ADH Ratio Reports. Specialist to Enrollee Specialists to Enrollee Ratio Ad-Hoc OnBase CM-55-H CM-55H Distance and time reports: PCP and OBGYN provider Distance and time reports: PCP and OBGYN provider Annually OnBase CM-55-H- ADH CM-55-H-ADH Distance and time reports: PCP and OBGYN provider Distance and time reports: PCP and OBGYN provider Ad-Hoc OnBase CM-55-I CM-55-I Distance and time reports: Acute and Rehabilitation Hospitals and Urgent Care Centers Distance and time reports: Acute and Rehabilitation Hospitals and Urgent Care Centers Annually OnBase CM-55-I- ADH CM-55-I-ADH Distance and time reports: Acute and Rehabilitation Hospitals and Urgent Care Centers Distance and time reports: Acute and Rehabilitation Hospitals and Urgent Care Centers Ad-Hoc OnBase CM-55-J CM-55-J Distance and time reports: Physician Specialists Distance and time reports: Physician Specialists Annually OnBase CM-55-J- ADH CM-55-J-ADH Distance and time reports: Physician Specialists Distance and time reports: Physician Specialists Ad-Hoc OnBase CM-55-K CM-55-K Distance and time reports: Pharmacies Distance and time reports: Pharmacies Annually OnBase CM-55-K- ADH CM-55-K-ADH Distance and time reports: Pharmacies Distance and time reports: Pharmacies Ad-Hoc OnBase CM-55-L CM-55-L Timeliness of Care Summary of Access and Availability: Timeliness of Care (Describe system in place to monitor and document access and appointment scheduling standards) Monthly OnBase CM-55-L- ADH CM-55-L-ADH Timeliness of Care Summary of Access and Availability: Timeliness of Care (Describe system in place to monitor and document access and appointment scheduling standards) Ad-Hoc OnBase CM-55-M CM-55-M Use of Out-of- Network Providers Summary of Access and Availability: Use of Out-of- Network Providers Annually OnBase CM-55-M- ADH CM-55-M-ADH Use of Out-of- Network Providers Summary of Access and Availability: Use of Out-of- Network Providers Ad-Hoc OnBase CM-56 CM-56 CMS Managed Care Program Annual Report (MCPAR) CMS Managed Care Program Annual Report (MCPAR) Annually OnBase CM-57 [RETIRED] ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System CM-58 CM-58 Application for MassHealth Data [for External Research Projects] Application for MassHealth Data Ad hoc Email CM-59 CM-59 Provider Enrollment True Up File Provider Enrollment True Up File Monthly SFTP CM-C1 CM-C1 Report and Compliance Certification Checklist Annual Report and Compliance Certification Checklist Annually OnBase CM-C2 CM-C2 Supplier Diversity Program (SDP) Spending Report for Prime Contractors The SDP Spending Report form may be found here: xxxxx://xxx.xxxx.xxx/lists/sdo-forms Quarterly Secure Email to assigned Contract Manager
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Samples: Standard Contract, Standard Contract, Standard Contract