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Contract Section      Report

3.7       Manual Maternity Kicker                  
3.18 Call Center Performance  
4.2 Autism Prior Authorization                                                                    
4.2 Autism Claims Payment                                                                       
4.2 PRTF Prior Authorization                                                                      
4.2 PRTF Claims Payment Accuracy                                                        
4.3 Additional Services Form  
4.8 Member Incentive Form  
5.4 Care Management  
6.3 Provider Network                                                                                      
7.3 PCMH updated
7.4 FQHC RHC Wrap Detail Data                                                                  
7.4 FQHC/RHC Wrap Summary Data  
9.1 Member Appeal Log  
9.1 Member Grievance Log  
9.2 Provider Dispute Log  
10.9 TPL Cost Avoidance  
10.9 TPL COB Savings  
10.9 TPL Recoveries                                                                         
10.9 TPL Casualty Cases                                                                    
11.1 PI Fraud and Abuse Definitions  
11.1 PI Monthly Fraud and Abuse Report  
11.1 PI Monthly Fraud and Abuse Report Instructions                            
11.1 PI Quarterly Fraud and Abuse  
11.1 PI Quarterly Fraud and Abuse Report Instructions                                
11.1 PI Termination for Cause  
11.1 PI Rules for Share Point Suspension Termination Exclusion            
11.1 PI Instructions-Use of SharePoint Suspension Termination Exclusion  
11.1 PI Annual Strategic Plan Format for MCOs                                            
11.2 PI Compliance Plan - DHHS                                                                  
11.2 PI Compliance Plan - MCO  
11.10 Pharmacy Lock In Member Letter updated
11.10 Pharmacy Lock In Member Instructions  
11.10 Pharmacy Lock In Member Removal Letter  updated
11.10 Pharmacy Lock In Pharmacy Letter  updated
13.1 Claims Payment Accuracy  
13.1 GME Report  
14.5 Encounter Submission Summary  
14.10 Encounter Quality Initiative (EQI)  
15.5 Alternative Payment Models                                                               
16.3 Managed Care Question and Answer Grid  

 

Additional Resources

       Health Plan Data Request Methodology Document 

       MLR Calculation Document

       HIPAA 5010 834 Transaction Layout

       Encounter Errors Mapping to 277CA

       Encounter Edit Code List

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