ATTACHMENT 13 Minimum Required Reporting List: OEIBA Program Notes: All reports should be submitted electronically. Recon should be sent to: and by secure email or enforced TLS. DBC recipient reports should be sent by secure email to: . If Supplier submits bid for two plans, use associated templates for each individual plan. Recipient Report Frequency Report Name Due Date Tab Attachment 14: Premium Discrepancy Reports Recon 14a Monthly PPO Premium 30 days after the premium Premium” “PPO Discrepancy remittance 14b Monthly Prepaid/Managed 30 days after the premium Premium” “Prepaid Premium Discrepancy remittance Attachment 15: Member Services Reports DBC 15a Monthly Member Services 20th of following “Telephone” Telephone Assistance Quarterly 60 days following the close of the Annual calendar quarter/year 15b Annual Member Satisfaction 60 days following close of “Survey” Survey Results calendar year Attachment 16: HIPAA, FWA, and Grievance Reports DBC 16a Quarterly HIPAA Incident 60 days following the close of the “HIPAA” Report calendar quarter 16b Quarterly Fraud, Waste, or 60 days following the close of the “Fraud” Abuse Prevention calendar quarter Incident Report 16c Quarterly PPO Grievance Report 60 days following the close of the Grievance” “PPO calendar quarter 16d Quarterly Prepaid/Managed 60 days following the close of the Grievance” “Prepaid Grievance Report calendar quarter Attachment 17: Network Changes Summary DBC 17a Monthly PPO Network 20th of following month Network “PPO Changes Summary Changes” 17b Monthly Prepaid/Managed 20th of following month Network “Prepaid Network Changes Changes” Summary Attachment 18: Dental Provider Network DBC 18a Annual PPO Dental Provider Due February 20th each year Network” “PPO Network Data as of January 1st of Plan Year 18b Annual Prepaid/Managed Due February 20th each year Network” “Prepaid Dental Provider Data as of January 1st of Plan Year Network
ATTACHMENT 13 Minimum Required Reporting List: OEIBA Program Notes: All reports should be submitted electronically. Recon should be sent to: and by secure email or enforced TLS. DBC recipient reports should be sent by secure email to: . If Supplier submits bid for two plans, use associated templates for each individual plan. Recipient Report Frequency Report Name Due Date Tab Attachment 14: Premium Discrepancy Reports Recon 14a Monthly PPO Premium Discrepancy 30 days after the premium remittance “PPO Premium” 14b Monthly Prepaid/Managed Premium Discrepancy 30 days after the premium remittance “Prepaid Premium” Attachment 15: Member Services Reports DBC 15a Monthly Quarterly Annual Member Services Telephone Assistance 20th of following 60 days following the close of the calendar quarter/year “Telephone” 15b Annual Member Satisfaction Survey Results 60 days following close of calendar year “Survey” Attachment 16: HIPAA, FWA, and Grievance Reports DBC 16a Quarterly HIPAA Incident Report 60 days following the close of the calendar quarter “HIPAA” 16b Quarterly Fraud, Waste, or Abuse Prevention Incident Report 60 days following the close of the calendar quarter “Fraud” 16c Quarterly PPO Grievance Report 60 days following the close of the calendar quarter “PPO Grievance” 16d Quarterly Prepaid/Managed Grievance Report 60 days following the close of the calendar quarter “Prepaid Grievance” Attachment 17: Network Changes Summary DBC 17a Monthly PPO Network Changes Summary 20th of following month “PPO Network Changes” 17b Monthly Prepaid/Managed Network Changes Summary 20th of following month “Prepaid Network Changes” Attachment 18: Dental Provider Network DBC 18a Annual PPO Dental Provider Network Due February 20th each year Data as of January 1st of Plan Year “PPO Network” 18b Annual Prepaid/Managed Dental Provider Network Due February 20th each year Data as of January 1st of Plan Year “Prepaid Network”
Solicitation0900000304Attachment13.docx