Claims data to Washington Health Alliance (WHA) for UMP Plans and ASB’s WHA Claims Data By 16 By request business in Washington State, and Report and APCD request to the APCD in standard formats as requested by the WHA or APCD HEDIS and the Healthcare Effectiveness Data and By 17 Common Measure By request Information Set (HEDIS) and Common request Set Measure Set data specified by the HCA Data & Analytics Dashboard reports; in-depth analysis of 18 Monthly Dashboard cost and utilization patterns Performance Guarantee results; delivered Yearly Performance March 19 Yearly to the HCA Senior Account Sponsor(s); Guarantee Report 31 include any Performance Credits 45 Days Quarterly Performance Guarantee results; delivered following 20 Performance Quarterly to the HCA Senior Account Sponsor(s); end of Guarantee Report include any Performance Credits quarter Modifications to network contracted discount arrangements may result in an 21 Network Discounts Variable Variable increase of 2% or more in monthly Claims costs Overall Trend Guarantee measured October annually for Claims paid through June 30 22 Overall Trend Yearly 31 of the current; draft report of initial measurements; final settlement report 45 Days following Third party liability activities; delivered to 23 Subrogation Report Quarterly end of the HCA Contract Manager quarter 30 Days Disabled following Routine monitoring/reporting; maintain 24 Dependent Monthly the end accurate and timely eligibility files Determinations of month Total number of cases reviewed and total 30 Days number of facility Claims denied for early OB Payment following 25 Monthly elective induction; presented at the Reform the end monthly Clinical Strategy Leadership of month Meeting
16 WHA Claims Data Report and APCD By request By request Claims data to Washington Health Alliance (WHA) for UMP Plans and ASB’s business in Washington State, and to the APCD in standard formats as requested by the WHA or APCD 17 HEDIS and the Common Measure Set By request By request Healthcare Effectiveness Data and Information Set (HEDIS) and Common Measure Set data specified by the HCA 18 Data & Analytics Dashboard Monthly Dashboard reports; in-depth analysis of cost and utilization patterns 19 Yearly Performance Guarantee Report Yearly March 31 Performance Guarantee results; delivered to the HCA Senior Account Sponsor(s); include any Performance Credits 20 Quarterly Performance Guarantee Report Quarterly 45 Days following end of quarter Performance Guarantee results; delivered to the HCA Senior Account Sponsor(s); include any Performance Credits 21 Network Discounts Variable Variable Modifications to network contracted discount arrangements may result in an increase of 2% or more in monthly Claims costs 22 Overall Trend Yearly October 31 Overall Trend Guarantee measured annually for Claims paid through June 30 of the current; draft report of initial measurements; final settlement report 23 Subrogation Report Quarterly 45 Days following end of quarter Third party liability activities; delivered to the HCA Contract Manager 24 Disabled Dependent Determinations Monthly 30 Days following the end of month Routine monitoring/reporting; maintain accurate and timely eligibility files 25 OB Payment Reform Monthly 30 Days following the end of month Total number of cases reviewed and total number of facility Claims denied for early elective induction; presented at the monthly Clinical Strategy Leadership Meeting