The Holman Group
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The Holman Group - Provider Manual
Quality Management Program
The Holman Group's commitment to quality care places great emphasis on the quality of its provider network. As a member of The Holman Group's provider network, each provider is considered to be an integral part of the Quality Management program and is expected to participate in quality improvement activities. These activities may include, but are not limited to the following:
- Evaluation of quality of care through:
- Clinical assessment and treatment plan reviews
- Chart audits
- Complaint/grievance reviews
- Site visits, where applicable
- Credentialing and recredentialing reviews
- Quality improvement studies
- Outcomes of care through:
- Discharge summary reviews
- Client satisfaction surveys
- Specific outcome studies
- Administrative procedures through:
- Review of compliance with program credentialing, quality and utilization standards
- Adherence to service standards, e.g., client access to care
- Review of compliance with Holman policies and procedures
The Holman Group believes that communication between individual providers and the organization will enhance the quality of the service it provides to clients. Therefore, providers are encouraged to share their comments and suggestions regarding ways to improve the delivery of careeither in writing to or by calling the Provider Relations department.
Credentialing
The credentialing of the provider network is an important aspect of The Holman Group’s Quality Management Program. All providers are required to participate in the credentialing process which is under the auspices of the Provider Relations Department.
Each applicant is required to complete a provider application and submit the following documents:
- Copies of license(s)
- Copies of certifications
- Evidence of malpractice insurance
- Resumé/vitae
- Taxpayer identification (W-9) form
- Afterhours access information
- Language Capability Attestation (Disclosure)
The completed application file is reviewed by the Peer Review and Credentialing Committee (PRCC) which makes the final determination for inclusion in the provider network. A site visit may be conducted, if applicable. Once an applicant has been approved, the Provider Relations Department will send provider contracts.
Recredentialing
Providers are required to submit current copies of licenses and malpractice insurance coverage’s in order to continue to participate in the provider network. Recredentialing occurs every three years and includes a review and update of provider documents as well as a review of the provider’s experience with The Holman Group. The PRCC will review the following in its evaluation process:
- Chart audit results
- Clinical and administrative Provider Evaluation forms
- Client satisfaction surveys
- Salutary comments
- Complaints/grievances
- Updated credentialing information
- Site visit results, as applicable
- Afterhours access information
Provider Updates
In addition to participating in the credentialing and recredentialing processes, providers are required to notify The Holman Group, Provider Relations Department, when changes occur in any of the following:
- Licensure
- Certification(s)
- Malpractice coverage
- Malpractice actions
- Hospital privileges
- Address(es) and/or phone number(s)
- Tax identification number
- Language Capability Attestation (Disclosure)
Chart Audits
As part of The Holman Group’s ongoing quality improvement procedures and as regulated by the Department of Managed Care, random chart audits will be conducted and compliance is mandatory. During this procedure, The Homan Group will randomly select a patient’s file to review. If any additional information is needed the reviewer will contact you. Failure to comply may result in provider being placed on “Hold” status and/or may lead to termination. For your convenience, The Holman Group has made available to you several forms that when filled out, would guarantee compliance with The Holman Group Chart Audit standards. One of the most important of these forms, “The Clinical Assessment Form,” when completed provides virtually all of the information that you need to provide inorder to pass an audit of your patient records.
The Quality Management Department has adopted standards for documentation which are in keeping with various regulatory and accreditation entities. This review will ensure that all essential components of the client's chart are present and that overall documentation is of a quality nature.
All forms and documentation should be thorough, legible, labeled with the client's name, and dated and signed by the provider. All forms submitted, such as Client Information or the Initial Clinical Assessment forms, should be complete, with "N/A" indicated when the item is not applicable for this particular patient. The state of California requires a listing of the patient's primary care physician, the date of the last medical examination, and a listing of the prescribed medications with the dosage and frequency as well as the name of the prescribing physician. Our expectation is that each chart submitted will contain the following:
Psychotherapist
Background Information:
Relevant medical, mental health, substance abuse, and treatment histories; presenting problems, risks and symptoms; and a bio-psychosocial history, which includes a regard for the cultural/religious background of the client; and current or past stressors affecting the patient's current functioning.
Diagnostic Information:
A completed Mental Status Examination; and documented DSM-IV (all Axes) or ICD.9, which shows consistency with the listed symptoms.
Treatment Plan:
Goals and measurable objectives which are concordant with the presenting problems and symptoms; an outline of the level of care, number of sessions anticipated, and duration of treatment; adaptation of the plan in accordance with the patient's strengths and weaknesses; interventions used as well as the patient's response to treatment; and documentation of appropriate referrals.
Termination Procedures:
If the patient has been terminated from treatment, the reason for the termination, and a completed Discharge Summary.
Record Keeping and Documentation:
Dates of contact with the patient and the patient's signature in the appropriate places (Release of Information, Treatment Plan, etc.)
Please be aware that process/progress notes need not be submitted, but much of the information requested may be provided through a combination of forms (e.g. Clinical Summary, Intake information,Clinical Assessment, Request for Treatment Authorization, Discharge Summary, etc.)
Physicians
Background Information:
Relevant medical, mental health, substance abuse, and treatment histories; presenting problems and symptoms; and current or past stressors affecting the patient's current functioning.
Diagnostic Information:
A completed Mental Status Examination; and documented DSM-IV (all Axes) or ICD.9, which shows consistency with the listed symptoms.
Treatment Plan:
Documentation of medications prescribed, including dosage and frequency; allergies to medications; and interventions which are concordant with the presenting symptoms and diagnosis.
Referrals:
Documentation of appropriate referrals.
Record Keeping and Documentation:
Dates of contact with the patient; your signature on the records; evidence of informed consent for medication; and the patient's signature in the appropriate places (Release of Information, Treatment Plan, Informed Consent, etc.)
Please be aware that progress/process notes need not be submitted, but much of the information requested may be provided through a combination of forms (e.g.: Clinical Summary, Request for Treatment Authorization, Discharge Summary).
Enrollee's Right to Amend File
Upon reviewing his/her file, any adult patient of a provider has the right to provide to that provider a written addendum to his/her patient file regarding any item or statement in the file which the patient believes to be incomplete or incorrect. The addendum must be limited to 250 words per alleged incomplete or incorrect item in the patient's record and must clearly indicate in writing that the patient wants the addendum made a part of his/her patient file. The provider must then attach the addendum to the patient's records and must include that addendum whenever the health care provider makes a disclosure of the file to any party.
Inquiry and Review
The Holman Group is committed to developing and maintaining a quality provider network. The Quality Management Program is responsible for identifying, reviewing and acting upon serious administrative and/or quality of care issues regarding a provider’s performance. Such concerns can be identified through:
- Client complaints/grievances
- Client satisfaction surveys
- Quality Improvement activities (e.g. chart audits, site visits, Provider Evaluations)
- Referral and treatment review
- Credentialing and recredentialing activities
- Regulatory, professional or legal entities (e.g. state licensing boards)
In an instance where there is a specific concern about a provider regarding a quality of care issue and/or a serious administrative infraction, the Provider Relations Department will contact the provider, either by telephone or in writing, to discuss the matter and request clarifying information. Many cases can be resolved at this point. Those issues requiring additional investigation and follow-up are referred to the Peer Review and Credentialing Committee (PRCC) for review. The provider is expected to participate fully in the resolution process as a condition of continued participation in the provider network.
A resolution plan is developed which can range from additional telephone remediation or a site visit to a change in the provider’s network participation status, including termination. The provider is notified in writing, with an explanation of the appeals process, of any action taken regarding a change in his/her network status.
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