Managed Care Reporting Deliverables

Weekly Reports (Every Wednesday by 5 p.m.) Revision Date
047 Crisis Response Team Home Health Services Report 6/26/20
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 6/11/20
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 2/27/15
152 Act 710 Report 7/7/20
160 Medication Therapy Management Report - Q 6/24/17
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 6/5/20
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
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.

 
RELATED INFO