Provider360™ Ongoing Sanctions Monitoring Overview

Compliance

Optum Provider360™ Ongoing Sanctions Monitoring service is approved by the National Committee for Quality Assurance (NCQA). It offers an effortless way for your plan to comply with rigorous requirements for continuous monitoring between credentialing cycles—during which you need to be fully certified by NCQA.

Sanctions monitoring

• Monitoring of Medicare/Medicaid sanctions
• Monitoring of sanctions and limitations of licensure
• Notification of new sanctions

Ongoing sanctions monitoring service

Ongoing Sanctions Monitoring provides health plans with a cost-effective, efficient solution to track sanctions, disciplinary actions, and limitations of licensure between provider credentialing cycles. We proactively notify you of any new or revised sanctioning incidents that meet the NCQA CR10 Standard for continuous sanctions monitoring.

OptumInsight compiles your reports from the sanction data contained in our Sanction Provider Datamart (SPD). The SPD is comprised of sanctions collected from state boards across the country and the Office of the Inspector General (OIG) for Medicare and Medicaid Sanctions.

Due to the lack of provider data identifiers made available by the reporting sources, OptumInsight has developed a matching process that is used to identify and link your network providers with the reported sanctions. This will help make certain that no sanction goes unreported.

OptumInsight will generate your OSM Report and deliver it twice each month to enable timely responses and follow-up. Your reports will be formatted in Microsoft® Excel and delivered via secure email or FTP.

NCQA

The National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral organizations, practitioner organizations and credentials verification organizations.