Dollar accuracy rate MCO claims Claim type: inpatient Comparison to Reported by payment accuracy hospital, behavioral baseline; MCOs reports health, nursing trending over monthly; facility, I/T/U, time evaluator may crossover, HCBS, summarize to dental, FQHC/RHC present annually Percentage of MCO grievances and MCO Comparison to Reported by grievances resolved appeals report baseline; MCOs on time trending over quarterly; time evaluator may summarize to present annually Percentage of MCO grievances and MCO Comparison to Reported by provider appeals appeals report baseline; MCOs resolved on time trending over quarterly; time evaluator may summarize to present annually Provider satisfaction MCO provider MCO Comparison to Annual survey results satisfaction survey baseline; report trending over time C. Has the state Number and MCO performance MCO Comparison to Annual successfully percentage of improvement project baseline; implemented providers using report trending over new processes electronic health time and technologies records/participating for program in the Health management, Information Exchange
Dollar accuracy rate MCO claims payment accuracy reports Claim type: inpatient hospital, behavioral health, nursing facility, I/T/U, crossover, HCBS, dental, FQHC/RHC Comparison to baseline; trending over time Reported by MCOs monthly; evaluator may summarize to present annually Percentage of grievances resolved on time MCO grievances and appeals report MCO Comparison to baseline; trending over time Reported by MCOs quarterly; evaluator may summarize to present annually Percentage of provider appeals resolved on time MCO grievances and appeals report MCO Comparison to baseline; trending over time Reported by MCOs quarterly; evaluator may summarize to present annually Provider satisfaction survey results MCO provider satisfaction survey report MCO Comparison to baseline; trending over time Annual C. Has the state successfully implemented new processes and technologies for program management, Number and percentage of providers using electronic health records/participating in the Health Information Exchange MCO performance improvement project report MCO Comparison to baseline; trending over time Annual
Evaluation%20of%20the%20Centennial%20Care%201115%20Demonstration%20Waiver%20-%201463080000006%20.docx