Exhibit 17.2 Reporting Requirements_02.10.2026.xlsx
XLSX spreadsheet 32 KB Posted
- Attached to
- Specialty Managed Care Plan
- Solicitation number
- 41NHA-S3708
- Issued by
- Clark County, Fish Springs CDP, Nevada
About this file
This is a Reporting Requirements exhibit for a Specialty Managed Care Plan contract with the Nevada Health and Human Services Authority (NVHA). The document establishes comprehensive reporting obligations for the contractor across operational, clinical, financial, and compliance domains. The initial contract year runs from July 1, 2027, through December 31, 2027, with subsequent contract years following the calendar year (January 1 through December 31). The exhibit details 104 distinct reporting requirements, each specifying the report title, contract reference section, frequency of submission, and due dates. Reports range from one-time submissions such as Certificate of Authority and Evidence of Required Insurance Coverages due at contract signing and before execution, respectively, to ongoing requirements including weekly Enrollee Change of Status reports due every Monday and monthly Data Quality Reports due on the 15th of the following month. Key operational reports include Implementation Plans required biweekly within 30 days of selection and continuing until contract go-live, Provider Termination reports due weekly on Fridays, and Active Provider Lists due monthly within 10 days of month-end. All reports are subject to request by NVHA at any time, and extension requests require detailed email justification to mcreports@nvha.nv.gov with responses expected within 2 business days.
The reporting framework incorporates multiple federal and state regulatory authorities, including the Social Security Act (SSA), Code of Federal Regulations (42 CFR and 45 CFR), and Nevada Revised Statutes (NRS). Critical compliance reports include Fraud, Waste, and Abuse investigations and overpayments tracking (due monthly by the 10th business day after month-end), Financial statements including Balance Sheets and Statements of Revenue and Expenses (due annually by March 31 of the following year), and Medical Loss Ratio Reports (due by December 31 of the following contract year). Clinical and quality-related submissions encompass EPSDT Plans, Prior Authorization Reports, Care Management Program Descriptions, and Quality Assessment and Performance Improvement Program documentation. Certain reports are designated with templates (marked "Y" in template column) to ensure standardized submission formats. Select reports including the Policy and Procedures Manual, Medication Coverage Policies, Provider Directory, and Community Reinvestment Plans are posted online for public access. Financial and actuarial reports, including the Independent Audit Report and IBNR Certification, must be submitted by designated deadlines to support state oversight of contractor solvency and medical expense management.
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Other files
| File | Type | Posted |
|---|---|---|
| Certification-regarding-lobbying~4.pdf | ||
| Terms-and-conditions-for-services~4.pdf | ||
| Attachment I - Planned Medicaid Policy Updates Memo_02.10.2026.docx | DOCX document | |
| Business Continuity Agreement revised 07.01.25~3.docx | DOCX document | |
| 41NHA-S3708-Reference-Questionnaire.docx | DOCX document | |
| Business Associate Agreement_02.10.2026.docx | DOCX document | |
