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Section J
EXHIBIT - A
DD Form 1423-1 Contract Data Requirements List (CDRL) TABLE OF CONTENTS Daily Reports.
D010 Pass Through Contractor Payment/Check Issue Data
Weekly Reports.
| W010 |
| Transition-In Status Report |
| W020 |
| Transition-Out Status Report |
Monthly Reports.
| M010 |
| Case Management Report |
| M030 |
| CQM Quality Intervention Report |
| M040 |
| Global Monthly Summary Report |
| M050 |
| HIPAA Privacy Complaint Report |
| M060 |
| Medical Evacuation Report |
| M070 |
| Preauthorizations/Authorizations and Referral Timeliness/Accuracy Report |
| M090 |
| Active duty Service Member(ADSM) Claims Report - Pended or Denied Claims |
| M100 |
| Network Adequacy/Inadequacy Report |
| M110 |
| Overpayment Cases Against VA Facilities |
| M120 |
| Overseas Currency Report |
| M130 |
| Paid Claims and Current Inventory Report (All Beneficiaries) |
| M140 |
| Non-Financially Underwritten Accounts Receivable Summary Report (Government Medicare Dual Eligible) |
| M150 |
| Non-Financially Underwritten Accounts Receivable Summary Report (Government TRICARE Only Eligible) |
| M160 |
| Non-Financially Underwritten Accounts Receivable Summary Report (Non-Government Medicare Dual Eligible |
| M170 |
| Non-Financially Underwritten Accounts Receivable Summary Report (Non-Government TRICARE Only Eligible) |
| M180 |
| Non-Financially Underwritten Bank Account Reconciliation Report (Non-Accrual Fund Eligible) |
| M190 |
| Non-Financially Underwritten Bank Account Reconciliation Report (MERHCF/Accrual Fund Eligible) |
| M200 |
| Non-Financially Underwritten Bank Account Statement Report (Medicare Dual Eligible) |
| M210 |
| Non-Financially Underwritten Bank Account Statement Report Account Statement Report (TRICARE Only Eligible) |
| M220 |
| Non-Financially Underwritten Bank Account Statement Report, Bank Cleared Payment Data |
| M230 |
| TOP Prime Remote PCM/Enrollment Report |
| M240 |
| TRICARE Premium Activity Report |
| M250 |
| Comprehensive Autism Care Demonstration Report (M) |
| M260 |
| Integrated Disability Evaluation System (IDES) Memorandum of Agreement (MOA) Claims Without Authorization |
| M270 |
| Advanced Rehabilitation Center Referrals |
Quarterly Reports.
| Q010 |
| Appeals Quality Assessment Report |
| Q020 |
| Internal Quality Management/Quality Improvement Report |
| Q040 |
| Fraud and Abuse Summary Report |
| Q050 |
| Remote ADSM Dental Report |
| Q060 |
| Mental Health Counselor Status Report |
| Q070 |
| Comprehensive Autism Care Demonstration Report (Q) |
| Q080 |
| Retrospective Review Validation Report |
Semi-Annual Reports.
| SA010 |
| Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) Report |
| SA020 |
| Comprehensive Autism Care Demonstration Report (SA) |
Annual Reports.
| A010 |
| Risk Assessment Letter of Assurance |
| A020 |
| Service Organization Control Report (SOC1) - Statement on Standards for |
Attestation Engagements, SSAE No. 18 (Prime with Subservice Organization)
| A030 |
| Bridge Letter in Support of Service Organization Control Report (SOC1) - |
Statement on Standards for Attestation Engagements, SSAE No. 18 (Prime with Subservice Organization)
| A040 |
| Service Organization Control Report (SOC1) - Statement on Standards |
for Attestation Engagements, SSAE No. 18 (Subservice Organization)
| A050 |
| Bridge Letter in Support of Service Organization Control Report (SOC1) - |
Statement on Standards for Attestation Engagements, SSAE No. 18 (Subservice Organization)
| A060 |
| Third Party Recoveries for Fiscal Year Report |
| A070 |
| NIST Certification of Compliance Report |
| A080 |
| Disaster Recovery Test Results Report |
| A090 |
| MOU with East Region Contractor |
| A100 |
| MOU with West Region Contractor |
| A110 |
| Clinical Quality Management Program (CQMP) Report |
| A120 |
| IDME Ratios for Children's Hospitals Report |
| A130 |
| Contract Releasable under FOIA |
| A140 |
| MOU with Uniformed Services Family Health Plan (USFHP) Designated Providers |
| A150 |
| Fraud Detection and Prevention Strategy and Internal Procedures |
| A160 |
| MOU with TRICARE Claims Review Contractor (TCRS) |
| A170 |
| MOU with Global Nurse Advice Line Contractor (GNAL) |
Plans.
| P010 |
| Clinical Quality Management Program/Clinical Quality Oversight Plan |
| P020 |
| Medical Management (MM)/Utilization Management (UM) Plan |
| P030 |
| Network Implementation Plan |
| P040 |
| Continuity of Operations Plan (COOP) |
| P050 |
| Case Management Plan |
| P060 |
| COCOM Contingency Support Pan |
| P070 |
| Contingency Program Plan |
| P080 |
| Contractor Owned Facilities Mitigation Plan |
| P100 |
| Internal Quality Management/Quality Improvement Program Plan |
As Required Plans/Reports.
| R020 |
| Appeals Processing Guidelines, Desk Instructions and Reference Materials |
| R030 |
| Responsibilities Assignment Matrix (RAM) |
| R040 |
| Inpatient Admission/Notification of Case Report |
| R050 |
| Malpractice Insurance and Licensure/Certification Requirements |
| R060 |
| Serious Reportable Events |
| R070 |
| Program Integrity Standard Operating Procedures (Desk Procedures) |
| R090 |
| DSMO Meeting Summary Report |
| R110 |
| MTF Notification of Active Duty Service Member (ADSM) Pended or Denied Claims |
| R120 |
| Declaration of Transfer and Destruction of Records |
| R130 |
| Fraud/Abuse Patient Harm-Initial Notification Checklist |
| R140 |
| Program Integrity Random Sample Audit Worksheet |
| R150 |
| DHA/MTF Fraud & Abuse Referral Cover Sheet |
| R160 |
| SOR with TAO Eurasia-Africa Director |
| R170 |
| SOR with TAO Latin America & Canada Director |
| R180 |
| SOR with TAO Pacific Director |
| R190 |
| SOR with Military Treatment Facility (MTF) |
| R200 |
| B2B Gateway Questionnaire |
| R210 |
| System Integration Test Plans |
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