Bayou Health Shared Savings Deliverables
| Documentation/Certifications | Revision Date |
| SF015 A - Key Staffing Organizational Listing - Shared | |
| SF016 A - Functional Organizational Chart and Function/Location Listing | |
| SQ66 Q - UM Committee Meeting Minutes | |
| SS139 Q - Member Advisory Council (minutes) | |
| SS141 A - Member Advisory Council | |
| SI159 Q - Back-up File List | |
| SF163 A - State Audit Exit Interview Yearly Report | |
| SF170 A - Form CMS 1513 Ownership and Control Interest Statement | |
| SF184 A - Annual Audited Financial Statement | |
| SF185 Q - Quarterly Unaudited Financial Statements & Financial Reporting Guide | |
| SF186 M - Monthly Financial Statements | |
| SF187 A - Electronic Data Processing (EDP) Audit | |
| Reports | revision date |
| SQ039 A - Case Management Report | 1.29.2013 |
| SQ042 A - CCMP Reports (Chronic Care Management Program) | 2.22.2013 |
| SI058 A - NCQA PCP-PCMH Recognition Report | |
| SQ069 Q - UM Medical Record Review Report | 11.20.2012 |
| SQ072 Q - QAPI PCP Profile Reports | 11.26.2012 |
| SI082 Q - PCP Linkages | |
| SS097 M - Initial Member Contact Report | |
| SS107 M - Member Service Call Center | |
| SM109 M - Marketing Activities Update | 2.20.2013 |
| SQ110 A - Marketing Activities Annual Review | |
| SI115 M - Provider Appeals Reporting | |
| SS116 M - Grievance, Appeal and Fair Hearing Log | |
| SS117 Q/A - Grievance, Appeal and Fair Hearing Log (redacted) | |
| SQ127 A - QAPI Performance Reporting Measures (Level I and Level II) | |
| SQ131 A - QAPI Performance Improvements Projects (outcomes) | |
| SQ132 A - Member Satisfaction Survey Report | |
| SI133 A - Provider Satisfaction Survey Report | |
| SI173 M - Shared Denied Claims Report | |
| SI181 M - Provider Call Center | |
| SI182 M - Provider Complaint & Appeal Summary Report | |
| SQ188 Q - PA and Pre-Cert Summary | 11.29.2012 |
| SQ216 A - QAPI Impact and Effectiveness of QAPI Program Evaluation | |
| SI217 M - QAPI Early Warning System Performance Measures | 11.20.2012 |
| SI220 - Network Adequacy Review | |
| SI221 Q - Prompt Pre-Processing | MOLINA |
| Plans Operational/Strategic | revision date |
| SQ041 A - CCMP Policies and Procedures (program evaluation) | |
| SQ044 A - CCMP Predictive Modeling Specifications | |
| SI053 A - NW Provider Development Management Plan | |
| SI056 A - PCMH Implementation Plan (patient-centered medical home) | |
| SQ121 A - QAPI Program Description and Work Plan | |
| SQ130 A - QAPI Performance Improvement Projects (descriptions) | |
| SI151 A - Systems Refresh Plan | |
| Electronic Data Submissions | revision date |
| SI103 W - Network Provider and Subcontractor Registry |