| Attachment L - Attestation to Specialty Managed Care Plan Qualifications_02.10.2026.docx | DOCX document | |
| Exhibit 17.1 Geographic Service Areas_02.10.2026.xlsx | XLSX spreadsheet | |
| 41NHA-S3708 - Insurance Schedule - RFP.docx | DOCX document | |
| 41NHA-S3708-Vendor-Information-Response.pdf | ||
| Attachment F - Technical Proposal Questions_02.10.2026.docx | DOCX document | |
| Exhibit 17.3 Standard Member Material Definitions_02.10.2026.docx | DOCX document | |
| Standard-form-contract.docx | DOCX document | |
| 41NHA-S3708 - Specialty Managed Care Plan - RFP.docx | DOCX document | |
| 41NHA-S3708 - SPMC SOW_02.10.2026.docx | DOCX document |
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Text version
Reporting Requirements
| Reporting Requirements Exhibit | |||||||||||
| ILLUSTRATIVE EXAMPLE; SUBJECT TO CHANGE. Updated January 2026 | |||||||||||
| The table below outlines the reporting requirements included in the Specialty Managed Care Plan. | |||||||||||
| Unless otherwise indicated, "days" refers to calendar days. All reports are required upon request by NVHA in addition to the frequencies provided below. | |||||||||||
| Reporting requirements will be adjusted to accommodate the abbreviated first year of the contract term. The initial contract year will run from July 1, 2027, through December 31, 2027. Each subsequent year will follow a full calendar year, beginning January 1 and ending December 31. | |||||||||||
| If a report extension is needed, send a detailed email request with the reason for the extension to mcreports@nvha.nv.gov. MCQA will respond within 2 business days of receipt of the request. | |||||||||||
| Order in Contract | Report No. | Report Title | Contract Reference | Template | Instructions | Frequency | Due Date(s) | Related Federal Law | Related State Authority | Posted Online? | |
| 1 | N/A | Certificate of Authority | 2.2.2. | N | N | Once | At signing of contract | SSA 1903(m)(1), 42 CFR 438.116(b) | N/A | No | |
| 2 | N/A | Evidence of Required Insurance Coverages | 2.3.1. | N | N | Once | Before contract execution | N/A | N/A | No | |
| 3 | N/A | Implementation Plan | 2.6.2. | N | N | Biweekly | Within 30 days of selection for contract negotiations, and every 2 weeks thereafter until Contract go-live | N/A | N/A | No | |
| 4 | N/A | Public-Facing Materials | 2.16.1, 9.9.13. | N | N | On occurrence | Prior to release of public materials | N/A | N/A | No | |
| 5 | N/A | Data Quality and Governance Documents, including Data Dictionaries and Interface Control Documents | 2.17.13.D. | N | N | Quarterly | 30 days after quarter-end | N/A | N/A | No | |
| 6 | N/A | Data Quality Report | 2.17.13.F. | N | N | Monthly | 15th of the following month | N/A | N/A | No | |
| 7 | N/A | Key Personnel Organizational Chart | 3.1.1.A. | N | N | On occurrence | Within 7 days of a significant change in personnel | N/A | N/A | No | |
| 8 | N/A | Notification of Key Personnel Vacancies | 3.1.4. | N | N | On occurrence | Within 7 days of vacancy | N/A | N/A | No | |
| 9 | N/A | Subcontractor Agreement and Checklist | 3.2.3. | Y | Y | On occurrence | Prior to subcontract execution | SSA 1124(a)(2)(A) | |||
| 42 CFR 455.105 | N/A | No | |||||||||
| 10 | 608 | Subcontractor Deliverables Tracker | 3.2.3. | Y | Y | Upon request | Within 35 days from date of request | SSA 1124(a)(2)(A) | |||
| 42 CFR 455.105 | N/A | No | |||||||||
