Exhibit_27_Minimum_Required_Reporting_List.docx
DOCX document 33 KB Posted
- Attached to
- OEIBA Program Commercial HMO, MSP, and MAPD Plans State and local contract opportunity
- Solicitation number
- EV00000681
- Issued by
- Oklahoma County, Hobart City, Oklahoma
About this file
Exhibit 27 is a Minimum Required Reporting List document from the Oklahoma Office of Management and Enterprise Services (OMES) for a health insurance program involving Medicare Advantage Prescription Drug (MAPD), Medicare Supplement (MSP), and Health Maintenance Organization (HMO) lines of business. The document details comprehensive monthly, quarterly, and annual reporting requirements across 38 different exhibits, covering areas such as member services, disenrollment changes, premium discrepancies, HIPAA incidents, fraud prevention, network changes, utilization reports, and advertising approvals. Reports must be submitted through secure email domains or FTP websites, with specific due dates ranging from weekly (e.g., MAPD disenrollment changes) to annual (e.g., member satisfaction surveys), typically within 10-60 days following the reporting period.
The reporting requirements are structured to provide detailed oversight of health insurance operations, with specific requirements for different lines of business. Reports must cover diverse aspects of health plan management, including telephone assistance performance, member satisfaction, HIPAA and fraud incidents, network provider changes, medication and utilization trends, high-cost claims analysis, and individual employer experience. The document indicates that suppliers must submit these reports electronically using specified secure communication channels, with different exhibits requiring Excel, Word, or other specific file formats. Timely and accurate reporting appears critical to maintaining compliance and transparency in the health insurance contract.
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Text version
Exhibit 27 Minimum Required Reporting List:
OEIBA Program Notes:
1. Separate reports are required for HMO, Medicare Supplement and MAPD lines of business.
2. Exhibit 28 should be loaded onto the secure ftp website.
3. Exhibits 29-38 should be sent electronically by a secure email domain. No additional security is necessary when a Supplier emails reports using the secure email domain.
a. Exhibit 29 should be sent as an Excel file to: EGID-General_Ledger_Unit@omes.ok.gov.
b. Exhibits 30-38 should be sent to: EGIDVendorReporting@omes.ok.gov.
i. Exhibits 30-37 should be sent as Excel files.
ii. Exhibit 38 should be sent as Word document.
| Report |
| Frequency |
| Report Name |
| Due Date |
| Tab |
Exhibit 28: MAPD File and Changes Reports
| 28a |
| Weekly |
| MAPD Disenrollment and Changes |
| Wednesday following the week being reported |
| “MAPD Changes” |
| 28b |
| Monthly |
| MAPD full file |
| 10th of same month |
| “MAPD Full File” |
Exhibit 29: Premium Discrepancy Reports
| 29a |
| Monthly |
| MAPD Premium discrepancy |
| 30 days after the premium remittance |
| “MAPD Premium” |
29b
| HMO/MSP Premium discrepancy |
| 60 days after the premium remittance |
| “HMO.MSP Premium” |
Exhibit 30: Member Services Reports
| 30a |
| Monthly |
Quarterly Annual
| Member Services Telephone Assistance |
| 20th of following month; |
60 days following the close of the calendar quarter/year “Telephone”
30b
MAPD Member Services Telephone Assistance
“MAPD Telephone”
| 30c |
| Annual |
| Member Satisfaction Survey Results |
| 60 days following the close of the calendar year |
| “Survey” |
30d
MAPD Member Satisfaction Survey Results
“MAPD Survey”
Exhibit 31: HIPAA, FWA, and Grievance Reports
| 31a |
| Quarterly |
| HIPAA Incident Report |
| 60 days following the close of the calendar quarter |
| “HIPAA” |
31b
Fraud, Waste, or Abuse Prevention Incident Report
“FWA”
31c
Grievance Report
“Grievance”
31d
MAPD Grievance Report
“MAPD Grievance”
Exhibit 32: Utilization Reports
| 32a |
| Quarterly |
Annual
| Executive Summary of Findings |
| 45 days following two months run-off data |
| “Exec Summary” |
32b
Top Fifteen Medications by Dollars and Number of Scripts
“Top Rx”
32c
Therapeutic Category
“Therapeutic”
32d
Top Ten Health Providers by Dollars
“Providers Dollars”
32e
Top Ten Health Providers by Utilization
“Providers Utilization”
32f
Top Ten Diagnosis by Dollars and Utilization
“Top Dx”
32g
Observations and Recommendations
“Observations”
Exhibit 33: Network Changes Summary
| 33a |
| Monthly |
| Network Changes Summary |
| 20th of following month |
| “Network Changes” |
Exhibit 34: Network Detailed Reports
| 34a |
| Quarterly |
| Summary of Provider Network Changes |
| 60 days following the close of the calendar quarter |
| “Summary of Network Changes” |
34b
Primary Care Physician Summary
“PCP Summary”
34c
Primary Care Physician Network
“PCP”
34d
Specialist Network
“Specialist”
34e
Pharmacy Network
“Pharmacy”
34f
Urgent Care Network
“Urgent Care”
34g
Hospital Network
“Hospital”
Exhibit 35: HMO Detailed Utilization Reports
| 35a-35f |
| Quarterly |
| Detailed Utilization Reports |
| 45 days following two months run-off data |
| “High Cost Claims YTD” |
"Monthly Claims Exhibit" "High Level Summary YTD" "High Level Sum (Rolling 12)" "All Plans YTD" "All Plans (Rolling 12)"
Exhibit 36: MAPD Detailed Utilization Reports
| 36a-36f |
| Quarterly |
| MAPD Detailed Utilization Reports |
| 45 days following two months run-off data |
| “High Cost Claims YTD” |
"Monthly Claims Exhibit" "High Level Summary YTD" "High Level Sum (Rolling 12)" "All Plans YTD" "All Plans (Rolling 12)"
Exhibit 37B: Individual Employer Experience Reports
| 37 |
| As requested |
| Individual Employer Experience Reports |
| Within ten (10) business days from EGID request. |
Exhibit 38: Advertising Approval Request Form
| 38 |
| As needed by Supplier |
| Advertising Approval Request form |
| Advertising approval request must be submitted for PRIOR approval |
Reminders* If awarded, refer to Attachment A, sections D.8.9. and D.23.2. Additional details will be sent to Suppliers.
1.
2. Member Handbook
3. Status for the distribution of member I.D. cards
4. Summary of Benefits and Coverage
5. Administrative Procedures Reference Manual
a. Evidence of Coverage
b. Annual Notice of Changes for MAPD and MSP (as applicable)
File details come from the government source that posted it. Updated .