Reporting to HCA. The Contractor shall develop and submit:
4.1 Monthly Contractor-readiness reports from the Contract’s Effective Date through Implementation of the Claims Clearinghouse date. The report shall contain any risks to implementation, progress with executing necessary data-sharing agreements/contracts, and mitigation strategies for at risk areas, and requests for TA where needed. Reports shall continue if there are unresolved/incomplete areas beyond Implementation of the Claims Clearinghouse date.
4.2 Monthly pre-submission reports that track error patterns in information received from the facilities and providers. The report shall include an analysis of the error patterns (e.g. lack of prior authorization, inappropriate billing codes, etc.) and the Contractor’s actions to address the issue with the facility/provider.
4.3 The Contractor shall develop a template that is approved by HCA to report the following key performance areas on a quarterly basis:
A. A breakdown of claims submitted by entity and by payer, reports on averages time frames from data submitted to claim submission and payment, compares rejection and denial rates between payors, tracks resubmission rates, identifies trends, and makes recommendations.
B. TA provided.
C. An Issue Tracking and Resolution report. This report shall track, log, monitor, and describe resolution of any questions/problems/TA requested by participating facilities and providers. The report shall be used to escalate emerging questions unresolved issues, and implementation barriers to HCA and MCOs, as appropriate. The Contractor shall track and report on resolution times to ensure timely assistance, and work with HCA to develop mitigation strategies.
4.4 Monthly reports on the Contractor’s system downtime and technical issues experienced with the Claims Clearinghouse.
4.5 The Contractor shall participate in a performance survey of the TPA led, developed, and implemented by HCA. The intent of the survey is to evaluate the performance of the TPA.
4.6 The Contractor shall develop, maintain, and submit to HCA a statewide map of enrolled Apple Health providers serving individuals through the Initiative, with breakdowns by affiliated Carceral Facility, provider type, and the number of Targeted Case Management providers the Contractor identified and/or the number of Carceral Facilities the Contractor provided TA support to ensure the facility met the Targeted Case Management requirement.
4.7 The Contractor shall provide a monthly fair...
