Get Nc Dhhs Form Dma-5167 2017-2025

The NC DHHS Form DMA-5167 is a crucial document for reporting non-compliance with processing thresholds. This guide will provide you with clear and detailed steps to fill out the form online, ensuring that you complete it accurately and efficiently.

Follow the steps to easily fill out the NC DHHS Form DMA-5167 online.

1. Click ‘Get Form’ button to access the online DMA-5167 form in your chosen editor.
2. Begin by filling out each section regarding APT/PPT thresholds. Indicate the program category that failed the threshold by providing the relevant information for each affected month, including the APT and PPT values.
3. Next, provide data on denial, withdrawal, and inquiry thresholds. Input the compliance rate based on your 12-month monitoring sample for each category.
4. Address the questions related to organization and management. Specify if one worker or unit was responsible and detail any actions taken to notify them. Include measures implemented to improve their performance.
5. Continue with the staffing and productivity section, indicating if understaffing was a factor for non-compliance. Fill in the current staffing levels and supervisory ratios.
6. Next, analyze any policy and procedure issues that may have contributed to non-compliance. Document incorrect interpretations and the steps taken to provide appropriate training.
7. Investigate external forces that may have affected compliance, such as unexpected application influxes or system downtimes. Document your findings with relevant dates and details.
8. Finally, list any other reasons for non-compliance not covered in previous sections. Outline your plan of action, including actions taken to prevent future occurrences.
9. After completing all sections, ensure all information is accurately filled. You can then save your changes, download, print, or share the completed form as needed.

Take the next step and complete the NC DHHS Form DMA-5167 online today!