By the 22nd of 26 Smart Health Data Monthly the following month 30 Days following Transgender Number of intake cases each quarter to 27 Monthly the end Surgery match the invoice of quarter All cases that were overturned at any level 30 Day of Appeal or IRO; include case number, following Appeals and IRO Claim number, diagnosis codes and 28 Annually the end report overturned descriptions, procedure codes and of the descriptions, indicator of HTA decision or year not, reason for overturn, case description March 1 Network access maps and access Network Access and statistical tables; remediation plan and 29 Semi-Annual Report October timeline if any provider type or geography 1 does not meet contractual standards 30 Days following Paying for Value All portions of survey results from ASB and 30 Annually the end Survey all network providers of the year Business continuity/disaster recovery plan Business Continuity designed to maintain uninterrupted Annually; and January 31 & Disaster business operations necessary to meet upon request 1 Recovery obligations during natural disasters or other abnormal events Number of expedited Appeal requests 32 Expedited Appeals Quarterly determined to be not urgent, denied or approved Core Team & 33 Weekly [See meeting list above] Clinical Action Log Overpayments, 15 Days Processes and service descriptions of Fraud and after the each; dollars identified as each for UMP; 34 Quarterly Erroneous quarter dollars collected for each; running annual payments reports ends totals Summary of the total expenditures for Primary Care 35 Annually May 31 Primary Care under both the UMP Plans Expenditures and the entire Book-of-Business
26 Smart Health Data Monthly By the 22nd of the following month 27 Transgender Surgery Monthly 30 Days following the end of quarter Number of intake cases each quarter to match the invoice 28 Appeals and IRO report overturned Annually 30 Day following the end of the year All cases that were overturned at any level of Appeal or IRO; include case number, Claim number, diagnosis codes and descriptions, procedure codes and descriptions, indicator of HTA decision or not, reason for overturn, case description 29 Network Access Report Semi-Annual March 1 and October 1 Network access maps and access statistical tables; remediation plan and timeline if any provider type or geography does not meet contractual standards 30 Paying for Value Survey Annually 30 Days following the end of the year All portions of survey results from ASB and all network providers 31 Business Continuity & Disaster Recovery Annually; and upon request January 1 Business continuity/disaster recovery plan designed to maintain uninterrupted business operations necessary to meet obligations during natural disasters or other abnormal events 32 Expedited Appeals Quarterly Number of expedited Appeal requests determined to be not urgent, denied or approved 33 Core Team & Clinical Action Log Weekly [See meeting list above] 34 Overpayments, Fraud and Erroneous payments reports Quarterly 15 Days after the quarter ends Processes and service descriptions of each; dollars identified as each for UMP; dollars collected for each; running annual totals 35 Primary Care Expenditures Annually May 31 Summary of the total expenditures for Primary Care under both the UMP Plans and the entire Book-of-Business