CCN-P Reporting Requirements



SubmitterReport NameFrequencyReceiverPosting on Making Medicaid Better WebsiteSB 207Reporting RequirementsDHHListing of Contracted CCNsby Geographical Service AreaAnnually(updated as contracts are executed)DHHYes§ 1300.22 (1)CCNOrganizational ChartAnnuallyDHH – Coordinated Care SectionCCNFunctional Organizational ChartAnnuallyDHH – Coordinated Care SectionCCNNetwork Provider and Subcontractor Registry(by type and service area)At Readiness Review and Monthly thereafterDHH – Coordinated Care SectionYesProvider Director and each CCN’s Website§ 1300.22 (2)CCNService Area Review of Appointment Availability /Twenty-four (24) hour Access and Availability SurveyAnnuallyDHH – Coordinated Care SectionYesAnnually§ 1300.22 (4)CCNNetwork Provider Development and Management PlanDuring readiness review and Annually thereafterDHH – Coordinated Care SectionDHH – Coordinated Care SectionReadiness Review ReportAs AppropriateCCNCCNPatient-Center Medical Home (PCMH)PCMH Implementation PlanB.? NCQA PCP-PCMH? recognition reportDuring Readiness Review and Annually thereafterDHH – Coordinated Care SectionYesAnnuallyCCN Member ServicesUnsuccessful new member contactsMember Services Call CenterMonthlyMonthly with an Annual SummaryDHH – Coordinated Care SectionYesQuarterly SummaryCCNProvider Call Center Monthly with an Annual SummaryDHH – Coordinated Care SectionYesAnnuallyCCN Provider Complaints ReportMonthly with an Annual SummaryDHH – Coordinated Care SectionYesAnnuallyCCNReferral PoliciesDuring Readiness Review, Annually thereafter, and prior to any revisionsDHH – Coordinated Care SectionCCNCCN Disenrollment ReportQuarterlyDHH - Coordinated Care SectionYesRedacted Quarterly SummaryCCNEPSDT Report (KIDMED services)(CMS 416)Quarterly and Annually, due March 31 (6 months after the end of the FFY)Quarterly DHH – Program Operations SectionAnnual - FIYesAnnuallyCCNMedical Record ReviewWithin 30 days from the date the Contract is signed, and Annually thereafterDHH – Coordinated Care SectionCCNUM reportsUM Committee Meeting minutesMedical Record ReviewsWithin 5 working days of each meetingQuarterly with an Annual SummaryDHH – Coordinated Care SectionCCNFraud and Abuse Activity ReportQuarterly with an Annual SummaryDHH – Coordinated Care SectionYesAnnuallyCCN CCMPReportsPredictive Modeling SpecificationsProgram EvaluationQuarterly with an Annual SummaryReadiness review and Annually thereafterAnnuallyDHH – Coordinated Care SectionYesAnnuallyCCNForm CMS 1513 Ownership and Control Interest StatementWith proposal and Annually, by October 1st, thereafterDHH – Coordinated Care SectionCCNEmergency Management PlanDuring readiness review, 30 days prior to proposed changes, Annual certificationDHH – Coordinated Care SectionYesAnnuallyCCNMember Satisfaction Survey ReportAnnuallyDHH – Coordinated Care SectionYesAnnually§ 1300.22 (13)CCNProvider Satisfaction Survey ReportAnnuallyDHH – Coordinated Care SectionYesAnnually§ 1300.22 (13)CCNGrievance, Appeal and Fair Hearing Log ReportMonthly, and Quarterly SummaryDHH – Coordinated Care Section§ 1300.22 (17)CCNGrievance, Appeal and Fair Hearing Log – Redacted(% of appeals overturned by state fair hearing)Monthly, and Quarterly SummaryDHH – Coordinated Care SectionYesRedacted Quarterly Summary§ 1300.22 (17)CCN Marketing ActivitiesMarketing PlanUpdatesAnnual ReviewDue at Readiness ReviewMonthlyAnnuallyDHH – Coordinated Care SectionYesAnnuallyCCNThird Party Liability CollectionsAnnuallyDHHYesAnnuallyCCNClaims Summary Report by GSA and Claim Type(including payments to non-network providers)QuarterlyDHH – Coordinated Care SectionYes Quarterly§ 1300.22 (8)CCNPrompt Payment Report by GSA and Claim TypeQuarterlyDHH – Coordinated Care SectionYes Quarterly§ 1300.22 (6)CCNClaims Processing Interest PaymentsQuarterlyDHH- Coordinated Care SectionYesAnnuallyCCNAnnual Medical Loss Ratio ReportBeginning second CY of implementation Due June 1 for previous CYDHH – Coordinated Care SectionYesAnnually§ 1300.22 (11)CCNPrior Authorization and Pre-Certification SummaryAnnuallyDHH – Coordinated Care Section§ 1300.22 (5)CCNSAS 70 ReportAnnuallyDHH – Coordinated Care SectionCCNTelephone and Internet Activity ReportMonthlyDHH-Coordinated Care SectionYesQuarterlyCCNFinancial ReportingAnnual Audited Financial StatementFour Quarterly Unaudited Financial Statements and Financial Reporting GuideMonthly if requested by DHHDHH – Coordinated Care SectionYesAnnually§ 1300.22 (14)CCNDenied Claims ReportMonthlyDHH – Coordinated Care SectionYesQuarterly§ 1300.22 (7)(a)-(e)CCNFQHC/RHC Encounter FileMonthlyDHH – Program OperationsYesQuarterlyCCNSystem Refresh PlanAnnuallyDHH - Coordinated Care SectionCCNElectronic Data Processing (EDP) AuditAnnuallyDHH- Coordinated Care SectionCCNCase Management ReportsQuarterly with an Annual SummaryDHH – Coordinated Care SectionCCNQuality Assurance (QA)QAPI Program description and QAPI PlanImpact and effectiveness of QAPI program evaluationPerformance Improvement Project descriptionsPerformance Improvement Projects OutcomesEarly Warning System Performance MeasuresLevel I and Level II Performance MeasuresPCP Utilization and Quality Profile ReportsDuring readiness review, and Annually thereafter30 days from the date of the Contract and Annually thereafterAnnuallyWithin 3 months of execution of Contract and at the beginning of each Contract year thereafterAnnuallyMonthlyAnnually and upon DHH requestQuarterly with an Annual SummaryDHH – Coordinated Care SectionYesQuarterly (as available)And Annually§ 1300.22 (12)CCNMember Advisory Council PlanAnnually with Quarterly updates of meeting minutes and correspondenceDHH – Coordinated Care SectionYesAnnuallySubmitterReport NameFrequencyReceiverPosting on Making Medicaid Better WebsiteSB 207Reporting RequirementsDHH – Coordinated Care SectionCCN Sanction ReportQuarterlyMaking Medicaid Better WebsiteYesQuarterly§ 1300.22 (16)EBCCN Enrollment Report(by CCN & eligibility group; auto assigned and member selectedMonthlyMaking Medicaid Better WebsiteYesQuarterly§ 1300.22 (3)§ 1300.22 (9)DHH – Coordinated Care SectionCCN Payment ReportQuarterlyMaking Medicaid Better WebsiteYesQuarterly§ 1300.22 (10)CCNAnnual Medical Loss Ratio & Refund ReportAnnuallyBeginning second CY of implementationDHH Coordinated Care SectionYesAnnually§ 1300.22 (11) ................
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