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Date: July 18, 2013

Audit Based On/Off Referral Status

Effective September 1, 2013, all ADvantage Case Management and Home Health Providers must score a 70% or greater, on their annual ADvantage Provider Audit in order to remain “on-referral” to accept new business from the ADvantage waiver. 

Any provider with annual ADvantage audit scores of less than 70%, will be placed in “off referral” status for a minimum of 90 days.

The following are mandatory steps to be completed by the Provider within the 90 days:

  • Onsite education will be provided by the Quality Assurance (QA) Advisor with the Provider
  • Provider will complete a Plan of Correction and two Progress Reports to be submitted  to the QA Manager for review
  • A follow up ADvantage audit will then be conducted by the audit team upon approval of the Plan of Correction and completion of the Progress Reports.  Only conditions that required a Plan of Correction will be reviewed at the follow up audit.

The follow up ADvantage audit score must result in a score of 80% or greater, for the provider to be placed back “on referral” to accept new ADvantage business. 

If the follow up ADvantage audit results in a score of less than 80%, the provider will remain “off referral” and will be subject to further education, training and re-auditing.

If you have any questions regarding the information provided above, please contact us at Provider Questions via your Smarter Mail account.

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