Medicaid Managed Care Plan Report Guide
The Medicaid Managed Care Plan Report Guide (Report Guide) is a companion to each Managed Care Plan’s Contract with the Agency for Health Care Administration. It provides details of plan reporting requirements including instructions, location of templates, and submission directions.
Beginning December 21, 2018, this Report Guide provides report guidance and requirements for the following types of Managed Care Plans:
- Intellectual and Developmental Disabilities (IDD) Managed Care Pilot Program
- Managed Medical Assistance Health Maintenance Organizations (MMA HMOs)
- Managed Medical Assistance Capitated Provider Service Networks (MMA Capitated PSNs)
- Managed Medical Assistance Specialty Plans (MMA Specialty Plans)
- Managed Medical Assistance Children’s Medical Services Plan (MMA CMS Plan)
- Comprehensive Long-term Care Plans (Comprehensive LTC Plans)
- Long-term Care Plus Plans (LTC Plus Plans)
- Dental Plans
Beginning August 1, 2024, this Report Guide provides report guidance and requirements for the Intellectual and Developmental Disabilities (IDD) Managed Care Pilot Program:
SMMC Managed Care Plan Report Guide
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Report Summary Chart
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SMMC Contract Submission Requirements Summary Chart
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SMMC Managed Care Plan Reports
- Achieved Savings Rebate (ASR) Claim Lags Reports
- ASR Dental Claim Lags Report
- ASR Dental Financial Report
- ASR Financial Report
- Actual Value of Enhanced Payment (AVEP) Dental Provider Incentive Program (DPIP) Report
- Actual Value of Enhanced Payment (AVEP) MMA Physician Incentive Program (MPIP) Report
- Administrative Subcontractors and Affiliates Report
- Adverse and Critical Incident Summary Report
- Annual and Quarterly Pharmacy Claims Reconciliation Report
- Annual Fraud and Abuse Activity Report
- Appointment Wait Times Report
- Case Management File Audit Report
- Case Manager and Provider Training Report
- Case Manager Caseload Report
- Child Staffing Attendance Report
- Claims Aging Report
- Critical Incident Report- Individual
- Denial, Reduction, Termination or Suspension of Services Report
- Denied/Suspended/Terminated Provider Report
- Enhanced Care Coordination Report
- Enrollee Complaints, Grievances and Appeals Report
- Enrollee Roster and Facility Residence Report
- ER Visits for Enrollees without PCP/PDP Appointment Report
- Estimated Value of Enhanced Reimbursement (EVER)/Qualified Provider Dental Provider Incentive Program (DPIP) Report
- Estimated Value of Enhanced Reimbursement (EVER)/Qualified Provider MMA Physician Incentive Program (MPIP) Report
- Health Risk Assessment Report
- Healthy Behaviors Report
- Hernandez Settlement Agreement Survey
- Hernandez Settlement Ombudsman Log
- Institution for Mental Diseases (IMD) Reimbursement Report
- Inter-Rater Reliability Report (IRR)
- Managed Care Plan Training Report
- Marketing Agent Status Report
- Marketing/Public/Educational Events Report
- Medical Foster Care Services Report
- Member Satisfaction Improvement Report
- Missed Services Report
- Non-Emergency Transportation Timeliness Report
- Non-Special Needs Plan (Non-SNP) Financial Report
- Oral Health Risk Assessment Report
- Participant Direction Option (PDO) Roster Report
- PCP/PDP Appointment Report
- Performance Measure Action Plan
- Performance Measures Report
- Provider Complaint Report
- Provider Network and Qualifications Report
- Provider Network File
- Quarterly Fraud and Abuse Activity Report
- Residential Psychiatric Treatment Report
- Service Authorization Performance Outcome Report
- Supplemental HIV/AIDS Report
- Suspected/Confirmed Fraud and Abuse Reporting
- Suspected/Confirmed Waste Reporting
- Unable to Provide Case Management Report
- Well Child Visit (CMS-416) and FL 80% Screening Report
