Contract Monitoring

1. Contract Monitoring

2. Disciplinary Actions • A monthly review of the U.S. Department of Health and Human Services, Office of Inspector General (OIG), the Excluded Parties List System (EPLS), National Plan and Provider Enumeration System (NPPES), the National Practitioner Data Bank (NPDB), and National Technical Information Service (NTIS) is performed by the Sandhills Center Credentialing and Contracting staff.

3. Social Security Administration (SSA) • Information from the SSA Death Master File (SSA DMF) is compared to the National Plan and Provider Enumeration System (NPPES) on a monthly basis by the Sandhills Center Credentialing and Contracting staff.

4. Insurance Monitoring • Is conducted based on the expiration date with the provider being notified 30 days prior to expiration and requested to submit an updated certificate.

5. License Monitoring • Conducted based on the expiration date with the provider being notified 30 days prior to expiration and requested to submit an updated license. • Licensure sanctions and limitations are checked monthly by the Sandhills Center Credentialing and Contracting staff.

6. Accreditation • For newly DMA enrolled providers is based on a benchmark status determined by the provider’s DMA enrollment date and then by a predetermined pattern as set by the NC General Statute for National Accreditation Benchmarks (122C-81). Providers have one year to achieve Accreditation.

7. Accreditation Renewal • Is monitored by Sandhills Center Credentialing and Contracting staff with providers being advised 30 days prior to expiration to submit accreditation renewal documentation.