L.A. Care Presents: New Provider Training, Onboarding, and Oversight & Monitoring
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- Jemima Atkinson
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1 L.A. Care Presents: New Provider Training, Onboarding, and Oversight & Monitoring Presented by: Alma Mejorado, Senior Manager Leslie Padilla, Senior Account Specialist New Provider Training, Onboarding, Oversight Webinar
2 Objectives Discuss one year post launch updates of the Provider Oversight and Monitoring process Discuss Network Training Best Practices Status of current Network Provider Training Compliance Discuss and Clarify reporting requirements and responsibilities Review training regulations New Provider Training, Onboarding, Oversight Webinar
3 Network Provider Training Compliance Self Reported Provider Training Compliance from Monthly PPG reports Data range below is from Quarter Quarter Quarter has received a significant loss in monthly reporting submissions New Providers (Total Number) New Providers Receive Training <10 days (Number) New Providers Received Training >10 days (Number) New Providers Received No Training (Number) % Compliance New Provider Training, Onboarding, Oversight Webinar
4 Training Regulation L.A. Care is utilizing the most stringent regulation regarding government sponsored training requirements DHCS training regulations Completed 10 business days of activation This aligns all of our product lines o Medi-Cal o Cal MediConnect o L.A. Care Covered o PASC SEIU This ensures compliance across state and federal regulations New Provider Training, Onboarding, Oversight Webinar
5 Regulatory Language To ensure we are abiding by all regulatory agency regulations, L.A. Care is utilizing the most stringent regulation regarding training and the DHCS contract which states the following language: Contractor shall ensure that all providers receive training regarding the Medi-Cal Managed Care program in order to operate in full compliance with the Contract and all applicable Federal and State statutes and regulations. Contractor shall ensure that provider training relates to Medi-cal Managed Care services, policies, procedures and any modifications to existing services, policies or procedures. Contractor shall conduct training for all providers within ten (10) working days after the contractor places a newly contracted provider on active status New Provider Training, Onboarding, Oversight Webinar
6 New Provider Orientation Training Requirements Within ten (10) business days of a providers effective date New provider orientation is required to be completed The 10 business day clock begins once the PCP/ Specialist is effective with the PPG/MSO Training providers before the effective date will result in training non-compliance New Provider Training, Onboarding, Oversight Webinar
7 New Provider Orientation Training Requirements Member Rights and Responsibilities Cultural Sensitivity Customer Service Access and Availability Standards Medi-Cal Managed Care Model of Care Federal and State Statutes Medical Management Delegation and Payment Responsibility Authorizations and Claims (include balanced billing) Eligibility Verification Seniors and Persons with Disabilities Child Health and Disability Prevention Mental Health Balance Billing Managed Long-Term Services and Supports Authorizations Health Assessments and Provider Toolkits Case Management Applicable Policies and Procedures *This is in the DHCS contract with L.A. Care. New Provider Training, Onboarding, Oversight Webinar
8 New Provider Orientation Training Requirements Cont. Provider will comply with all PPG and Health Plan applicable policies and procedures. Provider will comply with all Medi-Cal marketing guidelines.) Cal MediConnect (Applicable to CMC line of business only) Model of Care Dementia Training Member Rights Critical Incidents Interdisciplinary Care Team Continuity of Care Behavioral Health Critical Incidents Cultural Competency Disability Awareness CMC-Care Coordination Grievance and Appeals Managed Long Term Services and Supports New Provider Training, Onboarding, Oversight Webinar
9 L.A. Care Wants you to Succeed! Your success is important to us; therefore, L.A Care is providing you with the required training material for successful training: A PPG to Provider training booklet A PPG to Provider proper documentation Quarterly audits o Preparation for the annual audits with Compliance Department and regulatory agencies Dedicated address for report submissions o PNOtraining@lacare.org This presentation for your reference New Provider Training, Onboarding, Oversight Webinar
10 Reporting Requirements for Oversight and Monitoring Who? You the PPG/MSO What? Complete New Provider training within required time frames Document and submit required training as requested Document and submit a simple monthly training report Where? PNOtraining@lacare.org When? On a monthly basis Why? Regulatory requirement New Provider Training, Onboarding, Oversight Webinar
11 Network Training Best Practices Timeliness of reporting on a monthly basis Completeness of the reporting on a monthly basis Complete training within 10 business days at 100% of the time Timely and comprehensive responses of Corrective Action Plans on deficiencies found PPG Training Policy to include: Definition of provider effective date and 10 business day training material used Utilize the required L.A. Care Training Material provided for on boarded New Provider Training, Onboarding, Oversight Webinar
12 Monthly Reporting Requirements New Provider Training, Onboarding, Oversight Webinar
13 Quarterly Audits and Corrective Action Plan Responses 10 business days to prepare Corrective Action Plan (CAP) response Corrective Action Plans are utilized by the Health Plan to oversight and monitor training deficiencies identified This can result in ongoing submission requests of a CAP until deficiencies are met Providers will be selected at random by the Health Plan on a quarterly basis to identify evidence of provider training completion Quarter 1: January 1 st to March 31st Quarter 2: April 1st to June 30th Quarter 3: July 1 st to September 31st Quarter 4: October 1 st to December 31st New Provider Training, Onboarding, Oversight Webinar
14 Responsibilities It is your responsibility to comply with Federal and State regulations, as well as our policies and procedures It is your responsibility to downstream education to our contracted affiliated providers It is your responsibility to hold them accountable for documenting the trainings occurred New Provider Training, Onboarding, Oversight Webinar
15 Summary Confirm who your point of contact is for training compliance if it has recently changed Train in accordance with regulatory requirements and L.A. Care requirements Document, document, document! Accurately complete monthly training report submissions Provide ongoing corrective action plan responses Contact us with any questions! We are here to support you New Provider Training, Onboarding, Oversight Webinar
16 Questions? Please contact your dedicated Account Specialist, if you have any questions. New Provider Training, Onboarding, Oversight Webinar
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