| 11 | N/A | Subcontractor Monitoring Report | 3.2.4. | N | N | Upon request | Within 35 days from date of request | 42 CFR 455.105 | N/A | No | |
| 12 | N/A | Notification of Subcontractor Termination | 3.2.9. | N | N | On occurrence | Within 7 days of notification to subcontractor | N/A | N/A | No | |
| 13 | N/A | Policy and Procedures Manual | 3.3.4.B. | N | N | Ongoing | 60 days before contract go-live and within 7 days of the execution of any updates | N/A | N/A | Yes | |
| 14 | N/A | Marketing Materials | 3.3.6. | ||||||||
| 5.6.2. | N | N | Upon request | 60 days prior to the MAC meeting at which materials will be reviewed; | |||||||
| Within 7 days of request | 42 CFR 438.104 | ||||||||||
| 42 CFR 457.1224 | N/A | No | |||||||||
| 15 | 408 | Enrollee Change of Status | 4.1.7.A. | Y | Y | Weekly | Every Monday | 42 CFR 438.608(a)(3) | |||
| 42 CFR 457.1285 | N/A | No | |||||||||
| 16 | 408A | Enrollee Change of Status Attestation | 4.1.7.C. | Y | Y | Monthly | 15th of the following month | 42 CFR 438.608(a)(3) | |||
| 42 CFR 457.1285 | N/A | No | |||||||||
| 17 | N/A | Births Report | 4.4.1. | N | N | Weekly | Every Friday | N/A | N/A | No | |
| 18 | N/A | Good Cause Disenrollment - Contractor | 4.6.3. | N | N | On occurrence | within 14 days of the request for disenrollment | 42 CFR 438.56(b) |
42 CFR 457.1201(m)
| 42 CFR 457.1212 | N/A | No | |||||||||
| 19 | 437 | EPSDT Plan | 5.3.5.D. | N | N | Annually | 60 days prior to each contract year | SSA 1905(r) | |||
| 42 CFR 441 Subpart B | N/A | No | |||||||||
| 20 | N/A | Proof of Laboratory Service Provider CLIA Certification | 5.3.10.A. | N | N | Upon request | As indicated in the request | 42 CFR 493 | N/A | No | |
| 21 | N/A | Medication Coverage Policies | 5.3.11.D.7. | N | N | Ongoing | 30 days before go-live and 30 days before any change | 42 CFR 438.10(i), 42 CFR 457.1207 | N/A | Yes | |
| 22 | 422 | Pharmacy Lock-In Report | 5.3.11.I.3. | Y | Y | Quarterly | 10 days after the quarter end | N/A | MSM Chapter 1200 | No | |
| 23 | N/A | Drug Utilization Review (DUR) Program Report | 5.3.11.L.1.A. | ||||||||
| 5.3.11.M.2. | N | N | Annually | June 1 | SSA 1927(g) |
42 CFR 438.3(s)
| 42 CFR 456 Subpart K | N/A | No | |||||||||
| 24 | 113 | Pharmacy Supplemental Rebate Agreement | 5.3.11.N.1. | ||||||||
| 5.3.12.F.6. | Y | Y | Annually | July 1 | N/A | NRS 422.4025(8) | |||||
| NRS 422.4053 | No | ||||||||||
| 25 | 114 | Pharmacy Supplemental Rebate Detail | 5.3.11.N.1. | ||||||||
| 5.3.12.F.6. | N | Y | Quarterly | 90 days after quarter-end | N/A | NRS 422.4053 | |||||
| NRS 422.4056(1)(b) | No | ||||||||||
| 26 | N/A | Pharmacy Benefit Manager (PBM) Report | 5.3.12.B. | N | Y | Annually | By December 1 of each contract year | N/A | N/A | No | |
| 27 | N/A | Pharmacy Benefit Manager (PBM) Administrative Fee Formula | 5.3.12.D | N | N | Annually | 90 days before the start of each contract year | N/A | N/A | No | |
| 28 | 115 | Pharmacy Audit of Internal Controls - SOC-1 | 5.3.11.O. | ||||||||
| 5.3.12.F.1. | N | N | Annually | June 15th of every year | N/A | NRS 422.4056 | No | ||||
| 29 | N/A | Pharmacy Rebate Claim Errors Data | 5.3.12.B. |
5.3.12.D.
| 5.3.12.F.6. | N | N | N/A | N/A | N/A | N/A | No |
| 30 | N/A | Pharmacy Rebate Providers Data | 5.3.12.B. |
5.3.12.D.
| 5.3.12.F.6. | N | N | N/A | N/A | N/A | N/A | No |
| 31 | N/A | Pharmacy Rebate Medical Data | 5.3.12.B. |
5.3.12.D.
