Dental Benefit Plan Reporting Deliverables

Weekly Reports Revision Date Due Date
150 Encounter Data Certification Form - W 1/4/23 Every Wednesday by 5pm
       
Monthly Reports     
022 Third Party Liability (TPL) Report- M  1/10/23 Due 15 calendar days of the end of each month except where indicated
107 Member Service Call Center - M  9/26/23 Due 5 calendar days of the end of each month except where indicated
113 Grievance, Appeal and Fair Hearing Log - M 1/5/24 Due 15 calendar days of the end of each month except where indicated
148 Monthly Debarment/Exclusion Verification Attestation   Due 15 calendar days of the end of each month except where indicated
167 Claims Payment Accuracy Report - M   Due 15 calendar days of the end of each month except where indicated
173 Denied Claims Report - M  1/9/23 Due 15 calendar days of the end of each month except where indicated
181 Provider Call Center - M 10/29/21 Due 15 calendar days of the end of each month except where indicated
182 Provider Complaint & Appeal Summary Report - M 9/13/23  Due 15 calendar days of the end of each month except where indicated
221 Claims Payment Summary - M  1/9/23 Due 15 calendar days of the end of each month except where indicated
       
Quarterly Reports    
018 Medical Loss Ratio - Q 9/21/23 Due May 31, August 31, November 30, and February 28, except where indicated
069 Utilization Management Dental Record Review Report - Q 5/26/21  Due April 30, July 30, October 30, and January 30, except where indicated
072 QAPI PCD Profile Reports - Q 5/26/21  Due April 30, July 30, October 30, and January 30, except where indicated
082 PCD Linkages - Q 5/26/21  Due April 30, July 30, October 30, and January 30, except where indicated
109 Marketing and Member Education Activities Report - Q 6/24/22 Due April 30, July 30, October 30, and January 30, except where indicated
119 QAPI Committee (minutes) - Q 08/15/17  Due April 30, July 30, October 30, and January 30, except where indicated
145 Fraud and Abuse Activity Report - Q 8/9/23  Due April 30, July 30, October 30, and January 30, except where indicated
147 Sampling of Paid Claims Report 5/2/23 Due April 30, July 30, October 30, and January 30, except where indicated
152 Act 710 Healthy Louisiana Claims Report 11/15/23 Due April 30, July 30, October 30, and January 30, except where indicated
183 Claims Processing Interest Payments - Q 5/26/21  Due April 30, July 30, October 30, and January 30, except where indicated
185 Quarterly Unaudited Financial Statement - Q (60 days after QTR)* 2/10/23  Due May 31, August 31, November 30, and February 28
188 PA Summary - Q  10/29/21 Due April 30, July 30, October 30, and January 30, except where indicated
225 Network Summary Dental Report - Q  5/26/21 Due April 30, July 30, October 30, and January 30, except where indicated
      Due April 30, July 30, October 30, and January 30, except where indicated
Semi-Annual Reports     
220 Network Adequacy Review  1/26/24 July 31 & Jan. 31
Annual Reports    
017 Key Staff Organizational Chart Listing 3/5/24 January 30th 
019 Medical Loss Ratio - A 8/1/23 January 15th
053 NW Provider Development Management Plan - A   January 30th
068 Utilization Management Dental Record Review Stategy - A   January 30th
110 Marketing Activities Annual Review - A   January 30th
132 Member Satisfaction Survey Report (CAHPS) - A 9/8/23  April 30th
133 Provider Satisfaction Survey Report - A 9/8/23  April 30th
134 Appointment Availability Survey Report 8/17/23  April 30th
138 QAPI Performance Improvement Projects (outcomes) 3/14/17 June 30th
151 Systems Refresh Plan - A   January 30th
157 Emergency Management Plan - A   January 30th
159 Back-up File List - A 5/26/21  January 30th
170 Form CMS 1513 Ownership and Control Interest Statement - A   March 30th
177 Total and OON Claims 1/9/23 July 30th (30 days after the prior SFY)
184 Annual Audited Financial Statement - A 2/10/23 June 30th
189 Independent-Subcontractor EDP Audit (SSAE16) - A ***   Based on Audit Period (45 days after corporate audit complete)
216 QAPI Impact and Effectiveness of QAPI Program Evaluation - A   March 30th

Q/A means Quarterly and Annually 

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

**Draft versions are due 90 days after year end.

***- 45 days after the corporate audit Period is comlete.