/provider-enrollment

Credentialing Reminders• Re-Credentialing-Please note that at the time of re-

credentialing a billing review will be done for each Licensed Practitioner(LP). If there is no billing for the previous 12 months the provider will be decredentialed and unenrolled from the Alliance Network. The LP would be eligible to re-apply to the Network.

• Clinician License renewal reminder- Many clinical licenses expire on 6.30.18- in order to reduce risk of claim denials due to rendering providers license being expired please email a copy of the updated license to [email protected] in order for the updated license to reflect in Alpha. Please allow for a maximum of 3 business days for this to be updated in Alpha after this is submitted.

mailto:[email protected]

Attention LIP Solo ProvidersGeneral Liability Insurance Requirement

To be in accordance with Alliance’s contract with the State all contracted LIP Solo entities will be required to purchase and maintain Comprehensive General Liability Insurance which includes Bodily Injury and Property Damage Liability Insurance protecting the provider.Letters and email notices were sent out to all LIP Solo Providers in early May to any LIP Solo that did not submit the required insurance by the April 15 deadline.

Contracts will not be renewed for providers that do not submit this required insurance information.

Provider Network Updates

Contracts are in the process of being sent out via DocuSign. Please contact us if you have not received your Medicaid Contract by July 6 or your State Contract by August 6. Please send these inquiries to [email protected] be sure to indicate your Provider name and name and email of person that is legally responsible for signing the contract in order for our Contracts Department to follow up.


Accreditation Portal• In response to LME-MCO Communication #J254

which ended the use of the DHHS Agency (Routine) Monitoring Tool for agencies that are nationally accredited, Alliance is launching a new "Accreditation" tab in the Provider Maintenance Portal to monitor provider accreditation. Please log in to the Provider Maintenance Portal and update your accreditation information. A Provider Maintenance User Guide is available on the Alliance website. Questions may be directed to [email protected].

• https://portal.alliancebhc.org/Login/Index

https://portal.alliancebhc.org/Login/Indexmailto:[email protected]://portal.alliancebhc.org/Login/Index

This applies to…

• Council on Quality and Leadership (CQL)

• Council on Accreditation (COA)• CARF – Originally Council on

Accreditation of Rehabilitation Facilities, International (CARF)

• Joint Commission for the Accreditation of Healthcare Organizations (JCAHO)

Questions?• Email Questions to :

[email protected]

• More information to come in Provider News


2017 Survey Analysis

June 20, 2018

2017 ECHO Survey

Very small sample size (n=79 adult, n=100

child)

Due to this sample, high margin of error

High/Low benchmarks are the range between

all NC MCOs, not national standards

Care Coordination responses were too low to compare, especially for adult survey (need

>= 30 observations)

Concerns About Interpretation

Margin of Error

*The margin of error ranged between 12-15% above and below the reported score for each MCO.

Chart1

NC Overall0.050.05

Alliance0.130.13

Cardinal0.130.13

Eastpointe0.150.15

Partners0.120.12

Sandhills0.150.15

Trillium0.120.12

Vaya0.130.13

Q22 - Given as much information as wanted to manage condition

0.805

0.776

0.877

0.75

0.831

0.878

0.746

0.787

Adult

GlobalMCO Avg.Alliance 2017Alliance 2016RankNotes

Rating of Counseling and Treatment71.80%61.40%72.30%7Ranked 4 in 2016

CompositeMCO Avg.Alliance 2017Alliance 2016RankNotes

Information About Treatment Options54.90%57.40%60.80%3Ranked 4 in 2016

Perceived Improvement55.20%52.10%60.10%7Ranked 4 in 2016

Getting Treatment, Information52.60%32.20%52.80%6Ranked 3 in 2016

How Well Clinicians Communicate89.20%92.30%91.50%1Score higher than other MCOs; ranked 2 in 2016

Getting Treatment Quickly61.60%56.50%73.80%6Ranked 1 in 2016

Single Question MeasuresMCO Avg.Alliance 2017Alliance 2016RankNotes

A lot or somewhat helped by tx82.40%81.30%87.50%5Ranked 4 last year

Confident about privacy of tx info92.60%94.70%89.60%3Ranked 6 last year

Patient feels could refuse a type of tx81.50%77.60%85.40%7Ranked 2 last year

Given patient rights info90.90%91.40%93.60%3Ranked 2 last year

Given as much info as wanted80.50%77.60%79.60%5Ranked 4 last year

Talk about including family/friends in tx50.30%45.60%57.10%5Ranked 2 last year

Told about side effects of meds77.80%87.00%81.00%1Ranked 2 last year

Seen within 15 min. of appt time63.80%68.30%60.40%3Ranked 5 last year

Composite Rank Change20172016

Getting Treatment Quickly61

How Well Clinicians Communicate12

Getting Treatment, Information63

Perceived Improvement74

Information About Treatment Options34

Adult

MCO Avg.

