Attachment E- PMR Template- Dental Network.pptx

CCN Next Generation Program Management Review Monday, August XX, 202X

Presented by [PRESENTER name] [Presenter Organization] [Presenter Title]

This document and corresponding attachments will be submitted at least 15 Days prior to the PMR meeting.

Integrated Veteran Care

Work and Progress Summary Task Summary Schedule Summary Summary of Activities Planned Activities Self-Identified Corrective Actions and Improvements Medical Documentation Return Compliance Program and Payment Integrity Site Visit Findings Patient Safety Reports Referral Trends Risks Status Risk Register Summary Operations Support Activities Operation Support Activities Summary

Network Adequacy Outcomes Adequacy Outcomes Summary Provider Corrective Actions Continuous Query (CQ) Monitoring Compliance Customer Service Outcomes Customer Service Performance Summary Provider Satisfaction Survey Results Claims Processing Outcomes Claims Processing Performance Summary Fraud and Abuse Summary Report Other

Dental network pmr Table of Contents

This section focuses on the information contained in the Monthly Progress Reviews for the most recent quarter.

Summarizes the work that is being performed

Schedule Summary Summary of schedule elements specific to this reporting period from the quarterly updated IMS

Summary of Activities Summary of activities completed during the reporting period

Planned Activities Summary of activities to be completed during the upcoming period

Self-Identified Corrective Actions and Improvements This is a categorized narrative listing of the operational corrective actions and improvements that were executed

Medical Documentation Return Compliance This is a summary of the Medical Documentation Return Compliance Report Attachment

Program and Payment Integrity Site Visit Findings This is a summary of the Program and Payment Integrity Site Visit Findings and actions based on the feedback

Patient Safety Reports Overview This is a summary of the Clinical Quality and Patient Safety Issues Report Attachment In addition to the above report, at minimal, the following information should be reported:

Reporting VAMC and VISN (i.e., Dental or Medical) Category of care Network Provider NPI Referral/request for service/authorization number Type of issue Severity of harm level Date issues/event identified and resolved Resolution status Report to PRC (Y/N) PRC final recommendation Network provider and/or organizational tally with previous 12 months and flag trends

Referral Trends Provide results from referral audits and key referral data and trends

Risks and Issues This section addresses all risks and issues, including but not limited to the Risk Register during the reporting period.

Risk Register Summary This is a summary of the Project Risk Register Attachment

Operations Support Activities This section includes activities outlined in the Operations Support Plan as submitted with the proposal during this reporting period.

Operation Support Activities Summary This is a summary of VISN operational support and VAMC community care operations

Network Adequacy Outcomes This section includes an assessment of overall network adequacy, provider corrective actions, and the continuous query monitoring compliance during this reporting period.

Network Adequacy Outcomes Summary This is a summary of network adequacy outcomes, including any identified network inadequacies

Provider Corrective Actions This is a summary of the Provider Corrective Actions Attachment

Continuous Query Monitoring Compliance This is a summary of the Continuous Query Monitoring Compliance Attachment

Customer Service Outcomes This section includes results of customer service quality reviews, customer service availability statistics, and provider satisfaction survey results.

Customer Service Performance Summary This is a summary of customer service quality reviews and customer service availability statistics

Provider Satisfaction Survey Results This is a summary of the Provider Satisfaction Survey Results Attachment and an action plan to improve the results of any negative trends or results

Claims Processing Outcomes This section includes an overview of claims processing outcomes and fraud and abuse during the reporting period.

Claims Processing Performance Summary This is a summary of the claims processing key metrics and outcomes

This is a summary of the Fraud and Abuse Summary Report Attachment and any actions that will take place in the upcoming period

Title and populate this section with other topics you wish to discuss and/or highlight. Delete this section slide if not used.

