One Source Therapy Review ensures its reviewers are up to date on all state and federal regulatory requirements, adhere to Plan policies and procedures and are current on licensure.
- Advises the Plan on how to adhere to State and Federal regulation and policy changes and subsequently assist with updates to internal policies.
- GA Medicaid regulations
- Complies with state, NCQA, and federal Medicaid regulations regarding reviews and denials – All review decisions are easily accessible as they are housed on the Plan’s medical management documentation system
- Adheres to all Plan compliance policies such as HIPAA
- Ensures all reviewing therapists are licensed (licenses rechecked annually)
- Guarantees all therapists reviewers sign annual financial incentive attestations