Managed Care Organization Resources

Manuals and Companion Guides

 

 

Financial Reporting Requirements 

 

Report Templates

Weekly Reports (Due every following Wednesday by 5 p.m.)
# Report Name Published Date
150 Encounter Data Certification Form 11/3/22
316 Prior Authorization Denial Report for CSR 5/21/25
353 Chisholm Weekly PA Report 11/3/22
362 Transportation Addition/Deletion Report 11/3/22
Monthly Reports (Due 15th day of the month following end of reporting period, except where indicated otherwise)

 

# Report Name Published Date
010 Grievance Appeal and SFH Report 4/2/24
022 Third Party Liability (TPL) Report 12/16/22
039 Case Management Report 3/5/24
045 Home Health Services Report 12/16/22
047 Crisis Response Team Home Health Services Report 12/16/22
054 Pharmacy Benefits Management Report 12/16/22
055 Pharmacy Report (RX055) 12/16/22
107 Member Service Call Center (Due 5th day of the month) 7/8/25
137 Pregnancy Report 12/16/22
148 Exclusion Database Attestation 12/16/22
162 Health Plan Drug Utilization Review Report 3/11/24
165 Lock-In Report 2/18/25
173 Denied Claims Report 12/16/22
175 Hepatitis C 7/25/24
181 Provider Call Center Report 11/15/23
182 Provider Complaint and Appeal Summary Report 9/14/23
221 Claims Payment Summary 12/16/22
323 Chisholm Monthly Behavioral Health ASD Report 12/16/22
326 Adverse Incident Report (Instuctions, Form) 6/23/23
337 Behavioral Health Out-of-State Treatment Report 12/16/22
354 Chisholm PCS Member Aging Out Report 12/16/22
360 NEMT Oversight Report 12/16/22
361 Community Case Management Report 7/8/25
409 Behavioral Health Grievance, Appeal, and State Fair Hearing Logs 6/10/24
412 State Directed Payments: Nurse Recruitment and Retention 7/12/24
413 Overpayments and TIPS Report 11/18/24
415 Chisholm Monthly PAL Tracker 9/18/25
Bi-Monthly Reports (Due February 28, April 30, June 30, August 31, October 31 and December 31)
# Report Name Published Date
20 Payment Discrepancy Report 12/16/22
Quarterly Reports (Due April 30, July 30, October 30, and January 30, except where indicated otherwise)
# Report Name Published Date
011A MCIP Achievement Report - Quality and Outcome Improvement Network 6/4/25
011B MCIP Achievement Report - Louisiana Quality Network 4/22/25
069 Utilization Management Medical Review Report 2/13/23
109 Marketing and Member Education Activities Report 2/13/23
119 QAPI Committee (Minutes) 2/13/23
145 Fraud Waste and Abuse Report 8/9/23
147 Sampling of Paid Claims Report 5/2/23
152 Act 710 Healthy Louisiana Claims Report 11/15/23
160 Medication Therapy Management Report 12/18/24
185 Quarterly Unaudited Financial Statement (Due 5/31, 8/31, 11/30 and 2/28) 2/28/23
188/188BH Service Authorizations 11/30/23
312 Gambling and Tobacco Report  (Due 8th day of the month following reporting period) 10/24/23
313 Access to Wraparound Services Report 2/27/23
317 PASRR Report 6/3/25
328 Behavioral Health Provider Network Detail Report 2/28/23
329 Children in Restrictive Settings 2/27/23
336 Behavioral Health Providers by Level of Care Report 2/27/23
338 Behavioral Health Network Adequacy and GEO Access Review 2/28/23
339 Behavioral Health Prescriber Sufficiency Summary Report 3/1/23
346 Provider Credentialing and Contracting Report 10/11/23
348 Geo Access Mapping (Attestation Form) 3/1/23
358 Behavioral Health Quality Monitoring Report 10/20/23
359 Behavioral Health Network Appointment Availability Report 2/27/23
408 Specialized Behavioral Health Provider Network Monitoring 3/1/23
410 State Directed Payments: EBP Incentive/Retention 11/18/24
411 ABA QualityMonitoring Report 2/8/24
414 State Directed Payments: LMHP Incentives/Retention 11/18/24
Semi-Annual Reports 
# Report Name Published Date Due Date
013 LDH MCO Physician Incentive Plan Report 12/16/22 Feb. 1 & Aug. 30 
220 Network Adequacy Review 9/30/25 July 31 & Jan. 31 
355 Evidence Based Practices 9/3/25 Aug. 1 & Feb. 1 
Annual Reports
# Report Name Published Date Due Date
011A MCIP Achievement Report - Quality and Outcome Improvement Network 6/4/25 March 30
011B MCIP Achievement Report - Louisiana Quality Network 4/22/25 March 30
012A MCIP Annual Progress Reporting - Quality and Outcome Improvement Network 6/6/25 July 31
012B MCIP Annual Progress Reporting Template - Louisiana Quality Network 6/6/25 July 31
017 Key Staff Organizational Chart Listing 3/5/24 Jan. 30
019 Medical Loss Ratio 9/17/24 Jan. 15
053 Specialized Behavioral Health NW Provider Development Management Plan 1/6/23 Jan. 30
056 PCMH Implementation Plan 1/6/23 Jan. 31
132 Member Satisfaction Survey (CAHPS) 6/13/23 Aug. 30
136 QAPI Program Description, Work Plan, Impact and Effectiveness of Program Evaluation 1/31/23 March 31
138 QAPI Performance Improvement Projects 9/26/23 March 15
141 Member Advisory Council 9/26/23 Jan. 30
170 Disclosure of Ownership and Control Interest Statement 1/27/23 March 30
177 Total and out of Network Claims Report 5/15/23 July 30
184 Annual Audited Financial Statement 4/2/25 June 30
189 Independent-Subcontractor EDP Audit (SSAE16) 5/23/23 Based on Audit Period
300 NCCI MCO Cost Savings 1/28/25 July 15
334 Integration Assessment Report 2/21/24 March 28
349 Unmet Service Needs Resolution Plan 3/17/23 April 30
410 State Directed Payments: EBP Incentive/Retention 11/18/24 July 30
414 State Directed Payments: LMHP Incentives/Retention 11/18/24 July 30

 

Marketing and Member Education Resources
Member Education Template Checklists

 

Other Resources

 

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

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