We monitor sanction activity from state licensing boards, CMS, Office of Inspector General (OIG) and other regulatory bodies. If we find a care provider has a sanction that results in loss of license or material restriction, we terminate them from our network.
We have office site standards that you must follow, including:
We continually monitor member complaints relating to these standards against our established complaint threshold. If we receive a member complaint within 60 days of the threshold being met, we conduct a full-assessment site visit.
We use a standardized site visit survey form that lists office-site and medical/treatment record-keeping standards.
Based on the results of the site visit, we start corrective action to improve those office sites that do not meet standards. We conduct a follow up visit to evaluate the effectiveness of those corrections within 6 months. Should you fail to pass the revisit, we will continue to work with your office until the thresholds are met. We document each step of the process.