NCQA Accreditation Pitfalls Part 4: Member File reviews
There is always a member file review for both Health Plan
and Disease management. I can’t emphasize enough to have technical people
involved when creating the specifications for the file pull. If you have
questions or concerns get them addressed by NCQA well in advance of doing the
file pull. Go over the pull with your assigned NCQA rep to make sure the
contents are exactly what NCQA is looking for. Do not give NCQA the minimum
number of members. The point of the review is to prove that you are following for
established policies and procedures.
This should relatively easy to do with the documentation you have
already provided. This can be a nightmare if you are inconsistent in policies
and procedures.
No comments:
Post a Comment