Monitoring Requirements. 1. To review the ownership and control disclosures submitted by the MCO and those of any of the MCO’s subcontractors, upon request. 2. To collect (including through its agents and contractors) the following information from the MCO to improve the performance of the managed care program, including at a minimum: a. Enrollment and disenrollment trends in the MCO; b. Member grievance and appeal logs; c. Provider complaint and appeal logs; d. Findings from the State's External Quality Review process; e. Results from any Enrollee or provider satisfaction survey conducted by the State or MCO; f. Performance on required quality measures; g. Medical management committee reports and minutes; h. The annual quality improvement plan for the MCO; i. Audited financial and encounter data submitted by the MCO; j. The medical loss ratio summary reports required by 42 CFR 438.8; and k. Customer service performance data submitted by the MCO and performance data submitted by the beneficiary support system.
Appears in 5 contracts
Samples: Healthcare Agreements, Managed Care Organization Agreement, Managed Care Organization Agreement
Monitoring Requirements. 1. To review the ownership and control disclosures submitted by the MCO and those of any of the MCO’s subcontractors, upon request.
2. To collect (including through its agents and contractors) the following information from the MCO to improve the performance of the managed care program, including at a minimum:
a. A. Enrollment and disenrollment trends in the MCO;
b. B. Member grievance and appeal logs;
c. C. Provider complaint and appeal logs;
d. D. Findings from the State's External Quality Review process;
e. E. Results from any Enrollee or provider satisfaction survey conducted by the State or MCO;
f. F. Performance on required quality measures;
g. G. Medical management committee reports and minutes;
h. H. The annual quality improvement plan for the MCO;
i. I. Audited financial and encounter data submitted by the MCO;
j. J. Network adequacy assurances submitted by the MCO;
K. The medical loss ratio summary reports required by 42 CFR 438.8; and
k. L. Customer service performance data submitted by the MCO and performance data submitted by the beneficiary support system.
Appears in 2 contracts
Samples: Managed Care Organization Agreement, Managed Care Organization Agreement
Monitoring Requirements. 1. To review the ownership and control disclosures submitted by the MCO and those of any of the MCO’s subcontractors, upon request.
2. To collect (including through its agents and contractors) the following information from the MCO to improve the performance of the managed care program, including at a minimum:
a. A. Enrollment and disenrollment trends in the MCO;
b. B. Member grievance and appeal logs;
c. X. Provider complaint and appeal logs;
d. D. Findings from the State's External Quality Review process;
e. E. Results from any Enrollee or provider satisfaction survey conducted by the State or MCO;
f. F. Performance on required quality measures;
g. G. Medical management committee reports and minutes;
h. H. The annual quality improvement plan for the MCO;
i. I. Audited financial and encounter data submitted by the MCO;
j. J. Network adequacy assurances submitted by the MCO;
K. The medical loss ratio summary reports required by 42 CFR 438.8; and
k. L. Customer service performance data submitted by the MCO and performance data submitted by the beneficiary support system.
Appears in 1 contract
Samples: Managed Care Organization Agreement
