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Guidance explains review timing, how EORs are selected using self-directed service duration, and that providers are reviewed separately. The document clarifies documentation submission methods via encrypted systems, sampling approach for full versus modified reviews, privacy handling for staff records, and the supportive role of care managers and community navigators.","| Why are the reviews and this process needed now?\u003Cbr>EOR Performance Improvement Reviews are required under the NC Innovations Waiver. This is a new process for Vaya, and we have been preparing our review tools and processes for several months. The reviews are happening now because our tools and processes have been approved. |\n| --- |\n| You mentioned the tool was just approved today (July 18, 2023). This is difficult to understand, since these elements you're discussing are things you will require from us for the past year. What do you mean that the tool was just approved today?\u003Cbr>The review tools are based on EOR rules and requirements that have been in place for several years. After the Quality Management (QM) Department developed the review tools, Vaya leadership conducted an internal approval process to ensure they met our organization’s standards. |\n| When will these reviews begin officially?\u003Cbr>In the second half of August 2023. |\n| How will you select EORs for review?\u003Cbr>We will review all EORs over the next 12-15 months. The scheduling of the reviews will be based primarily on how long an EOR has been self-directing services. |\n| Is this review specific to EORs, or are providers also going to have this type of review?\u003Cbr>This process is specific to EORs. We review providers through different processes. |\n| You are requiring elements that were not required when many of us were with other MCOs prior to Vaya. Since we were not told about these requirements when we were moved to Vaya, how will you handle this?\u003Cbr>These requirements are not specific to Vaya and come from sources like the Innovations Waiver, Clinical Coverage Policies, and the NCDHHS Records Management and Documentation Manual, so we have to hold EORs to them. However, we will also work with EORs to correct any errors moving forward. |\n| Please clarify/describe the Care Manager's role in these reviews, if any.\u003Cbr>Typically, the care manager can offer general support. The Community Navigator can serve a larger role and help the EOR prepare for the review (for example, by verifying that all requested documentation is available or identifying what documentation is already in Vaya's possession) . |\n\n\n| As a newer EOR who has never had a review of records, I am feeling that it would be helpful if all of this information could be turned into an action check list. Is there a clear, easy way to go through and ensure our records are as expected?\u003Cbr>The review tools can easily be used as checklists. They will be available on the Individual and Family Directed Services (IFDS) page of Vaya's website. |\n| --- |\n| How will we get the tool?\u003Cbr>The tools will be available on the IFDS page of Vaya's website. We will also attach them to your review scheduling email before your review takes place. |\n| Many people may feel intimidated by this process. How will you ensure they are not?\u003Cbr>We understand that this may feel intimidating, especially because it is new and unfamiliar. But our intention is to make this a collaborative process. We know EORs are busy and focused on making sure their family member's needs are met. So, if issues are identified during the review, we will work with you to determine how to address them appropriately. This is one reason we will only be providing technical assistance for your initial review. As much as possible, we want this to be a positive experience for everyone. |\n| Submission of Documents |\n| How will QM review the EOR’s documentation?\u003Cbr>QM will include instructions for documentation submission in a notification letter after your review is scheduled. You will submit documentation using the Monitoring Document Upload Tool or through encrypted email. |\n| For the full review, will you be asking for a full year's worth of the items covered in the training? Or will the review include periodic, specific time frames?\u003Cbr>No, we will request a full year's worth of documentation. The review will cover a three-month period. We will give you the da","cbCaiva8DvtTKzek","https://ap.wps.com/l/cbCaiva8DvtTKzek","pdf",377569,8,7,"English","en",105,"# EOR Performance Improvement Reviews - purpose and timing\n## Review tools approval and start date\n## Selection criteria for EORs\n## Scope: EORs vs providers\n# Care manager and community navigator roles\n## Support during the review\n# Action checklist and access to tools\n## IFDS webpage availability\n## Review scheduling email delivery\n# Documentation submission and review approach\n## Where instructions come from\n## Upload and encrypted email options\n## Full review vs modified review sampling\n## How far back sample dates go\n# Privacy of member and staff records\n## Confidential scanning and transmission\n## Handling SSN and sensitive staff data","[{\"question\":\"Why are EOR Performance Improvement Reviews needed now?\",\"answer\":\"They are required under the NC Innovations Waiver. 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