Attachment J.10 - Contract Data Requirements List.pdf

Data Item No. Title of Data Item Contract Reference Frequency First Submission Subsequent Submissions File Format Distribution Source of Delivery

A001 Monthly Authorization Report C.9. Monthly 15th Calendar day of 2nd month of Health

Care Delivery (HCD) 15th calendar day of each month Microsoft, Excel COR, CO Email

A002 Customer Service Satisfaction Report C.1.2.3., C.9 Semi-Annual 180 Days After Contract Award (ACA) December and June of each year Microsoft Word or Excel COR, CO Email

A003 Customer Service Support Report Section C.2.1 C.9 Monthly 15th Calendar day of 2nd month of HCD 15th calendar day of each month Microsoft Word or Excel COR, CO Email

A004 Customer Service Telephone Report Section C.2.1.1. C.9. Monthly 15th Calendar day of 2nd month of HCD 15th calendar day of each month Microsoft, Excel COR, CO Email

A005 Claims Processing Procedures Manual Section C.2.2.1 C.9. One Time 10 business days ACA As updates occur

No specific format for 1st submission, ongoing electronic copy for subsequent submissions COR

Best commercial practice 1st Submission, e-Commerce (web-portal) thereafter A006 Annual Contract Activity Report Section C.2.3.5, C.9 Annually 180 Days ACA January of each year Microsoft, Excel COR, CO Email

A007 Monthly Claims Activity Report C.2.2. C.9 Monthly 15th Calendar day of 2nd month of Health

Care Delivery (HCD) 15th calendar day of each month Microsoft, Excel COR, CO Email

A008 Appeals Assessment Report C.2.2.10 C.9 Quarterly 90 Days ACA

Last business day in the month of Oct., Jan., Apr., and Jul. Microsoft, Excel COR, CO Email

A009 Credential, Accreditation and/or Certification Report, C.2.3. C.2.3.1., C.2.3.2. C.9 Quarterly 90 Days ACA

Last business day in the month of Oct., Jan., Apr., and Jul. Microsoft, Excel COR, CO Email A010 Financial Transaction Records C.2.3.7. C.9 One Time 30 Days after Contract final PoP None No specific format COR, CO Best Commercial Practice

A011 HIPAA Privacy Complaint Report Section C.2.3.9. C.9 Quarterly 90 Days ACA

Last business day in the month of Oct., Jan., Apr., and Jul. Microsoft, Excel COR, CO Email

A012 Internal Quality Control/Quality Improvement Plan Section C.2.4.2. C.9. Quarterly 90 Days ACA

Last business day in the month of Oct., Jan., Apr., and Jul. Microsoft Word or Excel COR, CO Email A013 Transition - In (Phase -in) Plan Section C.3.1. C.9. One Time Contract award As Changes Occur Microsoft Word or Excel COR, CO Email

A014 Transition-in Status Report Section C.3.1., C.9 Weekly 7 business days ACA Tuesday of each week for duration of transition Microsoft Word or Excel COR, CO Email A015 Transition - Out (Phase -out) Plan Section C.3.2. C.9. One Time Contract Award As Changes Occur Microsoft Word or Excel COR, CO Email

A016 Invitee Cost-Sharing/Reimbursement Component Report C.4. C.9 Monthly 15th Calendar day of 2nd month of HCD

15th calendar day of each month Microsoft, Excel COR, CO Email

A017 Monthly Enrollment Report C.5, C.6, C.7, C.9 Monthly 15th Calendar day of 2nd month of HCD 15th calendar day of each month Microsoft, Excel COR, CO Email

A018 Air Ambulance Report C.5.4. C.9 As Required 2 business days following Air Ambulance

Services Same as first No specific file format COR, CO Email

A019 Drug Utilization Report C.6.4., C.9 Monthly 15th Calendar day of 2nd month of HCD 15th calendar day of each month

Electronic access to report with an annual aggregate electronic report (No specific file format) the 15th of Dec. COR, CO

Electronic access with an annual aggregate electronic copy emailed the 15th of Dec.

A020 Group Health Insurance Policy Component Report C.7. C.9 Monthly 15th Calendar day of 2nd month of HCD

15th calendar day of each month No specific file format COR, CO Email

Attachment J.10 - Contract Data Requirements List (CDRL)

CDRL