Managed Care Reporting Deliverables
Weekly Reports (Every Wednesday by 5 p.m.) | Revision Date | |
047 | Crisis Response Team Home Health Services Report | 10/21/20 |
150 | Encounter Data Certification Form | 9/21/20 |
316 | Prior Authorization Denial Report for CSR | 11/10/15 |
353 | Chisholm Weekly PA Report | 12/8/16 |
Monthly Reports (Due 15 calendar days of the end of each month except where indicated) | Revision Date | |
010 | Grievance, Appeal and State Fair Hearing Logs | 8/7/20 |
022 | Healthy Louisiana Third Party Liability (TPL) Report - M | 8/10/17 |
039 | Case Management Report | 4/20/20 |
045 | Home Health Services Report | 10/21/20 |
054 | Pharmacy Benefits Management Report | 3/12/19 |
055 | Pharmacy Report (RX055) - M | 9/13/19 |
107 | Member Service Call Center - M | 3/15/16 |
109 | Marketing Plan Updates - M | 1/14/16 |
137 | End of Pregnancy Report | 5/13/20 |
148 | Exclusion Database Attestation | 5/19/15 |
162 | Health Plan Drug Utilization Review Report - M | 8/1/20 |
165 | Lock-In Report - M | 2/10/16 |
167 | Claims Payment Accuracy Report - M | 11/1/13 |
173 | Prepaid Denied Claims Report - M | 7/30/18 |
175 | Hepatitis C - M | 6/1/20 |
178 | Behavioral Health Pharmacy Utilization Report | 9/3/20 |
181 | Provider Call Center - M | 7/3/19 |
182 | Provider Complaint & Appeal Summary Report - M | 5/10/19 |
221 | Claims Payment Summary - M | 9/7/17 |
323 | Chisholm Monthly Behavioral Health ASD Report | 6/5/20 |
325 | Behavioral Health Pharmacy Report | 1/14/16 |
326 | Healthy Louisiana Adverse Incident Report | 10/16/18 |
337 | Behavioral Health Out-of-State Placement Report | 8/4/16 |
354 | Chisholm PCS Member Aging Out Report | 3/25/19 |
Bi-Monthly Reports (Due February 28, April 30, June 30, August 31, October 31 and December 31) | Revision Date | |
020 | MCO Payment Discrepancy Report | 11/27/17 |
Quarterly Reports (Due April 30, July 30, October 30, and January 30, except where indicated) | Revision Date | |
011A | MCIP Achievement Report - Quality and Outcome Improvement Network +++ |
12/12/19 |
011B | MCIP Achievement Report - Louisiana Quality Network +++ |
12/12/19 |
018 | Medical Loss Ratio - Q + |
10/9/18 |
069 | Utilization Management Medical Review Report - Q | 10/10/17 |
119 | QAPI Committee (minutes) - Q | 8/15/17 |
145 | Fraud, Waste and Abuse Activity Report - Q | 6/22/20 |
147 | Sampling of Paid Claims Report - Q | 10/19/20 |
152 | Act 710 Report | 7/7/20 |
160 | Medication Therapy Management Report - Q | 11/25/20 |
185 | Quarterly Unaudited Financial Statement - Q + | 9/1/20 |
188/188BH | Service Authorizations - Q |
7/30/18 |
300 | NCCI MCO Cost Savings - Q ++ | 8/8/17 |
312 | MCO Gambling and Tobacco Report | 11/13/18 |
313 | Access to Wraparound Services | 11/10/15 |
314 | Behavioral Health High Utilizers Report (pending revisions) | 4/1/16 |
317 | PASRR Report | 11/19/20 |
322 | Community Tenure Report | 2/9/17 |
328 | Behavioral Health Provider Network Detail Report | 3/27/19 |
329 | Children in Restrictive Settings | 1/25/16 |
332 | In Lieu of Reporting - Q/A | 10/17/17 |
336 | Behavioral Health Providers by Level of Care | 3/27/19 |
338 | Behavioral Health Network Adequacy and GEO Access Review | 3/27/19 |
339 | Behavioral Health Prescriber Sufficiency Summary | 3/27/19 |
346 | Provider Credentialing and Contracting Report | 4/2/20 |
348 | GeoAccess Mapping | 3/27/19 |
358 | Behavioral Health Provider Monitoring Tool Elements | 11/5/19 |
359 | Behavioral Health Network Appointment Availability Report | 2/28/18 |
Semi-Annual Reports (First submission is expected by Sep. 30, 2015) | Revision Date | Due Date | |
013 | LDH MCO Physician Incentive Plan Report | 1/7/21 | Feb. 1 & Aug. 30 |
220 | Network Adequacy Review | 7/13/20 | July 31 & Jan. 31 |
355 | Healthy Louisiana EBP Report | 1/30/20 | July 15 & Jan. 15 |
Annual Reports | Due Date | |
011A | MCIP Achievement Report - Quality and Outcome Improvement Network +++ |
90 days after the measurement year period |
011B | MCIP Achievement Report - Louisiana Quality Network +++ |
90 days after the measurement year period |
012A | MCIP Annual Reporting - Quality and Outcome Improvement Network | 90 days after the measurement year period |
012B | MCIP Annual Reporting Template - Louisiana Quality Network | 90 days after the measurement year period |
17 | Key Staff Organizational Chart Listing |
Jan. 30 |
19 | Medical Loss Ratio - A |
June 30 |
40 | Case Management Policies and Procedures Program - A (pending revisions) | March 30 |
41 | CCMP Policies and Procedures (program evaluation) - A | March 30 |
44 | CCMP Predictive Modeling Specifications - A | Jan. 30 |
53 | Specialized Behavioral Health NW Provider Development Management Plan - A | Jan. 30 |
56 | PCMH Implementation Plan | Jan. 31 |
68 | Utilization Management Medical Record Review Strategy - A | Jan. 30 |
111 | Call Center Quality Criteria and Protocol | Jan. 30 |
132 | Member Satisfaction Survey Report (CAHPS) - A | Aug. 30 |
136 | QAPI Program Description, Work Plan, Impact and Effectiveness of Program Evaluation - A | March 31 |
138 | QAPI Performance Improvements Projects Descriptions and Outcomes | June 30 |
141 | Member Advisory Council - A | Jan. 30 |
157 | Emergency Management Plan - A | Jan. 30 |
170 | Disclosure of Ownership and Control Interest Statement - A | March 30 |
177 | Total and Out of Network Claims Report | July 30 (30 days after after the prior SFY) |
184 | Annual Financial Statement - A* | June 30 |
189 | Independent-Subcontractor EDP Audit (SSAE16) - A | Based on Audit Period |
221 | Claims Payment Summary | July 30 |
333 | Strategy for Increasing Outcome Measures | 30 calendar days following the end of the year |
334 | MCO Integration Assessment Report | 30 days after the end of the reporting period |
349 | Unmet Service Needs Resolution Plan | April 30 |
351 | Behavioral Health Member Survey Report | June 30 |
352 | Adverse Incident Reporting Policies and Procedures (pending revisions) | March 30 |
356 | Provider Monitoring Strategy (pending revisions) | Within 30 calendar days of contract execution and 60 days prior to revision |
* Template not provided. Will accept Health Plans' corporate standard.
** Revisions made to template to incorporate Behavioral Health Integration are not due for implementation until 12/1/15.
+ Due May 31, August 31, November 30, and February 28.
++ Due April 15, July 15, October 15 and January 15.
+++ Achievement reports (011a, 011b, 012a, 012b) shall be submitted no later than ninety (90) days after the Measurement Year period (quarterly or annual) ends.
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