Provider Services Department

The Provider Services Department helps providers meet program standards and develop best practices to improve the quality of care received by our clients.


Provider Services

Contract Compliance
The COA Contract Compliance Team schedules and conducts regular reviews of contracted COA providers.

Contract Compliance Specialists are responsible for assuring providers meet the Conditions of Participation (COPs) and Service Specifications (SPECS) for all services they are contracted to provide. Throughout the year, Contract Compliance Specialists monitor the performance of the provider by tracking and trending provider issues both positive and negative. They work with Provider Relations Specialists, Accounting, Billing, and Long-term Care teams to ensure all provider issues are addressed.

Contract Compliance Specialists conduct at least one monitoring review within a two-year period. Providers that conduct care management and screening functions have at least one monitoring review annually.

Provider Relations
The Provider Relations Specialist Team (PRS) maintains relationships with providers, through communication, certifications, education, training, problem solving, guidance and policy clarification by serving as the liaison between providers and COA. The PRS Team will also work with providers to understand issues or concerns. This team provides assistance in helping providers identify root causes of problems and trends. A PRS team member will provide follow up and intervention relating to provider complaints, incidents, or concerns. An investigation of potential incidents and complaints will take place in order to ensure resolution of issues within all required time frames.

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Reviews

All reviews are performed using a team concept. The types of reviews to be performed may include but are not limited to:

Provider Relations Specialist Team conducts the following:

  1. Pre-certification: Initial on-site or desk review prior to certification as a COA provider which may include but is not limited to determining the agency`s ability to conduct business and to meet the Conditions of Participation and Service Specifications through provider developed policies and procedures.
  2. Educational: An Educational visit assesses implementation of the Conditions of Participation and Service Specifications as they relate to service delivery, billing, documentation, and personnel requirements. A PRS Team member will collaborate with the provider by offering technical assistance and additional instruction if applicable.

Contract Compliance Team conducts the following:

  1. Structural Compliance Review (SCR)/Review of Service Delivery Documentation: On-site visit or desk review which assesses compliance with COPs and SPECS, and reviews service delivery documentation and personnel files of direct service workers documented in the client records. SCRs may include: On-site or desk review verifying that what was billed by the provider was delivered to the client (unit verification); and review of records, operations, organizational structure, fiscal system, and internal controls of service providers.
  2. Other Reviews: Event-based reviews or follow-up reviews may also be conducted.

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Nutrition Monitoring and Education

The Nutrition Compliance and Development Specialist (NCDS) performs professional monitoring and development activities that are necessary to assure nutrition-specific service specification compliance, education, and training.

The NCDS attends on-site provider pre-certification reviews and provider structural compliance reviews with the Provider Relations Specialists, and the Contract Compliance Specialists, respectively. The focus of the NCDS is to verify compliance against established policies, procedures, food safety guidelines, and applicable regulations.

The NCDS furnishes training and guidance to contracted providers on food service practices and elderly nutrition essentials. The NCDS provides nutrition oversight by reviewing and approving Providers` menu plans. In addition, the NCDS aids in the oversight of COA`s contracted caterer, and works with the providers and caterer on menu development

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175 Tri County Parkway | Cincinnati, OH 45246 | (513) 721-1025