Suspected/Confirmed Fraud and Abuse Reporting Summary
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| Report Template | Effective Date | Plan Communication | Issue Date |
| Suspected/Confirmed Fraud and Abuse Reporting | 2/1/2025 |
- Model Health Plan Contract
- Expanded Benefits
- Agency Communications to SMMC Plans Effective 2025-2030
- Model Dental Plan Contract
- Agency-Approved Contract Materials
- SMMC: Achieved Savings Rebate (ASR) Financial Reports
- SMMC: ASR Claim Lags Report
- SMMC: ASR Dental Claim Lags Template
- SMMC: ASR Dental Financial Report
- SMMC: ASR Financial Report
- SMMC: Actual Value of Enhanced Payment (AVEP) Dental Provider Incentive Program (DPIP) Report
- SMMC: Actual Value of Enhanced Payment (AVEP) MMA Physician Incentive Program (MPIP) Report
- SMMC: Administrative Subcontractors and Affiliates Report
- SMMC: Annual Fraud, Waste and Abuse Activity Report
- SMMC: Annual Pharmacy Claims Reconciliation Report
- SMMC: Appointment Wait Times Report
- SMMC: Case Management File Audit Report
- SMMC: Adverse and Critical Incident Summary Report
- SMMC: Case Manager and Provider Training Report
- SMMC: Electronic Visit Verification Report
- SMMC: Eligibility Worksheet Report
- SMMC: Case Manager Caseload Report
- SMMC: Child Staffing Attendance Report
- SMMC: Claims Aging Report
- SMMC: Community Based Organization (CBO) Board Participation Report
- SMMC: Critical Incident Report- Individual
- SMMC: Denial, Reduction, Termination or Suspension of Services Report
- SMMC: Denied/Suspended/Terminated Provider Report
- SMMC: Dental Provider Incentive Program (DPIP) Metrics Report
- SMMC: Enhanced Care Coordination Report
- SMMC: Enrollee Complaints, Grievances and Plan Appeals Report
- SMMC: Enrollee Roster and Facility Residence Report
- SMMC: Enrollee Help Line Statistics Report
- SMMC: ER Visits for Enrollees without PCP/PDP Appointment Report
- SMMC: Estimated Value of Enhanced Reimbursement (EVER)/Qualified Provider Dental Provider Incentive Program (DPIP) Report
- SMMC: Estimated Value of Enhanced Reimbursement (EVER)/Qualified Provider MMA Physician Incentive Program (MPIP) Report
- SMMC: Health Risk Assessment Report
- SMMC: Healthy Behaviors Report
- SMMC: Hernandez Settlement Agreement Survey
- SMMC: Hernandez Settlement Ombudsman Log
- SMMC: Institution for Mental Diseases (IMD) Reimbursement Report
- SMMC: Inter-Rater Reliability (IRR) Report
- SMMC: Managed Care Plan Training Report
- SMMC: Marketing/Public/Educational Events Report
- SMMC: Marketing Agent Status Report
- SMMC: Medical Foster Care Services Report
- SMMC: Medication Administration Report
- SMMC: Member Satisfaction Improvement Report
- SMMC: Non-Emergency Transportation (NET) Timeliness Report
- SMMC: Missed Services Report
- SMMC: Participant Direction Option (PDO) Roster Report
- SMMC: Oral Health Risk Assessment Report
- SMMC: PCP/PDP Appointment Report
- SMMC: Performance Improvement Projects (PIP) Quarterly Progress Report
- SMMC: Performance Measures Report
- SMMC: Plan-Specific Commitments Progress Report
- SMMC: Provider Complaint Report
- SMMC: Provider Network and Qualifications Report
- SMMC: Provider Network File
- SMMC: Quarterly Fraud and Abuse Activity Report
- SMMC: Reactive Strategies Report
- SMMC: Residential Psychiatric Treatment Report
- SMMC: Service Authorization Performance Outcome Report
- SMMC: Special Populations Care Coordination Report
- SMMC: Supplemental HIV/AIDS Report
- SMMC: Suspected/Confirmed Fraud and Abuse Reporting
- SMMC: Suspected/Confirmed Recovered Fraud and Abuse Reporting
- SMMC: Suspected/Confirmed Waste Reporting
- SMMC: Unable to Provide Case Management Report
- SMMC: Quarterly Pharmacy Claims Reconciliation Report Template
- SMMC: MMA Physician Incentive Program (MPIP) Quality Measures Report
- SMMC: Annual Chronic Disease Management Program Report
- Quarterly Chronic Disease Management Program Report
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