| 5.3.12.F.6. | Y | Y | N/A | N/A | N/A | N/A | No | ||||
| 32 | N/A | Mental Health Parity and Addiction Equity Act (MHPAEA) Compliance Analysis | 5.5.6. | ||||||||
| 5.11.4.C. | Y | Y | Annually | 90 days before the start of each contract year | 42 CFR 438 Subpart K | NRS 687.B.404 | No | ||||
| 33 | N/A | Value Added Benefit Services Fact Sheet | 5.6.1. | N | N | Upon request | Within 7 days of request; | ||||
| 60 days prior to the MAC meeting at which materials will be reviewed | N/A | N/A | Yes | ||||||||
| 34 | N/A | Value added Benefit Services Usage | 5.6.1. | N | N | Upon request | Within 7 days of request | N/A | N/A | No | |
| 35 | 808 | Enrollee Gifts and Incentives Attestation | 5.6.3. | N | N | On occurrence | June 15th of each year for the next contract year; | ||||
| Within 7 business days of change | N/A | N/A | No | ||||||||
| 36 | N/A | Notification of Nursing Facility Stay >180 days | 5.7.1.J.1. | N | N | On occurrence | By the 175th day of an NF stay | N/A | MSM 3603.4D | No | |
| 37 | N/A | Notification of Swing Bed Stay >45 days | 5.7.2. | N | N | On occurrence | By the 40th day of a swing bed stay | N/A | MSM 3603.4E | No | |
| 38 | N/A | Prior Authorization Report | 5.8.2.N. | Y | N | Annually | By March 31st of the following year | 42 CFR 438.210(f) | N/A | Yes | |
| 39 | N/A | Notification of transfer to FFS or a Standard MCO during a hospitalization | 5.10.5. | N | N | On occurrence | As soon as the transition is known | N/A | N/A | No | |
| 40 | 440 | UM Program Description and Work Plan | 5.11.2. | N | N | Annually | By March 31st of each contract year | N/A | N/A | Yes | |
| 41 | 430 | Care Management Program Description | 6.3.1. | N | N | On occurrence | Within 90 days of contract execution and by March 31 of each contract year thereafter | 42 CFR 438(b) | N/A | No | |
| 42 | N/A | Processes and Protocols to support and monitor Targeted Case Management (TCM) | 6.3.2.I. | N | Y | On occurrence | TBD | 42 CFR 438(b) | N/A | No | |
| 43 | N/A | Declined CME-Provided TCM Report | 6.6.4. | Y | Y | Monthly | TBD | N/A | N/A | No | |
| 44 | N/A | Care Management Program Status Report | 6.12.1. | Y | Y | TBD | TBD | N/A | N/A | No | |
| 45 | N/A | Non-Renewal of Provider Contracts | 7.6.11 | N | N | On occurrence | Within 5 business days | N/A | NRS 687.B.692 | No | |
| 46 | N/A | Standard Participating Provider Agreement | 7.8.2. | N | N | On occurrence | As part of Readiness Review and upon request within 5 business days | N/A | N/A | No | |
| 47 | N/A | Notification of Unexpected Change in Provider Network | 7.9.5. | N | N | On occurrence | Within 1 business day of change | N/A | N/A | No | |
| 48 | N/A | Notification of Substantial Change in Provider Network | 7.9.6. | N | N | On occurrence | Within 1 business day of becoming aware of change and no later than 5 business days of known change | N/A | N/A | No | |
| 49 | 302 | Provider Termination | 7.9.8.A. | Y | Y | Weekly | Fridays | N/A | N/A | No | |
| 50 | 303 | Active Provider List | 7.9.8.C. | Y | Y | Monthly | 10 days after month end | 42 CFR 438.206 | |||
| 42 CFR 438.608(b) | N/A | No | |||||||||
| 51 | 304 | Comparison List | 7.9.8.C. | N | N | On occurrence | N/A | 42 CFR 438.206 | |||
| 42 CFR 438.608(b) | N/A | No | |||||||||
| 52 | 402 | Network Adequacy | 7.10.2.G. |
7.10.4.B.
7.10.5.A.
7.10.6.B.
