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 |
|
 |
|
|
|
|
 |