Clinical Reporting Requirements. 1) Pain specialist referral letter for each patient 2) Patient authorization for Drug Utilization Review
Clinical Reporting Requirements. The MCO shall submit utilization data, report on performance measurements and implement and report on performance improvement projects as described in Attachment M and Attachment N, respectively. Reports shall identify trends and patterns, when appropriate, and describe how the findings are used in MCO’s clinical management and decision making processes. Other quality measures may be phased in over the term of the contract at the discretion of DMA. DMA will provide guidance to the MCO in meeting the clinical reporting requirements of this contract. DMA will work with MCO vendors to collect and report additional state-wide performance and outcome measures. The MCO shall submit clinical reports that are timely, accurate, and complete. The submission of late, inaccurate, or otherwise incomplete reports shall constitute a failure to report and the MCO shall be subject to corrective actions or penalties and sanctions as specified in SOW Section 13. The DMA Contract administrator or QEHO unit shall furnish the MCO with timely notice of reporting requirements, including acceptable reporting formats, instructions, and timetables for submission and such technical assistance in filing reports and data as may be permitted by the DMA’s available resources. DMA reserves the right to modify from time to time the form, content, instructions, and timetables for collection and reporting of data. DMA agrees to involve the MCO in the decision process prior to implementing changes in format, and shall ask the MCO to review and comment on format changes before they go into effect. The timetable for new reports shall be negotiated by the MCO and DMA, taking into consideration the complexity and availability of the information needed.
Clinical Reporting Requirements. The LME shall submit utilization data, report on performance measurements and implement and report on performance improvement projects as described in Attachment M and Attachment N, respectively. Reports shall identify trends and patterns, when appropriate, and describe how the findings are used in the LME’s clinical management and decision making processes. Other quality measures may be phased in over the term of the contract at the discretion of DMA. DMA will provide guidance to the LME in meeting the clinical reporting requirements of this contract. The LME shall submit clinical reports that are timely, accurate, and complete. The submission of late, inaccurate, or otherwise incomplete reports shall constitute a failure to report and the LME shall be subject to corrective actions or penalties and sanctions as specified in SOW Section 13. The DMA Contract administrator or QEHO unit shall furnish the LME with timely notice of reporting requirements, including acceptable reporting formats, instructions, and timetables for submission and such technical assistance in filing reports and data as may be permitted by the DMA’s available resources. DMA reserves the right to modify from time to time the form, content, instructions, and timetables for collection and reporting of data. DMA agrees to involve the LME in the decision process prior to implementing changes in format, and shall ask the LME to review and comment on format changes before they go into effect. The timetable for new reports shall be negotiated by the LME and DMA, taking into consideration the complexity and availability of the information needed.
