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.
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.
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:
Contract Compliance Team conducts the following:
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