Reporting Templates & Vendor Documents | mydss.mo.gov

Reporting Templates

Monthly Reports	Grievance and Appeal Report: Member Issue Log (Open) Grievance and Appeal Report: Member Issue Log (Closed) Health Plan Hospital Services Reporting
Quarterly Reports	Private Duty Nursing Quarterly Report Instructions PDN Reporting Template CCBHC Claim Data Reporting Template CCBHC Claim Data Reporting Instructions Call Center Report Care Management Improvement Plan and Reporting Template Care Management Self Report - Pregnancy Care Management Report Complaint, Grievance, and Appeal Report: Provider Issues Log Critical Incident Log Disease Management Report Disease Management Report Summary Missouri Medicaid Encounter Data Health Plan Quarterly Report Fraud, Waste, and Abuse Activities Report: Case Log Overpayments Due to Fraud Reporting Template IMD Services Report - General Plan IMD Services Report - Specialty Plan MMAC MCO Referral Template Prior - Authorizations and Denial Log Third Party Savings Reports Timeliness of Claims Adjudication Report Provider Network Adequacy Standards NEMT Utilization Report AHB/Member Incentive Utilization Report Healthy Blue Home State Health Show Me Healthy Kids United Healthcare
Semi-Annual Reports	Health Plan Encounter Data Questionnaire
Annual Reports	FY2020 EPSDT Self Report Instructions Health Care Management Member Survey HEDIS Indicators by MO HealthNet Managed Care Health Plans Within Regions, Live Births located Parity Compliance Report Overpayments Due to Fraud Reporting Template Provider Preventable Conditions Subcontractor Oversight Annual Evaluation Report Trends in Missouri MO HealthNet Quality Indicators Healthcare Quality Data Reports - 2024 Healthcare Quality Data Instructions Healthcare Quality Data Template - Statewide Healthcare Quality Data Template - Regional Healthcare Quality Data Value Sets Quality Assessment and Improvement Evaluation Reports Quality Assessment and Improvement Evaluation Report Instructions Quality Assessment and Improvement Evaluation Report Attachment - 6 FQHC RHC CMHC LPHA Transaction Disclosure Health Plan Financial Reporting Form COA6 Expansion Instructions for MLR Report Template for MLR Report Ownership or Controlling Interest Disclosure CMS Adult and Child Core Set Reporting - 2024 Core Set Reporting Instructions Core Set Reporting Templates CMS Adult Core Set Resources CMS Child Core Set Resources SMI/SED Electronic Care Plan Access Report Provider Data Information Report (1115(a) SUD/SMI Demonstration Waiver)
Miscellaneous Deliverables	Federally Qualified Health Clinic and Rural Health Clinic M-1 Instructions and Form Inpatient Certifications File Specifications Ownership or Controlling Interest Disclosure Additional Health Benefit Submission Member Incentive Template Provider Incentive Program Tool Provider & Subcontractor Disclosure Transaction Disclosure Policies and Procedures Requiring Prior Approval Medicare Resource Report
Reporting Requirements	Reporting Requirements

Bidder & Vendor Documents

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