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Managed Care Plan Report Guide (Effective 9/1/2019)
Report Guide [1.46MB 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 9/1/19
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 [63KB MS Excel] Effective 4/1/19
Case Manager Caseload Report [93KB MS Excel] Effective 9/23/2020 (Template Updated 9/23/2020: Instructions Updated and Case Manager Tracking Tab Deleted)
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
Child Staffing Attendance Report [34KB MS Excel] Effective 9/1/19
Claims Aging Report [125KB MS Excel] Effective 4/1/19 (Update 9/6/19: Contract Citation Corrected in Instructions)
Critical Incident Individual Report [20KB MS Excel] Effective 9/1/19
Custody Arrangement Multiple Signature Verification Agreement Form [89KB PDF] Effective 12/1/18
Denial, Reduction, Termination or Suspension of Services Report [51KB MS Excel] Effective 9/1/19
Denied/Suspended/Terminated Provider Report [1.99MB MS Excel] Effective 4/1/19 (Template Locked, updated 7/12/19; Technical Update 9/23/19
Enhanced Care Coordination Report [58KB MS Excel]  Effective 9/1/19
Enrollee Complaints, Grievances and Appeals Report [12.99MB ZIP/MS Excel]  Effective 9/1/19 (Template Technical Corrections, Updated 2/6/20)
Enrollee Roster and Facility Residence Report [41KB MS Excel] Effective 9/1/19 (Update 6/16/2020: Formula added to Header Q to "Enrollee Roster" Tab; Update 7/14/2020: Formula in Column Q updated)
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 [71KB MS Excel] Effective 9/1/19
Healthy Behaviors Report [25KB MS Excel] Effective 12/1/18
Hernandez Settlement Agreement Log - MMA [238KB MS Excel] Effective 9/1/19
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 [55KB MS Excel] Effective 1/1/20
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 [136KB MS Excel] Effective 9/1/19
LTC Performance Measure Specifications [376KB PDF] Effective 12/1/2018
MMA Performance Measure Specifications [281KB PDF] Effective 4/1/2019
Marketing Agent Status Report [27KB MS Excel] Effective 9/1/19
Marketing Public Educational Events Report [111KB MS Excel] Effective 9/1/19
Medical Foster Care Services Report [211KB MS Excel] Effective 9/1/19
Member Satisfaction Improvement Report [56KB MS Excel] Effective 9/1/19 (Instructions Correction, Updated 9/13/19)
Missed Services Report [46KB MS Excel] Effective 9/1/19
Non-Emergency Transportation Missed Trips Report [44KB MS Excel] Effective 12/1/18
Non-SNP Financial Report [958KB MS Excel] Effective 12/1/18
Oral Health Risk Assessment Report [40KB MS Excel] Effective 9/1/19
PASRR Report [33KB MS Excel] Effective 12/1/18
Participant Directed Option Roster Report [96KB MS Excel] Effective 9/1/19
PCP/PDP Appointment Report [35KB MS Excel] Effective 9/1/19
Performance Measure Action Plan [40KB MS Excel] Effective 9/1/19 (Instructions Correction, Updated 9/13/19)
Performance Measures Report [458KB MS Excel] Effective 4/1/19 (Formula updates 6/17/19)
Provider Complaint/Appeal Report 11.15MB ZIP/MS Excel] Effective 9/1/2019 (Template Technical Corrections, Updated 9/12/19; Technical Edit in Drop-down Options of Column J on the Sept. Tab, Updated 9/17/2020)
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 [40KB MS Excel] Effective 9/1/19
Service Authorization Performance Outcome Report [93KB MS Excel] Effective 7/26/19
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