Common use of Contract Management Reports Clause in Contracts

Contract Management Reports. ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System CM-03 CM-03 Member Telephone Statistics Member Telephone Statistics Monthly OnBase CM-04 CM-04 Member Education and Related Orientation, Outreach Materials Member Education and Related Orientation, Outreach Materials (including enrollment materials for MH Customer Service Center (CSC) Ad-Hoc Secure Email CM-05 CM-05 Updated Provider Directory Provider Directory Ad-Hoc OnBase CM-06 CM-06 Provider Manual Provider Manual Ad-Hoc OnBase CM-07 CM-07 Marketing Materials Marketing Materials (60 days in advance of use, including materials to be distributed at Contractor and non-Contractor sponsored health fairs or community events) Ad-Hoc Secure Email CM-08 CM-08 Marketing Materials- Annual Executive Summary Marketing Materials- Annual Executive Summary (including a written statement that all of the Contractor’s marketing plans and materials are accurate and do not mislead, confuse, or defraud Members or the state) Annually OnBase CM-09 CM-09 Significant Changes in Provider Network Notification Significant Changes in Provider Network Notification. (Notification: Same Day) Ad-Hoc OnBase CM-10 [all] [RETIRED] ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System CM-11 CM-11 Access and Availability-Immediate Notification Access and Availability-Immediate Notification to EOHHS (only if changes occur that may impact Enrollee access to care, relative to contract standards for geographic access and PCP to enrollee ratio) Ad-Hoc OnBase CM-12 CM-12 Claims Processing Report Claims Processing Report Monthly OnBase CM-13 CM-13 Provider Financial Audit Provider Financial Audit Annually OnBase CM-14 [RETIRED] CM-15 CM-15 Notification of Scheduled Board of Hearing Cases Notification of Board of Hearing Cases (Notification: Same Day) Ad-Hoc OnBase and secure e-mail CM-16 CM-16 Implementation of Board of Hearing Decision Implementation of Board of Hearing Decision (within 30 days of receipt) Ad-Hoc OnBase CM-17-A CM-17-A Enrollee Inquiries Summary Inquiries, Grievances, Internal Appeals and Board of Hearing Summary: Enrollee Inquiries Annually OnBase CM-17-B CM-17-B Enrollee Grievances Summary Inquiries, Grievances, Internal Appeals and Board of Hearing Summary: Enrollee Grievances Annually OnBase CM-17-C CM-17-C Enrollee Internal Appeals Summary Inquiries, Grievances, Internal Appeals and Board of Hearing Summary: Enrollee Internal Appeals Annually OnBase CM-17-D CM-17-D Enrollee Board of Hearing Appeals Summary Inquiries, Grievances, Internal Appeals and Board of Hearing Summary: Enrollee BOH Appeals Annually OnBase CM-17-E CM-17-E - Appeals Report (per 1,000 Enrollees) Appeals Report (per 1,000 Enrollees) Monthly OnBase CM-17-F CM-17-F - Grievances Report (per 1,000 Enrollees) Grievances Report (per 1,000 Enrollees) Monthly OnBase CM-18 [RETIRED] CM-19 [RETIRED] CM-20 [RETIRED] CM-21 [RETIRED] ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System CM-22 CM-22 ACO/MCO Organization and Key Personnel Changes Organization and Key Personnel Changes. The Contractor will also include Behavioral Health subcontractor information if applicable. Ad-Hoc OnBase CM-23 CM-23 Notification of Termination of Material Subcontractor Notification of Intention to Terminate a Material Subcontractor (Notification: Same Day) Ad-Hoc OnBase CM-24 CM-24 Notification of New Material Subcontractor and Checklist Notification of Intention to Use a New Material Subcontractor and Checklist (Material Subcontract Checklist must be submitted no later than 60 days prior to requested implementation date) Ad-Hoc OnBase CM-25 CM-25 Material Subcontractor List Annual Summary Material Subcontractor List Annual Summary Annually OnBase CM-26 CM-26 Coordination of Benefits / Third Party Liability Report (Appendix H) Coordination of Benefits / Third Party Liability Report (Appendix H) a. Third Party Health Insurance Cost Avoidance Claims Amount by Carrier b. Third Party Health Insurance Total Recovery Savings by Carrier c. Accident Trauma Recoveries d. Accident/Trauma Cost Avoidance. Semi- Annually OnBase CM-27 CM-27 Third Party Liability (TPL) Identification Reporting (Appendix H) 1. TPL Indicator Form 2. Other EOHHS-specified electronic TPL reporting Ad-Hoc 1. Mail or Fax (FPL Indicator Form only) 2. Electronic Submission as further specified by EOHHS CM-28 CM-28 Benefits Coordination Structure (Appendix H) Benefits Coordination Structure (Appendix H) Ad-Hoc OnBase ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System CM-29 CM-29 Encounter Data Submission (Appendix E) Encounter Data Submission (Appendix E) Monthly Data Warehouse CM-30 CM-30 Sampling of Enrollees To Ensure Services Received Sampling of Enrollees To Ensure Services Received Were The Same as Providers Billed Annually OnBase CM-31 CM-31 Notification of Federally Required Disclosures Notification of Federally Required Disclosures (in accordance with Section 5.1.O) Ad-Hoc OnBase CM-32 CM-32 Notification of Reportable Findings /Network FRD Notification of Reportable Findings /Network