The Quality Management Department oversees quality assurance and improvement activities throughout Partners and its Provider Network.
Category: Quality Management and Corporate Compliance
At Partners, we think of ourselves as an MCO…a Member Care Organization™.
The system of care we manage is shaped by the choices of our members and their families and designed to meet the unique needs of each of the communities we serve.
NC-TOPPS
The North Carolina Treatment Outcomes and Program Performance System, also known as NC-TOPPS, is a web-based system developed and maintained by the NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services for gathering outcome and performance data on behalf of mental health and substance abuse consumers in North Carolina’s public system of services.
Incident Reporting
An incident is defined as any happening that is not consistent with the routine operation of a facility or service, or the routine care of a consumer that is likely to lead to adverse effects to the individual. Incidents are classified into three categories (Level I, Level II, and Level III) according to the severity […]
Regulatory Compliance
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 [...]
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Health Information Management
Partners’ Health Information Management Department is responsible for the protection of consumers’ medical records.
Program Integrity
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.
Applicable Laws and Regulations for Regulatory Compliance
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 [...]
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