7.10.6.C. Y Y Quarterly 30 days before go-live and within 30 days after quarter-end 42 CFR 438.68
42 CFR 438.207
| 42 CFR 457.1230 | N/A | No | |||||||||
| 53 | 427 | Single Case Agreement | 7.13.2. | Y | Y | Monthly | By the 10th of the following month | N/A | N/A | No | |
| 54 | N/A | Access Improvement | 7.14.2.A. | N | N | Annually | By March 31st of each year | N/A | N/A | Yes | |
| 55 | 802 | Provider Call Center Performance Standard Attestation | 7.15.2.C. | Y | Y | Monthly | By the 10th of the following month | N/A | N/A | No | |
| 56 | N/A | Calendar of Provider Trainings | 7.17.2. | N | N | Ongoing | 30 days before go-live and within 7 days of any updates | N/A | N/A | Yes | |
| 57 | 501 | Appeals and Grievances | 7.22.5. | ||||||||
| Y | Y | Quarterly | |||||||||
| Annually | 30 days after quarter-end; | ||||||||||
| 30 days after year-end | 42 CFR 438.416, 457.1260(h) | NRS 422.306 | No | ||||||||
| 58 | 414 | Clean Claims | 8.1.6. | Y | Y | Monthly | 15th of the following month | 42 CFR 447.45(d) | |||
| 42 CFR 447.46 | NRS 695C.185 | No | |||||||||
| 59 | N/A | Notification of Changes to Claims Processing Software System | 8.1.11. | N | N | On occurrence | No later than 30 days prior to change | N/A | N/A | No | |
| 60 | 210 | Third Party Liability | 8.2.4. | Y | Y | Monthly | 30 days after month-end | 42 CFR 433 Subpart D, 42 CFR 447.20 | N/A | No | |
| 61 | 213 | TPL Subrogation | 8.2.11.A. | y | y | Monthly | 30 days after month-end | 42 CFR 433 Subpart D, 42 CFR 447.20 | N/A | No | |
| 62 | 311 | Provider Preventable Conditions | 8.3.2. | Y | Y | Monthly | By the 10th business day after each month-end | 42 CFR 438.3(g) | |||
| 42 CFR 447.26 | N/A | No | |||||||||
| 63 | N/A | Physician Incentive Plans | 8.6. | N | N | Upon request | Within 7 days of request | SSA 1876 |
42 CFR 422.210
42 CFR 438.3(i) 42 CFR 438.10(f)(3)
| N/A | No | |||||||||
| 64 | N/A | Annual Payment Analysis | 8.11.4. | N | N | Annually | By March 31st of each contract year | 42 CFR 438.207(b)(3) | N/A | Yes |
| 65 | 801 | Enrollee Services Department Performance Standards Attestation | 9.8.5.B. | Y | Y | Monthly | By the 10th of the following month | N/A | N/A | No |
| 66 | N/A | Enrollee Handbook | 9.10.1. | N | N | Annually | Prior to the Contract start date and 90 days prior to the start of each contract year | 42 CFR 438.10(c)(4)(ii) |
42 CFR 438.10(g)(1)
42 CFR 457.1207
| 45 CFR 147.200(a) | N/A | Yes | |||||||||
| 67 | N/A | Enrollee Newsletters | 9.11. | N | N | Twice Annually | By June 30th and December 31st of each contract year | N/A | N/A | Yes | |
| 68 | N/A | Provider Directory | 9.13. | N | N | Ongoing | 30 days prior to go-live, quarterly for paper directories and on the Contractor's website within 30 calendar days of any change | 42 CFR 438.10(h)(4) | |||
| 42 CFR 457.1207 | N/A | Yes | |||||||||
| 69 | N/A | Specialty Managed Care Plan Monitoring Requirements | 10.1.2. | N | Y | TBD | TBD | 42 CFR 438 | N/A | No | |
| 70 | N/A | Quality Assessment and Performance Improvement (QAPI) Program | 10.2.2.C | ||||||||
| 10.3. | N | Y | Annually and Ongoing | Within 30 days of request | 42 CFR 438.330 |
42 CFR 438.109(c)(3)