FRD (Notification: Same Day) Ad-Hoc OnBase CM-33 CM-33 Summary of Reportable Findings/Network FRD Forms Summary of Reportable Findings/Network FRD Forms Annually OnBase CM-34 [RETIRED] CM-35 [RETIRED] CM-36 CM-36 Provider Materials Provider Materials (related to enrollee cost-sharing, changes to Covered Services and/or any other significant changes per contractual requirements) Ad-Hoc OnBase CM-37 CM-37 ACO/MCO Policies and Procedures ACO/MCO Policies and Procedures (New drafts and any changes to the most recent printed and electronic versions of the Provider procedures and policies which affect the process by which Enrollees receive care (relating to both medical health and Behavioral Health, if separate) for prior review and approval). Ad-Hoc OnBase CM-38 [RETIRED] CM-39 CM-39 PCP/Enrollee assignment Monthly report PCP/Enrollee assignment report Monthly Data Warehouse CM-40 CM-40 PCP/Enrollee assignment report Ad-Hoc PCP/Enrollee assignment report Ad-hoc Data Warehouse CM-41 CM-41 Excluded Provider Monitoring Report Excluded Provider Monitoring Report Monthly OnBase ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System CM-43-A CM-43-A Holiday Closures and Other Contractor Office Closures Annual Holiday Closures and Other Contractor Office Closures. (The Contractor shall also include Behavioral Health subcontractor information, if applicable). Annually OnBase CM-43-B CM-43-B Emergency Closures and Other Contractor Office Closures Ad Hoc Emergency Closures and Other Contractor Office Closures. (The Contractor shall also include Behavioral Health subcontractor information, if applicable). Ad Hoc OnBase CM-44 CM-44 Strategy-related Reports Strategy-related Reports Ad Hoc OnBase CM-45 [RETIRED] CM-46 CM-46 Enrollee and Provider Incentives Notification Enrollee and Provider Incentives Notification Ad-Hoc OnBase CM-47 [RETIRED] CM-48 CM-48 Copy of Press Releases (pertaining to MassHealth line of business) Copy of Press Releases (pertaining to MassHealth line of business) Ad-Hoc OnBase CM-49 CM-49 Written Disclosure of Identified Prohibited Affiliations Written Disclosure of Identified Prohibited Affiliations Ad-Hoc OnBase CM-50 [RETIRED] CM-51 [RETIRED] CM-52 [RETIRED] CM-53 CM-53 Involuntary Change in PCP Report Involuntary Change in PCP Report Ad-Hoc OnBase CM-54-A CM-54-A Hospital Payment Arrangement Report Hospital Payment Arrangement Report Annually OnBase CM-54-B CM-54-B Hospital Fee Schedule Exemption Form Hospital Fee Schedule Exemption Form Ad-Hoc OnBase CM-55-A CM-55-A Summary of A&A: Ensuring Enrollees access to Medically Necessary services Summary of Access and Availability: Description of Ensuring Enrollees have access to Medically Necessary services Annually OnBase ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System CM-55-A- ADH CM-55-A-ADH Summary of A&A: Ensuring Enrollees access to Medically Necessary services Summary of Access and Availability: Description of Ensuring Enrollees have access to Medically Necessary services Ad-Hoc OnBase CM-55-B CM-55-B Network Provider Lists: PCPs and OB/GYNs Network Provider Lists: PCPs and OB/GYNs Annually OnBase CM-55-B- ADH CM-55-B-ADH Network Provider Lists: PCPs and OB/GYNs Network Provider List: PCPs and OB/GYNs Ad-Hoc OnBase CM-55-C CM-55-C Network Provider Lists: Acute and Rehabilitation Hospitals and Urgent Care Centers Network Provider Lists: Acute and Rehabilitation Hospitals and Urgent Care Centers Annually OnBase CM-55-C- ADH CM-55-C-ADH Network Provider Lists: Acute and Rehabilitation Hospitals and Urgent Care Centers Network Provider Lists: Acute and Rehabilitation Hospitals and Urgent Care Centers Ad-Hoc OnBase CM-55-D CM-55-D Network Provider Lists: Physician Specialists Network Provider Lists: Physician Specialists Annually OnBase CM-55-D- ADH CM-55-D-ADH Network Provider Lists: Physician Specialists Network Provider Lists: Physician Specialists Ad-Hoc OnBase CM-55-E CM-55-E Network Provider List: Pharmacies Network Provider List: Pharmacies Annually OnBase CM-55-E- ADH CM-55-E-ADH Network Provider List: Pharmacies Network Provider List: Pharmacies Ad-Hoc OnBase CM-55-F CM-55-F Ratio Reports: PCP to Enrollee and OBGYN to Enrollee (female members age 10+) Showing open and closed adult PCPs and pediatric PCPs/Panels per number of Enrollees/OBGYN ratios for female members age 10+) Annually OnBase CM-55-F- ADH CM-55-F-ADH Ratio Reports: PCP to Enrollee and OBGYN to Enrollee (female members age 10+) Showing open and closed adult PCPs and pediatric PCPs/Panels per number of Enrollees/OBGYN ratios for female members age 10+) Ad-Hoc OnBase CM-55-G CM-55-G Ratio Reports: Specialist to Enrollee Specialists to Enrollee Ratio Annually OnBase CM-55-G- ADH CM-55-G-ADH Ratio Reports: Specialist to Enrollee Specialists to Enrollee Ratio Ad-Hoc OnBase ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System 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 ACO Contract Exhibit Number Name of Report Deliverable Frequency Target System CM-57 [RESERVED] CM-C1 CM-C1 Report and Compliance Certification Checklist Annual Report and Compliance Certification Checklist Annually OnBase