Bayou Health Reporting Requirements by d1uSz9lb

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									  Submitter               Report Name                       Frequency

                                                             Annually
                 Listing of Contracted Health Plans
                                                      (updated as contracts are
                   by Geographical Service Area
                                                             executed)


  Health Plan          Organizational Chart                  Annually



  Health Plan     Functional Organizational Chart            Annually



                       Network Provider and
                                                      At Readiness Review and
  Health Plan          Subcontractor Registry
                                                         Monthly thereafter
                     (by type and service area)


                     Service Area Review of
                    Appointment Availability
  Health Plan                                                Annually
                  /Twenty-four (24) hour Access
                     and Availability Survey


                  Network Provider Development        During readiness review
  Health Plan
                      and Management Plan             and Annually thereafter

DHH - Medicaid
 Managed Care        Readiness Review Report              As Appropriate
   Program




                                   1
Submitter              Report Name                   Frequency

                Patient-Center Medical Home
                           (PCMH)
                                               During Readiness Review
Health Plan   A. PCMH Implementation Plan
                                                and Annually thereafter
              B. B. NCQA PCP-PCMH™
                 recognition report

              Member Services
                                               A. Monthly
              A. Unsuccessful new member
Health Plan                                    B. Monthly with an
                 contacts
                                                  Annual Summary
              B. Member Services Call Center

                                               Monthly with an Annual
Health Plan         Provider Call Center
                                                     Summary


                                               Monthly with an Annual
Health Plan      Provider Complaints Report
                                                     Summary


                                               During Readiness Review,
Health Plan           Referral Policies         Annually thereafter, and
                                                 prior to any revisions

                 Health Plan’s Disenrollment
Health Plan                                           Quarterly
                           Report




                                2
Submitter             Report Name                     Frequency

                      EPSDT Report              Quarterly and Annually,
Health Plan         (KIDMED services)           due March 31 (6 months
                        (CMS 416)               after the end of the FFY)


                                                Within 30 days from the
                                                  date the Contract is
Health Plan       Medical Record Review
                                                 signed, and Annually
                                                       thereafter


              Utilization Management reports    A. Within 5 working
              A. UM Committee Meeting              days of each meeting
Health Plan
                 minutes                        B. Quarterly with an
              B. Medical Record Reviews            Annual Summary


                                                Quarterly with an Annual
Health Plan   Fraud and Abuse Activity Report
                                                       Summary


               Chronic Care Management
                                                A. Quarterly with an
              Program
                                                   Annual Summary
               A. Reports
Health Plan                                     B. Readiness review and
               B. Predictive Modeling
                                                   Annually thereafter
                  Specifications
                                                C. Annually
               C. Program Evaluation




                               3
Submitter              Report Name                      Frequency

                                                    With proposal and
              Form CMS 1513 Ownership and
Health Plan                                       Annually, by October 1st,
                Control Interest Statement
                                                        thereafter

                                                  During readiness review,
                                                  30 days prior to proposed
Health Plan    Emergency Management Plan
                                                      changes, Annual
                                                        certification

                Member Satisfaction Survey
Health Plan                                              Annually
                        Report

                Provider Satisfaction Survey
Health Plan                                              Annually
                          Report

                Grievance, Appeal and Fair        Monthly, and Quarterly
Health Plan
                   Hearing Log Report                   Summary

                 Grievance, Appeal and Fair
                  Hearing Log – Redacted          Monthly, and Quarterly
Health Plan
              (% of appeals overturned by state         Summary
                        fair hearing)


              Marketing Activities                A. Due at Readiness
              A. Marketing Plan                      Review
Health Plan
              B. Updates                          B. Monthly
              C. Annual Review                    C. Annually




                                4
Submitter              Report Name                       Frequency

Health Plan    Third Party Liability Collections          Annually


              Claims Summary Report by GSA
                       and Claim Type
Health Plan                                               Quarterly
                (including payments to non-
                     network providers)

              Prompt Payment Report by GSA
Health Plan                                               Quarterly
                     and Claim Type

                  Claims Processing Interest
Health Plan                                               Quarterly
                          Payments


                                                    Beginning second CY of
Health Plan   Annual Medical Loss Ratio Report     implementation Due June
                                                       1 for previous CY


                Prior Authorization and Pre-
Health Plan                                               Annually
                   Certification Summary


Health Plan             SAS 70 Report                     Annually

               Telephone and Internet Activity
Health Plan                                               Monthly
                          Report




                                 5
Submitter             Report Name                      Frequency



                                                 A. Annual Audited
                                                    Financial Statement
                                                 B. Four Quarterly
                                                    Unaudited Financial
Health Plan         Financial Reporting             Statements and
                                                    Financial Reporting
                                                    Guide
                                                 C. Monthly if requested
                                                    by DHH




Health Plan        Denied Claims Report                  Monthly


Health Plan     FQHC/RHC Encounter File                  Monthly


Health Plan         System Refresh Plan                 Annually


              Electronic Data Processing (EDP)
Health Plan                                             Annually
                           Audit

                                                 Quarterly with an Annual
Health Plan      Case Management Reports
                                                        Summary




                               6
Submitter             Report Name                    Frequency

                                               During readiness review,
                                               and Annually thereafter


                  Quality Assurance (QA)       A. 30 days from the date
              A. QAPI Program description         of the Contract and
                 and QAPI Plan                    Annually thereafter
              B. Impact and effectiveness of   B. Annually
                 QAPI program evaluation       C. Within 3 months of
              C. Performance Improvement          execution of Contract
                 Project descriptions             and at the beginning
Health Plan   D. Performance Improvement          of each Contract year
                 Projects Outcomes                thereafter
              E. Early Warning System          D. Annually
                 Performance Measures          E. Monthly
              F. Level I and Level II          F. Annually and upon
                 Performance Measures             DHH request
              G. PCP Utilization and Quality   G. Quarterly with an
                 Profile Reports                  Annual Summary




                                               Annually with Quarterly
                                                 updates of meeting
Health Plan   Member Advisory Council Plan
                                                    minutes and
                                                  correspondence




                               7
  Submitter              Report Name                     Frequency

DHH - Medicaid
 Managed Care      Health Plan Sanction Report            Quarterly
   Program

                  Health Plan Enrollment Report
                    (by Health Plan & eligibility
      EB                                                   Monthly
                 group; auto assigned and member
                              selected

DHH - Medicaid
 Managed Care      Health Plan Payment Report             Quarterly
   Program


                                                           Annually
                   Annual Medical Loss Ratio &
  Health Plan                                       Beginning second CY of
                         Refund Report
                                                        implementation




                                  8

								
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