Dental Benefit Plan Reporting Deliverables

Monthly Reports   Revision Date
022 Post Payment Recoveries (existence of TPL) - M  8/10/17
107 Member Service Call Center - M  
109 Marketing and Member Education Materials Distributed - M   
113 Grievance, Appeal and Fair Hearing Log - M 1/25/17
167 Claims Payment Accuracy Report - M  
173 Denied Claims Report - M  12/15/16
181 Provider Call Center - M 11/1/17 
182 Provider Complaint & Appeal Summary Report - M  
221 Claims Payment Summary - M  9/7/17
     
Quarterly Reports  
026 EPSDT Report (CMS 416) - Q/A  
066 Utilization Management Committee Meeting Minutes - Q  
069 Utilization Management Dental Record Review Report - Q  
072 QAPI PCD Profile Reports - Q  
082 PCD Linkages - Q  
114 Grievance, Appeal and Fair Hearing Log (redacted) - Q/A  
119 QAPI Committee (minutes) - Q 08/15/17 
145 Fraud and Abuse Activity Report - Q  
183 Claims Processing Interest Payments - Q  
185 Quarterly Unaudited Financial Statement - Q (60 days after QTR)*  
188 PA Summary - Q  12/19/16
217 QAPI Early Warning System Performance Measures - Q  
220 Network Adequacy Review - Q  
225 Network Summary Dental Report - Q  11/18/16
     
Annual Reports  
017 Key Staff Organizational Chart Listing 8/29/17
053 NW Provider Development Management Plan - A  
068 Utilization Management Dental Record Review Stategy - A  
110 Marketing Activities Annual Review - A  
121 QAPI Program Description and Work Plan - A  
127 QAPI Performance Reporting Measures - A *  
132 Member Satisfaction Survey Report (CAHPS) - A  
133 Provider Satisfaction Survey Report - A  
138 QAPI Performance Improvement Projects (outcomes) 3/14/17
146 Annual Fraud, Waste & Abuse Report   
151 Systems Refresh Plan - A  
157 Emergency Management Plan - A  
159 Back-up File List - A  
170 Form CMS 1513 Ownership and Control Interest Statement - A  
177 Total and OON Claims 9/7/17
184 "DRAFT" Annual Audited Financial Statement - A **  
184 Annual Audited Financial Statement - A  
189 Independent-Subcontractor EDP Audit (SSAE16) - A ***  
216 QAPI Impact and Effectiveness of QAPI Program Evaluation - A  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Q/A means Quarterly and Annually 

* Template not provided. Will accept Health Plans' corporate standard.

**Draft versions are due 90 days after year end.

***- 45 days after the corporate audit Period is comlete.