Department of Health and Human Services
Alliance Health respectfully submits the following corrective action plan for the year ended June 30, 2023.
Audit period: July 01, 2022– June 30, 2023
The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered co...
Department of Health and Human Services
Alliance Health respectfully submits the following corrective action plan for the year ended June 30, 2023.
Audit period: July 01, 2022– June 30, 2023
The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number assigned in the schedule.
FINDINGS—FEDERAL AWARD PROGRAMS AUDITS
DEPARTMENT OF HEALTH AND HUMAN SERVICES
2023-001 Block Grants for Community Mental Health Services – CFDA No. 93.958
Recommendation: The Organization should design controls to ensure an adequate review process is in place to ensure that services billed through NC Tracks are supported by adequate provider documentation.
Explanation of disagreement with audit finding: There is no disagreement with the audit finding.
Action taken in response to finding: Per statute (NC GS § 122C-111) Alliance Health’s Provider Network Evaluation Team will continue to monitor public mental health, intellectual/developmental disability and substance abuse services. Types of monitoring include routine monitoring utilizing the State-mandated DHHS North Carolina Monitoring Process for LME/MCOs, targeted monitoring and investigations to address grievances, complaints, or quality of care concerns. In addition, Alliance Health employs a team of Provider Network Relations staff, Provider Network Operations staff and claims analysts to assist providers with technical assistance and support.
Other existing controls include various analytics to detect unusual claim activity such as billing excluded services, improbable dates of services, and atypical billing patterns. Subsequent investigation is initiated as needed upon detection/discovery of questionable billing.
To further mitigate this risk, Alliance Health will utilize Alliance’s All Provider Meeting as a platform to re-educate providers on the requirements to have written notes and documentation on file, prior to billing for a service. This will be addressed by Alliance’s Director of Network Operations during Alliance’s 10.19.2023 All Provider Meeting. The meeting will be taped and placed on Alliance’s website for future reference.
In addition, Alliance’s Program Integrity Department is actively evaluating the billing in question and will pursue investigation, repayment, and other actions as determined appropriate.
Name of the contact person responsible for corrective action: Lynn Widener, Director of Provider Network Operations
Planned completion date for corrective action plan: 12/31/2023.
If the Department of Health and Human Services has questions regarding this plan, please call Kelly Goodfellow, CFO at 919-651-8757.