Denied/Suspended/Terminated Provider Report Summary
[
130.9 kB
]
| Report Template | Effective Date | Plan Communication | Issue Date |
Denied/Suspended/Terminated Provider Report [ 
2 MB
]
| 4/15/2021 | RCN 2021-02 | 1/15/2021 |
|
Denied/Suspended/Terminated Provider Report
[
2 MB
]
Plans notified via email template updated 9/23/19: Technical Update Plans notified via email template updated 7/12/19: Template Locked | 4/1/2019 |
- 2018-2023 Medicaid Managed Care Plan Report Guide
- 2025-2030 Medicaid Managed Care Plan Report Guide
- Denial, Reduction, Termination or Suspension of Services Report
- IDD: Eligibility Worksheet
- IDD: Medication Administration Report
- IDD: Reactive Strategies Report
- SMMC Contract Submission Requirements Summary Chart Archive
- SMMC Managed Care Report Guide Archive
- SMMC Report Guide Summary Archive
- SMMC: Actual Value Enhanced Payment DPIP Report
- SMMC: Actual Value Enhanced Payment MPIP Report
- SMMC: Administrative Subcontractors and Affiliates Report
- SMMC: Adverse and Critical Incident Report
- SMMC: Annual and Quarterly Pharmacy Claims Reconciliation Report
- SMMC: Annual Fraud and Abuse Activity Reporting
- SMMC: Appointment Wait Times Report
- SMMC: ASR Claim Lags Template
- SMMC: ASR Dental Claims Lag Template
- SMMC: ASR Dental Financial Report
- SMMC: ASR Financial Reporting
- SMMC: Case Management File Audit Report
- SMMC: Case Manager and Provider Training Report
- SMMC: Case Manager Caseload Report
- SMMC: Child Staffing Attendance Report
- SMMC: Claims Aging Report
- SMMC: Critical Incident Individual Report
- SMMC: Denied/Suspended/Terminated Provider Report
- SMMC: Enhanced Care Coordination Report
- SMMC: Enrollee Complaints, Grievances, and Appeals Report
- SMMC: Enrollee Roster and Facility Residence Report
- SMMC: ER Visits without PCP/PDP Appointment Report
- SMMC: Estimated Value of Enhanced Reimbursement DPIP Report
- SMMC: Estimated Value of Enhanced Reimbursement MPIP Report
- SMMC: Health Risk Assessment Report
- SMMC: Healthy Behaviors Report
- SMMC: Hernandez Settlement Agreement Log - MMA
- SMMC: Hernandez Settlement Agreement Survey - MMA
- SMMC: IMD Reimbursement Report
- SMMC: Inter-Rate Reliability Report
- SMMC: Managed Care Plan Training Report
- SMMC: Marketing Agent Status Report
- SMMC: Marketing/Public/Educational Events Report
- SMMC: Medical Foster Care Services Report
- SMMC: Member Satisfaction Improvement Report
- SMMC: Missed Services Report
- SMMC: Non-Emergency Transportation Missed Trips Report
- SMMC: Non-SNP Financial Report
- SMMC: Oral Health Risk Assessment Report
- SMMC: Participant Direction Option Roster Report
- SMMC: PCP/PDP Appointment Report
- SMMC: Performance Measure Action Plan
- SMMC: Performance Measures Report
- SMMC: Provider Complaint/Appeal Report
- SMMC: Provider Network and Qualifications Report
- SMMC: Provider Network File
- SMMC: Quarterly Fraud and Abuse Activity Report
- SMMC: Residential Psychiatric Treatment Report
- SMMC: Service Authorization Performance Outcome Report
- SMMC: Supplemental HIV/AIDS Report
- SMMC: Suspected/Confirmed Waste Reporting
- SMMC: Unable to Provide Case Management Report
- SMMC: Well Child Visit Report
- SMMC: •Suspected/Confirmed Fraud and Abuse Reporting
Document reader download links:
