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In addition, any claim date of service cited out of compliance on the post-payment review shall be identified as an overpayment and require a payback to Alliance through the recoupment process. If the provider disagrees with the monitoring action taken, plan of correction, or recoupment, they may request reconsideration as outlined in their results letter.
Failure to submit an acceptable Plan of Correction or substantially minimize or eliminate deficiencies will be presented to the Alliance Corporate Compliance Committee and may result in sanction up to and including termination from the Network.
Access a presentation on Plan of Correction Training. Providers may request technical assistance regarding the Review or Plan of Correction requirements and processes from the provider monitoring team. Technical assistance will not include previewing provider information to determine if it meets compliance criteria. Skip to content Main Navigation. The Alliance Provider Helpdesk is available to answer provider questions about authorization, billing, claims, enrollment and credentialing, ACS, or other issues.
Provider Monitoring The Provider Monitoring process is designed for: Entry into the provider network The review of service providers in accordance with State and Federal Requirements. Providers that are Nationally Accredited — the appropriate Post Payment Tool will be utilized and is based on the combination of services included in the sample. Refer to the Instructions and Overview sections in each workbook for a detailed description of how the workbooks are organized and for more information on how all the component parts of the review fit together.
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