Alliance 2017

Alliance 2016

Composite Areas for ECHO Adult Survey

Child

MCO Avg.

Alliance 2017

Alliance 2016

Single Item Measures for ECHO Adult Survey

Margin of Error






How Well Clinicians Communicate90.20%89.00%93.60%6Ranked 1 in 2016






Given patients rights info89.50%84.30%88.90%7Ranked 4 last year


Told about different txs that are available71.30%68.10%59.30%6Ranked 7 last year

Child had someone to talk to for counseling or tx80.00%83.10%76.50%2Ranked 4 last year



Margin of Error

MCO Avg.

Alliance 2017

Alliance 2016

Composite Areas for ECHO Child Survey

MCO Avg.

Alliance 2017

Alliance 2016

Single Item Measures for ECHO Child Survey

Q22. Given as much information as wanted to manage condition

Achievement Score#Margin of Error

NC Overall80.5%3855.0%

Alliance77.6%5813.0%

Cardinal87.7%5713.0%

Eastpointe75.0%4015.0%

Partners83.1%6512.0%

Sandhills87.8%4115.0%

Trillium74.6%6312.0%

Vaya78.7%6113.0%

0.050.05

0.130.13

0.130.13

0.150.15

0.120.12

0.150.15

0.120.12

0.130.13

Margin of Error Q22 - Given as much information as wanted to manage condition

Adult Composite Areas

Chart1

Information About Treatment OptionsInformation About Treatment OptionsInformation About Treatment Options

Perceived ImprovementPerceived ImprovementPerceived Improvement

Getting Treatment, InformationGetting Treatment, InformationGetting Treatment, Information

How Well Clinicians CommunicateHow Well Clinicians CommunicateHow Well Clinicians Communicate

Getting Treatment QuicklyGetting Treatment QuicklyGetting Treatment Quickly

MCO Avg.

Alliance 2017

Alliance 2016

0.549

0.574

0.608

0.552

0.521

0.601

0.526

0.322

0.528

0.892

0.923

0.915

0.616

0.565

0.738

Adult
























Adult

MCO Avg.

Alliance 2017

Alliance 2016


Child

MCO Avg.

Alliance 2017

Alliance 2016



















MCO Avg.

Alliance 2017

Alliance 2016


MCO Avg.

Alliance 2017

Alliance 2016


Child Composite Areas

Chart1

Perceived ImprovementPerceived ImprovementPerceived Improvement

Getting Treatment, InformationGetting Treatment, InformationGetting Treatment, Information

How Well Clinicians CommunicateHow Well Clinicians CommunicateHow Well Clinicians Communicate

Getting Treatment QuicklyGetting Treatment QuicklyGetting Treatment Quickly

MCO Avg.

Alliance 2017

Alliance 2016

0.623

0.607

0.569

0.489

0.555

0.554

0.902

0.89

0.936

0.641

0.675

0.706

Adult
























Adult

MCO Avg.

Alliance 2017

Alliance 2016


Child

MCO Avg.

Alliance 2017

Alliance 2016



















MCO Avg.

Alliance 2017

Alliance 2016


MCO Avg.

Alliance 2017

Alliance 2016


Provider Satisfaction Survey

Alliance improved in the areas of access, appeals, communications, and compliance from the 2016 survey.

Scores declined in authorizations, claims, provider networks, and training.

Alliance scored above the state average in all areas except Claims.

Training Needs

• There were considerable decreases in the number of providers requesting trainings on Clinical Coverage Policies and Audit Reimbursement from the 2016 survey.

• Despite the decrease, Clinical Coverage Policies and Quality Management/Reporting remain the two highest areas of training requested from providers in 2017.

Access

Chart1

LME/MCO staff is easily accessible for information, referrals, and scheduling of appointmentsLME/MCO staff is easily accessible for information, referrals, and scheduling of appointments

LME/MCO staff are referring consumers whose clinical needs match the service(s) my practice/agency provides.LME/MCO staff are referring consumers whose clinical needs match the service(s) my practice/agency provides.

Alliance 2017

State 2017

Alliance vs State

87.9

85.6

86

78.4

Survey Results

2017 DHHS Provider Survey analysis

Alliance Behavioral Healthcare

3-19-2018

Alliance 2014Alliance 2015Alliance 2016Alliance 2017

AreaQuestionTopic2014201520162017ABH Change 2016 vs 2015ABH Change 2017 vs 2016State 2016State 2017ABH vs State Difference 2016ABH vs State Difference 2017

Access5LME/MCO staff is easily accessible for information, referrals, and scheduling of appointments73.182.385.887.93.52.186.685.6-0.82.3

Access6LME/MCO staff are referring consumers whose clinical needs match the service(s) my practice/agency provides.60.872.785.786.013.00.381.478.44.37.6

Appeals26My agency is satisfied with the appeals process for denial, reduction, or suspension of service(s).46.859.276.180.816.94.780.677.5-4.53.3

Authorizations23Authorizations for treatment and services are made within the required timeframes.88.390.495.591.55.1-4.091.690.63.90.9

Authorizations24Denials for treatment and services are explained.74.379.286.885.17.6-1.785.783.61.11.5

Authorizations25The authorizations issued are accurate.86.091.596.995.35.4-1.695.294.81.70.5

Claims9When I speak with staff about claims issues I am given consistent and accurate information.77.276.981.682.24.70.684.084.3-2.4-2.1

Claims11Our claims are processed in a timely and accurate manner.87.793.193.488.60.3-4.892.791.60.7-3.0

Communications27The LME/MCOs website has been a useful tool for helping my agency find the tools and materials needed to provide services.74.982.784.686.01.91.482.980.61.75.4

Compliance18The LME/MCO staff conducts fair and thorough investigations.55.065.883.590.017.76.586.987.1-3.42.9

Compliance19After the audit or investigation, LME/MCO requests for corrective action plans and other supporting materials are fair and reasonable.50.367.386.089.618.73.688.489.2-2.40.4

Overall7LME/MCO staff responds quickly to provider needs.74.974.681.582.36.90.880.280.11.32.2

Overall20Technical assistance and information provided by staff is accurate and helpful.82.581.292.891.011.6-1.889.188.83.72.2

Overall28Please rate your overall satisfaction with the LME/MCO.84.285.088.087.73.0-0.386.285.41.82.3

Provider Networks13Provider Network meetings are informative and helpful.64.363.190.390.327.20.084.287.86.12.5

Provider Networks14Provider Network keeps providers informed of changes that affect my local Provider Network.77.875.893.386.817.5-6.587.685.65.71.2

Provider Networks15Provider Network staff are knowledgeable and answer questions consistently and accurately.70.274.292.285.418.0-6.884.683.57.61.9

Provider Networks17How would you rate your overall satisfaction with Provider Network?79.581.588.387.86.8-0.585.785.12.62.7

Stakeholders8Customer Service is responsive to local community stakeholders.58.568.887.287.718.40.586.284.71.03.0

Stakeholders16Our interests as a network provider are being adequately addressed in the local Provider Council.50.956.581.181.124.60.076.380.14.81.0

Training10Claims trainings meet my needs.71.371.688.186.716.5-1.487.786.40.40.3

Training12Information Technology trainings are informative and meet my agency's needs.63.264.290.488.826.2-1.688.287.92.20.9

Training21Trainings are informative and meet our needs as a provider/agency.71.971.589.290.317.71.187.788.71.51.6

AreaCombined change per area for 2017 vs 2016Combined change per area for 2016 vs 2015

Access2.416.5

Appeals4.716.9

Authorizations-7.318.1

Claims-4.25.0

Communications1.41.9

Compliance10.136.4

Overall-1.321.5

Provider Networks-13.869.5

Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015

Combined Change in Scores per Area: 2017 vs 2016 and 2016 vs 2015

Training

LME/MCO staff is easily accessible for information, referrals, and scheduling of appointments

LME/MCO staff are referring consumers whose clinical needs match the service(s) my practice/agency provides.

Alliance Access Over Time

Alliance 2017

State 2017

Alliance vs State

2017 Provider Survey analysis

March 19, 2018

22: More training and education materials?201420152016201715 vs 1616 vs 172016 StateABH-State 20162017 StateABH-State 2017

Clinical Coverage Policies37.441.245.736.4-4.5-9.338.47.337.2-0.8

Quality Management/Reporting40.443.130.527.5-12.6-3.028.91.628.9-1.4

Audit/Reimbursement36.330.830.525.7-0.3-4.825.84.726.5-0.8

Provider Monitoring34.535.424.426.5-11.02.131.1-6.732.2-5.7

Enrollment17.519.621.322.21.70.916.25.119.72.5

Claims Processing26.321.920.325.7-1.65.421.8-1.524.11.6

Information Technology22.216.217.816.01.6-1.813.44.417.2-1.2

Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Chart1

20142014

20152015

20162016

20172017




73.1

60.8

82.3

72.7

85.8

85.7

87.9

86

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State


March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Appeals

Chart1

My agency is satisfied with the appeals process for denial, reduction, or suspension of service(s).My agency is satisfied with the appeals process for denial, reduction, or suspension of service(s).

