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Managed Care Plan Report Guide (Effective 4/1/2019)
Report Guide [1.43MB PDF]
Managed Care Plan Report Guide Templates:
Actual Value Enhanced Payment MPIP Report [34KB MS Excel] Effective 12/1/18
Adverse and Critical Incident Summary Report [23KB MS Excel] Effective 4/1/19
ASR Claim Lags Template [38KB MS Excel] Effective 12/1/18
ASR Dental Claim Lags Template [17KB MS Excel] Effective 12/1/18
ASR Dental Financial Report [839KB MS Excel] Effective 4/1/19
ASR Financial Report [2.26MB MS Excel] Effective 4/1/19
Administrative Subcontractors and Affiliates Report [649KB MS Excel] Effective 12/1/18
Annual Fraud and Abuse Activity Report [45KB MS Excel] Effective 4/1/19 (Update 7/12/19: Template Locked; Update 8/13/19: Technical Corrections)
Appointment Wait Times Report [55KB MS Excel] Effective 4/1/19
Case Manager Caseload Report [92KB MS Excel] Effective 12/1/18
Case Management File Audit Report [27KB MS Excel] Effective 12/1/18
Case Manager and Provider Training Report [21KB MS Excel] Effective 12/1/18
Claims Aging Report [129KB MS Excel] Effective 4/1/19
Critical Incident Individual Report [14KB MS Excel] Effective 12/1/18
Custody Arrangement Multiple Signature Verification Agreement Form [89KB PDF] Effective 12/1/18
Denial, Reduction, Termination or Suspension of Services Report [35KB MS Excel] Effective 12/1/18
Denied/Suspended/Terminated Provider Report [1.95MB MS Excel] Effective 4/1/19 (Template Locked, updated 7/12/19)
Enhanced Care Coordination Report [55KB MS Excel]  Effective 4/1/19
Enrollee Complaints, Grievances and Appeals Report [12.11MB ZIP/MS Excel]  Effective 1/16/2019
Enrollee Roster and Facility Residence Report [37KB MS Excel] Effective 4/1/19
ER Visits without PCP/PDP Appointment Report [19KB MS Excel] Effective 12/1/18
Estimated Value of Enhanced Reimbursement MPIP Report [328KB MS Excel] Effective 12/1/18
Health Risk Assessment Report [27KB MS Excel] Effective 12/1/18
Healthy Behaviors Report [25KB MS Excel] Effective 12/1/18
Hernandez Settlement Agreement Log - MMA [238KB MS Excel] Effective 12/1/18
Hernandez Settlement Agreement Survey - MMA [31KB MS Excel] Effective 12/1/18
Hernandez Settlement Survey Requirements [90KB PDF] Effective 12/1/18
HIV/AIDS DM Algorithm [54KB MS Excel] Effective 7/1/19
HIV/AIDS Performance Measures Attachment [21KB MS Excel] Effective 4/1/19
IMD Reimbursement Report [43KB MS Excel] Effective 12/1/18
Insolvency Protection Multiple Signature Verification Agreement Form [48KB PDF] Effective 12/1/18
Inter-Rate Reliability Report [26KB MS Excel] Effective 4/1/19
LTC Performance Measure Specifications [376KB PDF] Effective 12/1/2018
MMA Performance Measure Specifications [281KB PDF] Effective 4/1/2019
Marketing Agent Status Report [20KB MS Excel] Effective 12/1/18
Marketing Public Educational Events Report [97KB MS Excel] Effective 12/1/18
Medical Foster Care Services Report [200KB MS Excel] Effective 4/1/19
Missed Services Report [38KB MS Excel] Effective 12/1/18
Non-Emergency Transportation Missed Trips Report [44KB MS Excel] Effective 12/1/18
Non-SNP Financial Report [958KB MS Excel] Effective 12/1/18
PASRR Report [33KB MS Excel] Effective 12/1/18
Participant Directed Option Roster Report [87KB MS Excel] Effective 12/1/18
PCP/PDP Appointment Report [19KB MS Excel] Effective 12/1/18
Performance Measures Report [458KB MS Excel] Effective 4/1/19 (Formula updates 6/17/19)
Provider Complaint/Appeal Report [12.04MB ZIP/MS Excel] Effective 4/1/2019
Provider Network and Qualifications Report [42KB MS Excel] Effective 4/1/19 (Drop-down boxes updated 7/12/19)
Quarterly Fraud and Abuse Activity Report [2.34MB MS Excel] Effective 4/1/19 (Template Locked, updated 7/12/19)
Residential Psychiatric Treatment Report [39KB MS Excel] Effective 4/1/19
Service Authorization Performance Outcome Report [51KB MS Excel] Effective 4/1/19
Suspected/Confirmed Waste Reporting [28.69MB MS Excel] Effective 4/1/19 (Update 7/12/19: Template Locked; Update 8/12/19: Technical Corrections)
Unable to Provide Case Management Report [13KB MS Excel] Effective 12/1/18
Well Child Visit Report [230KB MS Excel] Effective 4/1/19