Email Your Email Address Questions

Thank you For more information contact -

Dental network PMR Attachments The following attachments are provided as part of the PMR review and when appropriate, are in alignment with the Schedule of Deliverables Table requirements:

Integrated Master Schedule (IMS) Project Risk Register Continuous Query (CQ) Monitoring Results Provider Satisfaction Survey Results Key Metrics and Fraud and Abuse Summary Report Clinical Quality and Patient Safety Issues Reports

Schedule Summary Summary of Activities Planned Activities Self-Identified Corrective Actions and Improvements Medical Documentation Return Compliance Program and Payment Integrity Site Visit Findings Patient Safety Reports Overview Value-Based Care Report Referral Trends Risks Status Risk Register Summary

Adequacy Outcomes Summary Provider Corrective Actions Continuous Query (CQ) Monitoring Compliance Customer Service Outcomes Customer Service Performance Summary Provider Satisfaction Survey Results Claims Processing Outcomes Claims Processing Performance Summary

Medical network pmr Table of Contents – Medical Network

This section focuses on the information contained in the Monthly Progress Reviews for the most recent quarter.

Summarizes the work that is being performed

Schedule Summary Summary of schedule elements specific to this reporting period from the quarterly updated IMS

Summary of Activities Summary of activities completed during the reporting period

Planned Activities Summary of activities to be completed during the upcoming period

Self-Identified Corrective Actions and Improvements This is a categorized narrative listing of the operational corrective actions and improvements that were executed

Medical Documentation Return Compliance This is a summary of the Medical Documentation Return Compliance Report Attachment

Program and Payment Integrity Site Visit Findings This is a summary of the Program and Payment Integrity Site Visit Findings and actions based on the feedback

Patient Safety Reports Overview This is a summary of the Clinical Quality and Patient Safety Issues Report Attachment In addition to the above report, at minimal, the following information should be reported:

Reporting VAMC and VISN (i.e., Dental or Medical) Category of care Network Provider NPI Referral/request for service/authorization number Type of issue Severity of harm level Date issues/event identified and resolved Resolution status Report to PRC (Y/N) PRC final recommendation Network provider and/or organizational tally with previous 12 months and flag trends

Value-Based Care Report This is a summary of the Value-Based Care Report Attachment

Referral Trends Provide results from referral audits and key referral data and trends

Risks Status This section addresses all risks and issues, including but not limited to the Risk Register during the reporting period.

Risk Register Summary This is a summary of the Project Risk Register Attachment

This section includes activities outlined in the Operations Support Plan as submitted with the proposal during this reporting period.

This is a summary of VISN operational support and VAMC community care operations

This section includes an assessment of overall network adequacy, provider corrective actions, and the continuous query monitoring compliance during this reporting period.

Network Adequacy Outcomes Summary This is a summary of network adequacy outcomes, including any identified network inadequacies

Provider Corrective Actions This is a summary of the Provider Corrective Actions Attachment

Continuous Query Monitoring Compliance This is a summary of the Continuous Query Monitoring Compliance Attachment

Customer Service Outcomes This section includes results of customer service quality reviews, customer service availability statistics, and provider satisfaction survey results.

Customer Service Performance Summary This is a summary of customer service quality reviews and customer service availability statistics

Provider Satisfaction Survey Results This is a summary of the Provider Satisfaction Survey Results Attachment and an action plan to improve the results of any negative trends or results

Claims Processing Outcomes This section includes an overview of claims processing outcomes and fraud and abuse during the reporting period.

Claims Processing Performance Summary This is a summary of the claims processing key metrics and outcomes

This is a summary of the Fraud and Abuse Summary Report Attachment and any actions that will take place in the upcoming period

Title and populate this section with other topics you wish to discuss and/or highlight. Delete this section slide if not used.

Email

Questions

Thank you For more information contact -

Medical network pmr Attachments The following attachments are provided as part of the PMR review and when appropriate, are in alignment with the Schedule of Deliverables Table requirements:

Integrated Master Schedule (IMS) Project Risk Register Continuous Query (CQ) Monitoring Results Provider Satisfaction Survey Results Key Metrics and Fraud and Abuse Summary Report Clinical Quality and Patient Safety Issues Reports Value-Based Care Report image1.png