Preparation for Regulatory Licensure, Accreditation and Oversight Audits

pmpm® accreditation and regulatory experts assist clients preparing for survey by NCQA or a contracted health plan, and for audit by various regulator agencies. Whether the client is the subject of an oversight audit, a survey, or is initiation an accreditation or licensing effort, we perform readiness assessments and evaluations of current operations, assist in the development of policies and procedures, as well as the formal application for licensure. We prepare a compliance matrix that delineates all requirements and required documents to serve as a checklist for client use to gather or develop policies, procedures and other required documentation.

pmpm® Consultants serve as a liaison and represent clients with State licensing agencies and with Medicare to review documents, respond to any requests for additional information, and complete any required site walkthrough.

As DMHC reviewers, pmpm® knows the financial solvency requirements, and understands what the regulators expect to see in a corrective action plan (CAP) to satisfy compliance requirements. Our Consultants assist clients in the preparation of CAPs, as well as oversee and monitor the implementation process.