42 CFR 438.340
42.CFR 441.730(a)
| 441.302(h) | N/A | Yes | |||||||||
| 71 | N/A | Performance Improvement Project (PIP) Report | 10.3.4.D. | N | N | Annually | By June 30 of each contract year | 42 CFR 438.330 | N/A | No | |
| 72 | 702 | Critical Incident Report | 10.10.2. | Y | Y | On occurrence | Within 1 business day of discovery | N/A | N/A | No | |
| 73 | 423 | Population Health Annual Strategy | 10.12.1. | ||||||||
| 10.12.2. | N | N | Annually | Within 90 days of contract execution and by January 31 of each contract year thereafter | N/A | N/A | No | ||||
| 74 | 404 | Cultural Competency Plan (CCP) Report | 10.13.2.C. | ||||||||
| 10.13.5. | N | N | Annually | By June 30th of each contract year | 42 CFR 438.206(c)(2) | ||||||
| 42 CFR 457.1230(a) | NRS 422.2734 | No | |||||||||
| 75 | 315 | Compliance Review Tool | 11.2.1. | ||||||||
| 11.2.2. | Y | Y | Annually | By June 30th of each contract year | 42 CFR 438.608 | ||||||
| 42 CFR 457.1285 | N/A | No | |||||||||
| 76 | 316 | Attachment A Goals and Objectives | 11.2.1. | ||||||||
| 11.2.2. | Y | Y | Annually | By June 30th of each contract year | 42 CFR 438.608 | ||||||
| 42 CFR 457.1285 | N/A | No | |||||||||
| 77 | 306 | Embezzlement and Theft Report | 11.2.5. | Y | Y | On occurrence | 5 days after identification | 42 CFR 438.608 | |||
| 42 CFR 457.1285 | N/A | No | |||||||||
| 78 | 307 | FWA Provider Referral Report | 11.5.3. | Y | Y | On occurrence | CAF Referrals: Within 10 business days after determination; | ||||
| Non-CAF Referrals: Within 10 business days after opening an investigation | 42 CFR 438.608(a)(7) | ||||||||||
| 42 CFR 457.1285 | N/A | No | |||||||||
| 79 | 317 | Credible Allegation of Fraud | 11.5.3. | Y | Y | On occurrence | Within 10 days of discovery | 42 CFR 438.608(a)(7) | |||
| 42 CFR 457.1285 | N/A | No | |||||||||
| 80 | 318 | Overpayments Recovered | 11.5.3. |
11.10.1.
11.10.4
8.3.2. Y Y Annually By March 31 of the following contract year 42 CFR 438.608(d)
42 CFR 457.1285
| 42 CFR 447.26 | N/A | No | |||||||
| 81 | 308 | FWA Recipient Referral Report | 11.5.3. | Y | Y | On occurrence | CAF Referrals: Within 10 business days after determination; | ||
| Non-CAF Referrals: Within 10 business days after opening an investigation | 42 CFR 438.608(a)(7) | ||||||||
| 42 CFR 457.1285 | N/A | No | |||||||
| 82 | 309 | Provider Investigations List | 11.10.1. | Y | Y | Monthly | By the 10th business day after each month-end | 42 CFR 438.608, | |
| 42 CFR 457.1285 | N/A | No | |||||||
| 83 | 310 | Recipient Investigations List | 11.10.1. | Y | Y | Monthly | By the 10th business day after each month-end | 42 CFR 438.608, | |
| 42 CFR 457.1285 | N/A | No | |||||||
| 84 | 312 | Fraud, Waste, Abuse (FWA) Overpayments Report | 11.10.2. | ||||||
| 11.10.3. | Y | Y | Monthly | By the 10th business day after each month-end | 42 CFR 438.608 | ||||
| 42 CFR 457.1285 | N/A | No | |||||||
| 85 | 313 | Overpayments Related to Administrative Errors Report | 11.10.2. | ||||||
| 11.10.3. | Y | Y | Monthly | By the 10th business day after each month-end | 42 CFR 438.608 | ||||
| N/A | No | ||||||||
| 86 | 305 | Contractor Disclosures | 11.13.1. |
11.13.2.
11.13.3.
