Due Report Date to Report Name Content Frequency the HCA 30th of Case management count of open bariatric Medical the and transgender cases. Medical Policy 1 Management OPS Monthly following updates and ABA Participation Report month Spreadsheet. PowerPoint deck to include: Claims inventory; customer service call volumes 30th of and top 5 reasons for calling; escalations the 2 OPS Report Monthly report and Appeals/Complaints reports; following pre-authorization reasons; ABA summary; month detailed summary of annual service hours used to date Email to HCA Contract Manager of Claims 3 Paid Claims Weekly paid 15 Days Overpayments that have not been Erroneous following recovered; any money recovered will be 4 Quarterly Payments end of credited to the HCA at the time of quarter recovery. Description of Written description of Clinical Management Clinical 5 Annually May 1 program, which has been approved by the Management Medical Director ASB’s Program 30 Days Changes in Medical Notice of changes in medical policy that 6 Variable prior to Policy materially affect Plan payments change Detailed program statistics, including Clinical By disease type, Case Manager work, 7 Management By request request outcomes, and other information as Program Statistics determined by the HCA 7 Days after 8 IRO Decisions Variable Copies of each IRO decision final decision
Report Name Report Frequency Due Date to the HCA Content 1 Medical Management OPS Report Monthly 30th of the following month Case management count of open bariatric and transgender cases. Medical Policy updates and ABA Participation Spreadsheet. 2 OPS Report Monthly 30th of the following month PowerPoint deck to include: Claims inventory; customer service call volumes and top 5 reasons for calling; escalations report and Appeals/Complaints reports; pre-authorization reasons; ABA summary; detailed summary of annual service hours used to date 3 Paid Claims Weekly Email to HCA Contract Manager of Claims paid 4 Erroneous Payments Quarterly 15 Days following end of quarter Overpayments that have not been recovered; any money recovered will be credited to the HCA at the time of recovery. 5 Description of Clinical Management Program Annually May 1 Written description of Clinical Management program, which has been approved by the ASB’s Medical Director 6 Changes in Medical Policy Variable 30 Days prior to change Notice of changes in medical policy that materially affect Plan payments 7 Clinical Management Program Statistics By request By request Detailed program statistics, including disease type, Case Manager work, outcomes, and other information as determined by the HCA 8 IRO Decisions Variable 7 Days after final decision Copies of each IRO decision