UTILIZATION MANAGEMENT REPORTS. PHYSICAL HEALTH ------------------------------------------------ Physical health (PH) utilization management reports are required on a semi-annual basis with submission of data files that are, at a minimum, due to TDH or its designee on a quarterly basis no later than 150 days following the end of the period. Refer to Appendix J for the standardized reporting format for each report and detailed instructions for obtaining specific data required in the report and for data file submission specifications. The PH Utilization Management Report and data file submission instructions may periodically be updated by TDH to facilitate clear communication to the health plan.
UTILIZATION MANAGEMENT REPORTS. PHYSICAL HEALTH Physical health (PH) utilization management reports are required on a semi-annual basis. Refer to Appendix J for the standardized reporting format for each report and detailed instructions for obtaining specific data required in the report.
12.9.1 In addition, data files are due to the TDH External Quality Review Organization five working days following the end of each State Quarter. See Appendix J for submission instructions. The PH utilization report and data file submission instruction may periodically be updated by TDH to facilitate clear communication to the health plan.
UTILIZATION MANAGEMENT REPORTS. The CONTRACTOR shall comply with 8.307.14.13 NMAC related to Utilization and Quality Management Reporting, including monthly utilization review activity reports that provide service-specific data related to requests, approval, clinical denials, termination of care, reductions of care, administrative denials and “pends,” reports related to all Member and provider appeals, expedited appeals, and Fair Hearings. HSD and CONTRACTOR shall agree on reporting elements, formats, and submission templates by an agreed upon date that will allow CONTRACTOR sufficient time to program such reports.
UTILIZATION MANAGEMENT REPORTS. PHYSICAL HEALTH ------------------------------------------------ Physical health (PH) utilization management reports are required on a semi-annual basis. [Deletion] Refer to Appendix J for the standardized reporting format for each report and detailed instructions for obtaining specific data required in the report. [Deletion]
12.9.1 In addition, data files are due to the TDH External Quality Review Organization five (5) working days following the end of each State Quarter. See Appendix J for submission instructions. The PH utilization report and data file submission instruction may periodically be updated by TDH to facilitate clear communication to the health plan.
UTILIZATION MANAGEMENT REPORTS. 56 (a) HEDIS Reporting ....................................................................................56 (b) Physical Health ....................................................................................56 (c) Behavioral Health ..................................................................................56 SECTION 17.05 FOCUSED STUDIES REPORTS ..........................................................................56 SECTION 17.06 ANNUAL QUALITY IMPROVEMENT PLAN (QIP) SUMMARY REPORT .............................................57 SECTION 17.07
UTILIZATION MANAGEMENT REPORTS. PHYSICAL HEALTH ------------------------------------------------ Physical health (PH) utilization management reports are required on a semi-annual basis with submission of data files that are, at a minimum, due to TDH or its designee on a quarterly basis no later than 150 days following the end of the period. Refer to Appendix J for the standardized reporting format for each report and detailed 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 109 instructions for obtaining specific data required in the report and for data file submission specifications. The PH Utilization Management Report and data file submission instructions may periodically be updated by TDH to facilitate clear communication to the health plan.
UTILIZATION MANAGEMENT REPORTS. The CONTRACTOR shall:
UTILIZATION MANAGEMENT REPORTS. BEHAVIORAL HEALTH -------------------------------------------------- Several behavioral health (BH) utilization management reports are required on a quarterly basis and are due 120 days following the end of the State fiscal quarter and are to be provided in hard copy and in a format specified by TDH. Refer to Appendix H for the standardized reporting format for each report and detailed instructions for obtaining the specific data required in the report. The BH utilization report instructions may periodically be updated by TDH to include new codes and to facilitate clear communication to the health plan.
UTILIZATION MANAGEMENT REPORTS. PHYSICAL HEALTH ------------------------------------------------ Physical health (PH) utilization management reports are required on a quarterly basis and are due no later than 120 days after the end of the State Fiscal Quarter and are El Paso Service Area HMO Contract to be provided in hard copy and in a format specified by TDH. Refer to Appendix J for the standardized reporting format for each report and detailed instructions for obtaining specific data required in the report. The PH Utilization Management Report instructions may periodically be updated by TDH to include new codes and to facilitate clear communication to the health plan.
UTILIZATION MANAGEMENT REPORTS. PHYSICAL HEALTH ------------------------------------------------ Physical health (PH) utilization management reports are required on a semi-annual basis. Refer to Appendix J for the standardized reporting format for each report and detailed instructions for obtaining the specific data required in the report.
12.9.1 In addition, data files are due to TDH or its designee no later than the fifth working day following the end of each month. See Utilization Data Transfer Encounter Submission Manual for submission instructions. The PH utilization report and data file submission instructions may periodically be updated by TDH to facilitate clear communication to the health plans. AGREED AND SIGNED by an authorized representative of the parties on August 2, 2001. TEXAS DEPARTMENT OF HEALTH Superior Health Plan, Inc. By: /s/ XXXXXXX X. XXXX, M.D. By: /s/ XXXXXXX X. XXXXXXXX ------------------------------ ------------------------------ Xxxxxxx X. Xxxx M.D. Xxxxxxx X. XxXxxxxx, M.D. Executive Deputy Commissioner of Health President Approved as to Form: /s/ XXXX XXX XXXXXX ------------------------------ Office of General Counsel TDH Doc. # 7427705425* 2001-01G TDH Doc. # 7427705425* 2001-01F AMENDMENT No. 5 TO THE 1999 CONTRACT FOR SERVICES BETWEEN THE TEXAS DEPARTMENT OF HEALTH AND HMO This Amendment No. 5 is entered into between the Texas Department of Health (TDH) and Superior Health Plan, Inc. (HMO), to amend the 1999 Contract for services between the Texas Department of Health and HMO. The effective date of this Amendment is the date TDH signs this Amendment. All other contract provisions remain in full force and effect. The Parties agree to amend the Contract as follows:
