| Managed Care Plan Report Guide (Effective 4/1/2019) |
|---|
Report Guide [ 
1.4 MB
]
|
| Managed Care Plan Report Guide Templates: |
Actual Value Enhanced Payment MPIP Report
[
33.9 kB
]
Effective 12/1/18 |
|
Adverse and Critical Incident Summary Report
[
22.3 kB
]
Effective 4/1/19 |
|
ASR Claim Lags Template
[
37.4 kB
]
Effective 12/1/18 |
|
ASR Dental Claim Lags Template
[
16.5 kB
]
Effective 12/1/18 |
|
ASR Dental Financial Report
[
838.3 kB
]
Effective 4/1/19 |
|
ASR Financial Report
[
2.3 MB
]
Effective 4/1/19 |
|
Administrative Subcontractors and Affiliates Report
[
647.3 kB
]
Effective 12/1/18 |
|
Annual Fraud and Abuse Activity Report
[
44.2 kB
]
Effective 4/1/19 (Update 7/12/19: Template Locked; Update 8/13/19: Technical Corrections) |
|
Appointment Wait Times Report
[
54.2 kB
]
Effective 4/1/19 |
|
Case Manager Caseload Report
[
92 kB
]
Effective 12/1/18 |
|
Case Management File Audit Report
[
26.1 kB
]
Effective 12/1/18 |
|
Case Manager and Provider Training Report
[
20.1 kB
]
Effective 12/1/18 |
|
Claims Aging Report
[
124 kB
]
Effective 4/1/19 |
|
Critical Incident Individual Report
[
13.9 kB
]
Effective 12/1/18 |
|
Custody Arrangement Multiple Signature Verification Agreement Form
[
88.9 kB
]
Effective 12/1/18 |
|
Denial, Reduction, Termination or Suspension of Services Report
[
34.7 kB
]
Effective 12/1/18 |
|
Denied/Suspended/Terminated Provider Report
[
2 MB
]
Effective 4/1/19 (Template Locked, updated 7/12/19) |
|
Enhanced Care Coordination Report
[
54.3 kB
]
Effective 4/1/19 |
Enrollee Complaints, Grievances and Appeals Report
[
12.1 MB
]
Effective 1/16/2019 |
|
Enrollee Roster and Facility Residence Report
[
36.9 kB
]
Effective 4/1/19 |
|
ER Visits without PCP/PDP Appointment Report
[
18.6 kB
]
Effective 12/1/18 |
|
Estimated Value of Enhanced Reimbursement MPIP Report
[
327.5 kB
]
Effective 12/1/18 |
|
Health Risk Assessment Report
[
26.2 kB
]
Effective 12/1/18 |
|
Healthy Behaviors Report
[
24.7 kB
]
Effective 12/1/18 |
|
Hernandez Settlement Agreement Log - MMA
[
238 kB
]
Effective 12/1/18 |
|
Hernandez Settlement Agreement Survey - MMA
[
31 kB
]
Effective 12/1/18 |
|
Hernandez Settlement Survey Requirements
[
89.4 kB
]
Effective 12/1/18 |
|
HIV/AIDS DM Algorithm
[
53.9 kB
]
Effective 7/1/19 |
|
HIV/AIDS Performance Measures Attachment
[
44.9 kB
]
Effective 4/1/19 |
|
IMD Reimbursement Report
[
42.9 kB
]
Effective 12/1/18 |
|
Insolvency Protection Multiple Signature Verification Agreement Form
[
47 kB
]
Effective 12/1/18 |
|
Inter-Rate Reliability Report
[
25.4 kB
]
Effective 4/1/19 |
|
LTC Performance Measure Specifications
[
375.4 kB
]
Effective 12/1/2018 |
|
MMA Performance Measure Specifications
[
280.1 kB
]
Effective 4/1/2019 |
|
Marketing Agent Status Report
[
19.6 kB
]
Effective 12/1/18 |
|
Marketing Public Educational Events Report
[
96.7 kB
]
Effective 12/1/18 |
|
Medical Foster Care Services Report
[
199.1 kB
]
Effective 4/1/19 |
|
Missed Services Report
[
37.2 kB
]
Effective 12/1/18 |
|
Non-Emergency Transportation Missed Trips Report
[
43 kB
]
Effective 12/1/18 |
|
Non-SNP Financial Report
[
957.4 kB
]
Effective 12/1/18 |
|
PASRR Report
[
32 kB
]
Effective 12/1/18 |
|
Participant Directed Option Roster Report
[
86.3 kB
]
Effective 12/1/18 |
|
PCP/PDP Appointment Report
[
18.5 kB
]
Effective 12/1/18 |
|
Performance Measures Report
[
426.5 kB
]
Effective 4/1/19 (Formula updates 6/17/19) |
|
Provider Complaint/Appeal Report
[
12 MB
]
Effective 4/1/2019 |
|
Provider Network and Qualifications Report
[
41.8 kB
]
Effective 4/1/19 (Drop-down boxes updated 7/12/19) |
|
Quarterly Fraud and Abuse Activity Report
[
2.3 MB
]
Effective 4/1/19 (Template Locked, updated 7/12/19) |
|
Residential Psychiatric Treatment Report
[
38.4 kB
]
Effective 4/1/19 |
|
Service Authorization Performance Outcome Report
[
50.5 kB
]
Effective 4/1/19 |
|
Suspected/Confirmed Waste Reporting
[
28.7 MB
]
Effective 4/1/19 (Update 7/12/19: Template Locked; Update 8/12/19: Technical Corrections) |
|
Unable to Provide Case Management Report
[
158.6 kB
]
Effective 12/1/18 |
|
Well Child Visit Report
[
230 kB
]
Effective 4/1/19 |