15.2.1. Y Y On occurrence TBD 42 CFR 438.608(c)(2)
42 CFR 457.1285
42 CFR 455.100-104(b) SSA 1903(m)(2)(A)(viii) SSA 1124(a)(2)(A)
| SSA 1903(m)(4)(A)-(B) | N/A | No | |||||||||
| 87 | 109 | Independent Audit Report (CPA) | 12.3.2. | N | Y | Annually | By April 30th of each contract year | 42 CFR 438.3(m) | |||
| 42 CFR 457.1285 | N/A | No | |||||||||
| 88 | 105 | Balance Sheet - Assets, Liabilities, and Equities | 12.3.3. | Y | Y | Annually | By March 31st of the following year | 42 CFR 438.3(m), 42 CFR 457.1285 | N/A | No | |
| 89 | 106 | Statement of Revenue, Expenses and Equity | 12.3.3. | Y | Y | Annually | 90 days after each calendar year-end | 42 CFR 438.3(m), 42 CFR 457.1285 | N/A | No | |
| 90 | N/A | IBNR Certification | 12.4.1. | N | N | Annually | By June 30th of each contract year | N/A | N/A | No | |
| 91 | 108 | Medical Loss Ratio (MLR) Report | 12.5.1. | ||||||||
| 12.5.4. | Y | Y | Annually | By December 31st of the following contract year | 42 CFR 438.8, | ||||||
| 42 CFR 457.1203(f) | N/A | No | |||||||||
| 92 | N/A | Cost Containment and Cost Avoidance Initiatives Report | 12.6.1. | N | N | On occurrence | 60 days before contract go-live and within 7 days of the execution of any updates | N/A | N/A | No | |
| 93 | 111 | Community Reinvestment Plan | 12.7.4. | N | N | Annually | By March 1st of each contract year | N/A | N/A | Yes | |
| 94 | 112 | Community Reinvestment Expenditure | 12.7.4. | Y | Y | Annually | By March 1st of each contract year | N/A | N/A | Yes | |
| 95 | N/A | Service-Specific Encounter Data | 13.3.8. | ||||||||
| 13.3.9. | N | N | On occurrence | 90 days from receipt of encounter from a provider | 42 CFR 438.604(a)(1) |
42 CFR 438.606
| 42 CFR 438.818 | N/A | No | |||||||
| 96 | N/A | Encounter Response File | |||||||
| (aka Encounter Reporting Form (ERF)) | 13.3.13.H. | N | N | On occurrence | Within 60 days of receipt of the rejected encounter file | N/A | N/A | No | |
| 97 | 314 | Certification of Data, Documentation, and Information | 13.4.1. | Y | Y | Monthly | By the 10th business day after each month-end | 42 CFR 438.604 |
42 CFR 438.606
42 CFR 457.1201
| 42 CFR 457.1285 | N/A | No | |||||||||
| 98 | 424 | IMD 15-Day Report | 14.2.7.D.1. | Y | Y | Monthly | 15th of the following month | SSA 1905(a)(30)(B) | N/A | No | |
| 99 | 204 | Maternity Kick Payment - SOBRA Request | 14.3.4. | Y | Y | On occurrence | Within 180 days of a qualifying delivery | 42 CFR 438.6(b)(1) | N/A | No | |
| 100 | 206 | Stop Loss Payment Request | 14.5.2. | Y | Y | On occurrence | Within 90 days from the date of payment exceeding $500,000, with an additional 45 days allowed for claims from out-of-state providers | 42 CFR 438.6(b)(1) | N/A | No | |
| 101 | 205 | Disputed/Retroactive Capitation Request | 14.6.1. | Y | Y | Monthly | Between 45-225 days after the end of the month the payment was supposed to cover | N/A | MSM 3603.25.B | No | |
| 102 | 207 | Excess Capitation Report | 14.7.1.A. | ||||||||
| 14.7.1.B. | Y | Y | Quarterly | 15 days after quarter-end | 42 CFR 438.608(c)(3) | N/A | No | ||||
| 103 | N/A | Corrective Action Plans (CAPs) | 16.2.3. | N | N | On occurrence | Within 21 days of request from state | N/A | N/A | No | |
| 104 | N/A | Termination Transition Plan | 16.5.3.B.1. | N | N | On occurrence | 90 days prior to the contract termination date | N/A | N/A | No |
File details come from the government source that posted it. Updated .