Managed Care Reporting Deliverables

Weekly Reports (Every Wednesday by 5 p.m.) Revision Date
316 Prior Authorization Denial Report for CSR 11/10/15
353 Chisholm Weekly PA Report 12/8/16

 

Monthly Reports (Due 15 calendar days of the end of each month except where indicated) Revision Date
022 Healthy Louisiana Third Party Liability (TPL) Report - M 8/10/17
055 Pharmacy Report (RX055) - M 11/10/17
107 Member Service Call Center - M 3/15/16
109 Marketing Plan Updates - M 1/14/16
112 Grievance Detail Reports - M 4/21/16
113 Appeal and State Fair Hearing Log - M 3/23/16
129 Returned Mail Report 12/2/16
137 End of Pregnancy Report 5/9/17
148 Exclusion Database Attestation 5/19/15
160 Medication Therapy Management Report - M 2/10/16
161 Behavioral Health Pharmacy Utilization Report - M 5/31/16
162 Health Plan Drug Utilization Review Report - M 2/10/16
165 Lock-In Report - M 2/10/16
167 Claims Payment Accuracy Report - M 11/1/13
171  Substance Use Disorder Report - M  2/10/16
172 Retroactive Reimbursement - M 4/5/17
173 Prepaid Denied Claims Report - M 12/15/16
175 Hepatitis C - M 5/31/16
181 Provider Call Center - M 11/1/17
182 Provider Complaint & Appeal Summary Report - M 2/3/16
221 Claims Payment Summary - M 9/7/17
323 Chisholm Monthly Behavioral Health ASD Report  11/20/15
325 Behavioral Health Pharmacy Report 1/14/16
326 Healthy Louisiana Adverse Incident Report 9/5/17
335 Adult Mental Health Rehabilitation Services LOC Report - M/A (Discontinued as of 4/7/16) 1/25/16
337 Behavioral Health Out-of-State Placement Report 8/4/16
347 Adult Mental Health Rehabilitation Service Authorization Timelines (Discontinued as of 4/7/16) 3/23/16
354 Chisholm PCS Member Aging Out Report 12/13/16

 

Quarterly Reports (Due April 30, July 30, October 30, and January 30, except where indicated)  Revision Date
018 Medical Loss Ratio - Q +  
020 MCO Payment Discrepancy Report + 8/30/17
026 EPSDT Report (CMS 416) - Q 11/1/13
039 Case Management Report - Q/A 6/1/17
042 CCMP Reports (Chronic Care Management Program) - Q/A 6/26/15
069 Utilization Management Medical Review Report - Q 3/22/16
119 QAPI Committee (minutes) - Q 8/15/17
145 Fraud and Abuse Activity Report - Q 7/13/16
147 Sampling of Paid Claims Report - Q 2/27/15
185 Quarterly Unaudited Financial Statement - Q + 3/7/17
188/188BH Service Authorizations - Q

9/27/17

220 Network Adequacy Review - Q 11/1/13
300 NCCI MCO Cost Savings - Q ++ 8/8/17
312 MCO Gambling and Tobacco Report 11/10/15
313 Access to Wraparound Services 11/10/15
314 Behavioral Health High Utilizers Report 4/1/16
317 PASRR Report 5/6/16
318 Utilization of HCBS Report 5/5/16 
321 Behavioral Health Related ED Presentations Report 3/18/16
322 Community Tenure Report  2/9/17
328 Behavioral Health Provider Network Detail Report 2/10/16
329 Children in Restrictive Settings 1/25/16
331 Higher LOCs Report 3/30/16
332 In Lieu of Reporting - Q/A 4/6/16
336 Behavioral Health Providers by Level of Care 2/10/16
338 Behavioral Health Network Adequacy and GEO Access Review 2/10/16
339 Behavioral Health Prescriber Sufficiency Summary 2/10/16
343 Behavioral Health Geo Access Density Summary 2/10/16
344 Behavioral Health Cultural Competency Report 2/10/16
346 Provider Credentialing and Contracting Report 8/10/16
348 GeoAccess Mapping 4/11/16

 

Semi-Annual Reports (First submission is expected by Sep. 30, 2015)  Revision Date  Due Date
355 Healthy Louisiana EBP Report 5/23/17 July 15 & Jan. 15

 

Annual Reports   Due Date
17 Key Staff Organizational Chart Listing

Jan. 30

19 Medical Loss Ratio - A

June 30

41 CCMP Policies and Procedures (program evaluation) - A March 30
44 CCMP Predictive Modeling Specifications - A Jan. 30
53 NW Provider Development Management Plan - A Jan. 30
56 PCMH Implementation Plan Jan. 31
68 Utilization Management Medical Record Review Strategy - A Jan. 30
111 Call Center Quality Criteria and Protocol Jan. 30 
132 Member Satisfaction Survey Report (CAHPS) - A Aug. 30
133 Provider Satisfaction Survey Report - A April 30
138 QAPI Performance Improvements Projects Descriptions and Outcomes March 30
141 Member Advisory Council - A Jan. 30
157 Emergency Management Plan - A Jan. 30
170 Disclosure of Ownership and Control Interest Statement - A March 30
177 Total and Out of Network Claims Report Jan. 30 (6 months after the prior SFY) 
184 Annual Financial Statement - A* June 30
189 Independent-Subcontractor EDP Audit (SSAE16) - A Based on Audit Period
333 Strategy for Increasing Outcome Measures 30 calendar days following the end of the year 
334 MCO Integration Assessment Report 30 days after the end of the reporting period 
349 Unmet Service Needs Resolution Plan  April 30
351 Behavioral Health Member Survey Report  June 30
352 Adverse Incident Reporting Policies and Procedures March 30


* Template not provided. Will accept Health Plans' corporate standard.

** Revisions made to template to incorporate Behavioral Health Integration are not due for implementation until 12/1/15.

+ Due May 31, August 31, November 30, and February 28.

++ Due April 15, July 15, October 15 and January 15.

 

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