Medicaid Managed Care Manual

Intro Text

To be Developed

EOHHS Medicaid Managed Care Reporting Templates

11.1 Reports of Legal and Other Proceedings

11.2 EOHHS Core Contract Requirements for Reporting and Intermediate Sanctions 2020 Policy

11.3 Attestation Statement for Health Plan Reporting Submission (10/2021)

11.4 Medicaid Managed Care Report Date Change Request Form (10/2018)

11.5 DRAFT - CY22 MCO Core Contract Reporting Calendar (10/2021)

EOHHS Medicaid Managed Care Reporting Templates

11.6 AE Quality Measure QPY4

11.7 Clinical Data Exchange Implementation Status

11.8 MCO AE Milestone Performance Report (PY3)

11.9 MCO AE Milestone Performance Report (PY4)

11.10 AEIP Quarterly Outcome Metrics OPY4

11.11 AEIP Annual Outcome Metrics

11.12 TCOC Performance Report

11.13 Final TCOC Performance

11.14 AE Base Contract Checklist

11.15 Final ROI Project

11.16 APM Report

11.17 Access Report

11.18 Care Management

11.19 Claims Timely Filing Processing

11.20 QIP

11.21 Appeals

11.22 MCO Call Center Metrics

11.23 Grievance Complaints

11.24 MCO Program Integrity

11.25 Member Fraud Out of State

11.26 MCFU Case Presentation Report

11.27 837 Processing

11.28 Newborn File

11.29 Vendor Address Change

11.30 COVID Vaccine Non-Risk Base Payment

11.31 Immunization Tracker

11.32 Provider Termination and Network Change

11.33 Member Transition Plan

AE Attribution Technical Requirements

11.34 AE Attribution Technical Requirement V2.0

11.35 AE Attribution Technical Appendix NHPRI V2.0

11.36 AE Attribution Technical Appendix UHC V2.0

AE Provider Roster Technical Requirements

11.37 AE Provider Roster Specifications Technical Requirements 2.0

11.38 AE Provider Roster Technical Appendix UHC V2.0

11.39 AE Provider Roster Technical Appendix NHP V2.0