Alliance 2017

State 2017

Alliance vs State

80.8

77.5

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State

Alliance 2017

State 2017

Alliance vs State


March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Chart1

2014

2015

2016

2017

My agency is satisfied with the appeals process for denial, reduction, or suspension of service(s).

Alliance Appeals Over Time

46.8

59.2

76.1

80.8

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State

Alliance 2017

State 2017

Alliance vs State




March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Authorizations

Chart1

201420142014

201520152015

201620162016

201720172017

Authorizations for treatment and services are made within the required timeframes. Denials for treatment and services are explained. The authorizations issued are accurate.

Denials for treatment and services are explained.

The authorizations issued are accurate.

Alliance Authorizations Over Time

88.3

74.3

86

90.4

79.2

91.5

95.5

86.8

96.9

91.5

85.1

95.3

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State

Alliance 2017

State 2017

Alliance vs State



Alliance 2017

State 2017

Alliance vs State






March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Chart1

Authorizations for treatment and services are made within the required timeframes.Authorizations for treatment and services are made within the required timeframes.

Denials for treatment and services are explained.Denials for treatment and services are explained.

The authorizations issued are accurate.The authorizations issued are accurate.

Alliance 2017

State 2017

Alliance vs State

91.5

90.6

85.1

83.6

95.3

94.8

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State

Alliance 2017

State 2017

Alliance vs State



Alliance 2017

State 2017

Alliance vs State






March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Claims

Chart1

When I speak with staff about claims issues I am given consistent and accurate information.When I speak with staff about claims issues I am given consistent and accurate information.

Our claims are processed in a timely and accurate manner.Our claims are processed in a timely and accurate manner.

Alliance 2017

State 2017

Alliance vs State

82.2

84.3

88.6

91.6

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State

Alliance 2017

State 2017

Alliance vs State



Alliance 2017

State 2017

Alliance vs State





Alliance 2017

State 2017

Alliance vs State

When I speak with staff about claims issues I am given consistent and accurate information. Our claims are processed in a timely and accurate manner.

Our claims are processed in a timely and accurate manner.

Alliance Claims Over Time


March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Chart1

20142014

20152015

20162016

20172017




77.2

87.7

76.9

93.1

81.6

93.4

82.2

88.6

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State

Alliance 2017

State 2017

Alliance vs State



Alliance 2017

State 2017

Alliance vs State





Alliance 2017

State 2017

Alliance vs State





March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Communications

Chart1

The LME/MCOs website has been a useful tool for helping my agency find the tools and materials needed to provide services.The LME/MCOs website has been a useful tool for helping my agency find the tools and materials needed to provide services.

Alliance 2017

State 2017

Alliance vs State

86

80.6

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State

Alliance 2017

State 2017

Alliance vs State



Alliance 2017

State 2017

Alliance vs State





Alliance 2017

State 2017

Alliance vs State




Alliance 2017

State 2017

Alliance vs State

The LME/MCOs website has been a useful tool for helping my agency find the tools and materials needed to provide services.

Alliance Communications Over Time


March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Chart1

2014

2015

2016

2017



74.9

82.7

84.6

86

Survey Results



3-19-2018



























Access2.416.5

Appeals4.716.9


Claims-4.25.0


Compliance10.136.4

Overall-1.321.5


Stakeholders0.543.0

Training-1.960.4

Survey Results

2017 vs 2016

2016 vs 2015


Training




Alliance 2017

State 2017

Alliance vs State

Alliance 2017

State 2017

Alliance vs State



Alliance 2017

State 2017

Alliance vs State





Alliance 2017

State 2017

Alliance vs State




Alliance 2017

State 2017

Alliance vs State




March 19, 2018






Enrollment17.519.621.322.21.70.916.25.119.72.5



Appeals17.514.617.316.12.7-1.215.61.715.80.3

Payment Policy12.38.515.215.16.7-0.111.43.812.52.6

Compliance

Chart1

20142014

20152015

20162016

20172017

The LME/MCO staff conducts fair and thorough investigations. After the audit or investigation, LME/MCO requests for corrective action plans and other supporting materials are fair and reasonable.

After the audit or investigation, LME/MCO requests for corrective action plans and other supporting materials are fair and reasonable.

Alliance Compliance Over Time

55

50.3

65.8

67.3

83.5

86

90

89.6

Survey Results



3-19-2018









Claims9When I speak with staff about claims issues

all provider meeting june 20 , 2018 1:00pm – 3:00pm 4600 … · 2018-11-12 · insurance...

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