| Managed Care Plan Report Guide (Effective 9/1/2019) |
|---|
Report Guide [ 
1.5 MB
]
Report Summary Chart [ 
28.3 kB
]
|
| Managed Care Plan Report Guide Templates: |
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Actual Value Enhanced Payment MPIP Report
[
33.9 kB
]
Effective 12/1/18 |
|
Adverse and Critical Incident Summary Report
[
22.6 kB
]
Effective 9/1/19 AIRS User GUIDE for Health Plans |
|
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 Report template updated with Policy Transmittal 2019-21 issued 10/08/2019 Report template updated with Policy Transmittal 2020-01 issued 01/17/2020 Report template updated with Policy Transmittal 2020-21 issued 04/05/2020 |
|
ASR Financial Report
[
2.3 MB
]
Effective 4/1/19 Report template updated with Policy Transmittal 2019-21 issued 10/08/2019 Report template updated with Policy Transmittal 2020-01 issued 01/17/2020 Report template updated with Policy Transmittal 2020-21 issued 04/05/2020 |
|
Administrative Subcontractors and Affiliates Report
[
647.3 kB
]
Effective 12/1/18 |
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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
[
62.3 kB
]
Effective 4/1/19 Report template updated with Policy Transmittal 2019-24 issued 12/05/2019 |
|
Case Manager Caseload Report
[
92.4 kB
]
Effective 9/23/2020 (Template Updated 9/23/2020: Instructions Updated and Case Manager Tracking Tab Deleted) |
|
Case Management File Audit Report
[
26.1 kB
]
Effective 12/1/18 |
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Case Manager and Provider Training Report
[
20.1 kB
]
Effective 12/1/18 |
|
Child Staffing Attendance Report
[
33.2 kB
]
Effective 9/1/19 |
|
Claims Aging Report
[
124.6 kB
]
Effective 4/1/19 (Update 9/6/19: Contract Citation Corrected in Instructions) |
|
Critical Incident Individual Report
[
19.5 kB
]
Effective 9/1/19 AIRS User GUIDE for Health Plans |
|
Custody Arrangement Multiple Signature Verification Agreement Form
[
88.9 kB
]
Effective 12/1/18 |
|
Denial, Reduction, Termination or Suspension of Services Report
[
50.7 kB
]
Effective 9/1/19 |
|
Denied/Suspended/Terminated Provider Report
[
2 MB
]
Effective 4/1/19 (Template Locked, updated 7/12/19; Technical Update 9/23/19 |
|
Enhanced Care Coordination Report
[
57.3 kB
]
Effective 9/1/19 |
Enrollee Complaints, Grievances and Appeals Report
[
13 MB
]
Effective 9/1/19 (Template Technical Corrections, Updated 2/6/20) |
|
Enrollee Roster and Facility Residence Report
[
40.8 kB
]
Effective 9/1/19 (Update 6/16/2020: Formula added to Header Q to "Enrollee Roster" Tab; Update 7/14/2020: Formula in Column Q updated) |
|
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
[
70.4 kB
]
Effective 9/1/19 |
|
Healthy Behaviors Report
[
24.7 kB
]
Effective 12/1/18 |
|
Hernandez Settlement Agreement Log - MMA
[
105 kB
]
Effective 9/1/19 |
|
Hernandez Settlement Agreement Survey - MMA
[
31 kB
]
Effective 12/1/18 |
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Hernandez Settlement Survey Requirements
[
89.4 kB
]
Effective 12/1/18 |
|
HIV/AIDS DM Algorithm
[
54.3 kB
]
Effective 1/1/20 |
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HIV/AIDS Performance Measures Attachment
[
44.9 kB
]
Effective 4/1/19 |
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IMD Reimbursement Report
[
42.9 kB
]
Effective 12/1/18 |
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Insolvency Protection Multiple Signature Verification Agreement Form
[
47 kB
]
Effective 12/1/18 |
|
Inter-Rate Reliability Report
[
135.2 kB
]
Effective 9/1/19 |
|
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
[
26.8 kB
]
Effective 9/1/19 |
|
Marketing Public Educational Events Report
[
110 kB
]
Effective 9/1/19 |
|
Medical Foster Care Services Report
[
210.1 kB
]
Effective 9/1/19 Report template updated with Policy Transmittal 2019-19 issued 09/16/2019 |
|
Member Satisfaction Improvement Report
[
55.5 kB
]
Effective 9/1/19(Instructions Correction, Updated 9/13/19) |
|
Missed Services Report
[
45.3 kB
]
Effective 9/1/19 |
|
Non-Emergency Transportation Missed Trips Report
[
43 kB
]
Effective 12/1/18 |
|
Non-SNP Financial Report
[
957.4 kB
]
Effective 12/1/18 |
|
Oral Health Risk Assessment Report
[
39.4 kB
]
Effective 9/1/19 |
|
PASRR Report
[
32 kB
]
Effective 12/1/18 |
|
Participant Directed Option Roster Report
[
95.7 kB
]
Effective 9/1/19 |
|
PCP/PDP Appointment Report
[
35 kB
]
Effective 9/1/19 |
|
Performance Measure Action Plan
[
39.2 kB
]
Effective 9/1/19 (Instructions Correction, Updated 9/13/19) |
|
Performance Measures Report
[
426.5 kB
]
Effective 4/1/19 (Formula updates 6/17/19) |
|
Provider Complaint/Appeal Report
[
11.2 MB
]
11.15MB ZIP/MS Excel] Effective 9/1/2019 (Template Technical Corrections, Updated 9/12/19; Technical Edit in Drop-down Options of Column J on the Sept. Tab, Updated 9/17/2020) |
|
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
[
39.4 kB
]
Effective 9/1/19 |
|
Service Authorization Performance Outcome Report
[
92.2 kB
]
Effective 7/26/19 |
|
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 |
