Managed Care Reporting Deliverables

The report templates below are only applicable to the MCO emergency contract which ended on December 31, 2022.

Weekly Reports (Every Wednesday by 5 p.m.) Revision Date
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
362 Transportation Addition/Deletion Report 2/4/22

 

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 8/30/22
022 Healthy Louisiana Third Party Liability (TPL) Report - M 7/27/21
039 Case Management Report 5/31/22
045 Home Health Services Report 10/21/20
047 Crisis Response Team Home Health Services Report 11/5/21
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
137 Pregnancy Report 10/27/21
148 Exclusion Database Attestation 5/19/15
162 Health Plan Drug Utilization Review Report - M 8/25/21
165 Lock-In Report - M 2/10/16
167 Claims Payment Accuracy Report - M 11/1/13
173 Prepaid Denied Claims Report - M 7/27/21
175 Hepatitis C - M 5/5/21
178 Behavioral Health Pharmacy Utilization Report 4/29/21
181 Provider Call Center - M 7/3/19
182 Provider Complaint & Appeal Summary Report - M 8/23/22
221 Claims Payment Summary - M 7/27/21
323 Chisholm Monthly Behavioral Health ASD Report  6/5/20
325 Behavioral Health Pharmacy Report 1/14/16
326 Healthy Louisiana Adverse Incident Report 8/4/21
337 Behavioral Health Out-of-State Placement Report 8/4/16
354 Chisholm PCS Member Aging Out Report 3/25/19
360 NEMT Oversight Report 10/26/21
361 Community Case Management Report 12/6/22
401 Shot Per 100,000 COVID Vaccine Incentive Report 11/1/22
402 DOJ-AR Case Management Report 5/31/22
403 MCO Crisis Line Report 5/19/22
404 Behavioral Health Crisis Care Report 5/19/22
405 Community Brief Crisis Support Report 5/19/22
406 Crisis Stabilization Report 10/6/22

 

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 +++

6/30/22
011B MCIP Achievement Report - Louisiana Quality Network +++

6/30/22
018 Medical Loss Ratio - Q +

 6/22/21
069 Utilization Management Medical Review Report - Q 10/10/17
109 Marketing and Member Education Activities Report - Q 6/24/22
119 QAPI Committee (minutes) - Q 8/15/17
145 Fraud, Waste and Abuse Activity Report - Q 7/25/22
147 Sampling of Paid Claims Report - Q 9/22/21
152 Act 710 Report 2/23/21
160 Medication Therapy Management Report - Q 11/25/20
185 Quarterly Unaudited Financial Statement - Q + 10/14/22
188/188BH Service Authorizations - Q

6/20/22
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
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
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 8/25/22
348 GeoAccess Mapping 3/27/19
358 Behavioral Health Quality Monitoring 12/13/21
359 Behavioral Health Network Appointment Availability Report 2/28/18
364

Enrollee Reassignment Report

 1/5/22

 

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 5/20/21 July 31 & Jan. 31
355 Healthy Louisiana EBP Report 5/19/21 Aug. 1 & Feb. 1

 

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  Annual Progress Report: July 31; Annual Meeting Report: at least one per measurement year 
012B MCIP Annual Reporting Template - Louisiana Quality Network Annual Progress Report: July 31; Annual Meeting Report: at least one per measurement year 
17 Key Staff Organizational Chart Listing

Jan. 30
19 Medical Loss Ratio - A

June 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


* 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) shall be submitted no later than ninety (90) days after the Measurement Year period (quarterly or annual) ends.

 
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