Quality Management and Corporate Compliance

Celebrating Provider Excellence The NC-TOPPS Kudos Corner is all about recognizing the agencies across our network who demonstrate excellence in NC-TOPPS reporting. Every timely submission, completed interview and goal-driven data point contributes to better outcomes for the individuals we serve—and we think that’s worth celebrating. This page highlights top-performing agencies, answers frequently asked questions and

The Deficit Reduction Act (DRA) of 2005, effective January 1, 2007, Section 6032 amended and codified at 42 USC § 1396(a)(68) requires any entities that receive or make annual payments under the Medicaid State plan… 

Overview Partners Health Management is committed to delivering high-quality, person-centered care. A key part of this commitment is the Healthcare Effectiveness Data and Information Set (HEDIS®) — a national tool developed by the National Committee for Quality Assurance (NCQA) and used by most U.S. health plans to measure performance in preventive care, chronic disease management

NC-TOPPS Overview North Carolina Treatment Outcomes and Program Performance System (NC-TOPPS) is a statewide, web-based program that collects outcome and performance data for individuals receiving mental health and substance use services in North Carolina’s public service system. The system is designed to: Measure the impact of treatment Support clinical decision-making Improve service quality across the

Partners’ Regulatory Compliance Unit is responsible for compliance relating to health care fraud, waste, and financial abuse, health information management, and the Health Insurance Portability and Accountability Act (HIPAA). The Regulatory Compliance Unit offers education and training to providers on a variety of regulatory compliance-related topics. Primary Areas Covered by Regulatory Compliance Regulatory Compliance deals

Partners’ Health Information Management Department is responsible for the protection of consumers’ medical records.

Partners is charged with ensuring that funds are being used for the appropriate level and intensity of services as well as in compliance with federal, state, and general accounting rules. The Partners’ Program Integrity Unit is responsible for billing audits for contracted providers.

Federal / State Rules & Regulations Federal Rules/Regulations Rule/Regulation Brief Description Public Law No: 114-255 21st Century Cures Act Grants to Address Opioid Abuse Crisis CMS Policy per 42 CFR §438 State Guide to CMS Criteria for Medicaid Managed Care Contract Review 42 CFR §455.410 Enrollment and screening of providers 42 CFR §455.434 Criminal background