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Post-Payment Review Tools for Licensed Independent Practitioners. Presented by Alison Rieber Provider Network Evaluation Supervisor Alliance Behavioral Healthcare Representing the NC Council of Community Programs. Revised 3-4-14. Developed by the NC DHHS-LME/MCO-Provider
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Presented by Alison Rieber
Provider Network Evaluation Supervisor
Alliance Behavioral Healthcare
Representing the NC Council of Community Programs
Developed by the
The PPR Tool questions address these areas:
Q 1: Is there a referral from an approved source prior to the date of service, if applicable?CCP 8C 5.4.1, 5.4.2 and 7.3.6
Q 1 continued:
Q 2: Is there a valid utilization management authorization for the service billed, if applicable?
Q 3: Is there a valid consent for treatment in the service record?10A NCAC 27G.0205; CCP 8C
Q 3 continued:
Q 4: Is there a valid/appropriate service plan current for the date of service?CCP 8C
Q 4 continued:
Q 5: Is there a valid service order for the service billed, if applicable?CCP 8C
Q 5 continued:
Q 6: Is there an appropriate service plan that identifies the type of service billed?
Q7: Is the documentation signed by the person who delivered the service?CCP 8C – 7.3
Q 8: Does the service note relate to goals listed in the service plan?CCP 8C
Q 9: Does the service documentation include an assessment of progress toward goals?CCP 8C
Q 10: Does the documentation reflect the specific service billed?CCP 8C
Q 11: Is the service note individualized specific to the date of service?CCP 8C
Q 11 continued:
Q 12: Does the documentation reflect treatment for the duration of the service billed?CCP 8C
Q 12 continued:
Q 13: Is there documentation that the staff is qualified to provide the service billed?
Q 13 continued:
Q 14: Do the results of the Comprehensive Clinical Assessment (CCA) support the level of care for the treatment service recommended?CCP 8C
Q 14 continued:
Q 15: Is there documentation that coordination of care is occurring with both medical and non-medical providers involved with the individual receiving services?CCP 8C
If you have any questions about how the use the automated workbook and review tools, please send your questions to the Provider Monitoring mailbox:
Please include in the Subject line the nature of your question.