Managed Care Reporting Deliverables (Feb. 2012 - Jan. 2015)

The following information is listed for historical purposes only. It will not be updated.

Monthly Reports 

  Prepaid   Shared
022 Post Payment Recoveries (existence of TPL) - M            
055 Pharmacy Report (RX055) - M            
107 Member Service Call Center - M            
109 Marketing Plan Updates - M          
113 Grievance, Appeal and Fair Hearing Log - M            
  Grievance Narrative Cover Letter Template            
115 Provider Appeals Reporting - M            
116 Grievance, Appeal and Fair Hearing Log - M            
164 HIV/AIDS - M            
167 Claims Payment Accuracy Report - M            
173 Prepaid Denied Claims Report - M          
175 Hepatitis C - M            
181 Provider Call Center - M          
182 Provider Complaint & Appeal Summary Report - M          
221 Prompt Pre-Processing Report - M            
221 Claims Payment Summary - M            
                 
Quarterly Reports Prepaid   Shared
022 Post Payment Recoveries (existence of TPL) - Q            
026 EPSDT Report (CMS 416) - Q/A            
039 Case Management Report - Q/A          
042 CCMP Reports (Chronic Care Management Program) - Q/A          
066 UM Committee Meeting Minutes - Q          
069 Utilization Management Medical Record Review Report - Q          
072 QAPI PCP Profile Reports - Q          
082 PCP Linkages - Q          
114 Grievance, Appeal and Fair Hearing Log (redacted) - Q/A            
117 Grievance, Appeal and Fair Hearing Log (redacted) - Q/A            
119 QAPI Committee (minutes) - Q          
139  Member Advisory Council (minutes) - Q          
145 Fraud and Abuse Activity Report - Q          
183 Claims Processing Interest Payments - Q            
185 Quarterly Unaudited Financial Statement - Q *          
188 PA and Pre-Cert Summary - Q          
217 QAPI Early Warning System Performance Measures - Q          
220 Network Adequacy Review - Q          
220F PCP Care Management - Q            
300 NCCI MCO Cost Savings            
                 
Annual Reports Prepaid   Shared
015  Key Staff Organizational Listing - A          
016  Functional Organizational Chart - Location Listing and Key Staff Job Description - A          
019  Medical Loss Ratio - A            
022 Post Payment Recoveries (existence of TPL) - A            
041  CCMP Policies and Procedures (program evaluation) - A          
044  CCMP Predictive Modeling Specifications - A          
053 NW Provider Development Management Plan - A  

       
058 NCQA PCP-PCMH Recognition Report - A          
068 Utilization Management Medical Record Review Stategy - A          
110 Marketing Activities Annual Review - A          
121 QAPI Program Description and Work Plan - A          
127 QAPI Performance Reporting Measures (Level I and Level II) - A *          
130 QAPI Performance Improvement Projects (descriptions) - A          
131 QAPI Performance Improvement Projects (outcomes) - A          
132 Member Satisfaction Survey Report - A          
133 Provider Satisfaction Survey Report - A          
141 Member Advisory Council - A          
146 Annual Fraud, Waste & Abuse Report - A          
151 Systems Refresh Plan - A          
157 Emergency Management Plan - A          
159 Back-up File List - A          
170 Disclosure of Ownership and Control Interest Statement - A          
184 "DRAFT" Annual Audited Financial Statement - A            
184 Annual Audited Financial Statement - A *  

         
184 "DRAFT" Annual Audited Financial Statement - A            
184 Annual Audited Financial Statement - A            
189 Independent-Subcontractor EDP Audit (SSAE16) - A            
216 QAPI Impact and Effectiveness of QAPI Program Evaluation - A          

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Template not provided. Will accept Health Plans' corporate standard.