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REPORT MONITORING TOOL
2015 CCO Contractually Required Deliverables and Reports Last Update 7/21/15
**All deliverables and Reports are sent to OHA-CAU unless noted in this matrix**
CONTRACT FORMS PAGE LINK http://cco.health.oregon.gov/Pages/CCO-Contract-Forms.aspx
Contract
Deliverables/Reports Reference Due Date Special Instructions/Website
Exhibit
System of Care (SOC) Wraparound Policy & Part
Procedure B/M 1 1/30/2015
Grievance System Policy & Procedure B 3 1/31/2015
Third Party Liability Personal Injury Lien Policy & B 8 1/31/2015
Procedure
Fraud and Abuse P & P B 8 1/31/2015
B 8 1/31/2015
Affiliated Medicare Advantage Plan Report
Transformation Plan Second Progress Review(year K 1/31/2015
2013-2015)
CASII/ESCII Policy & Procedure B/M 2 2/1/2015
Technology Plan (year two) B 9 2/15/2015 http://www.oregon.gov/oha/analytics/CCOData/Year%20Two%20Technology%20Plan%20and%20Data%20Submission%20Guidance%20Documentation.pdf
Grievance and Appeal Quarterly Summary (Q4) I 2/15/2015
2014
I 2/15/2015
Grievance and Appeal Quarterly Log
B 4 2/27/2015 30 days following the end of each
PCPCH report (member assignment list) Q4, 2014 quarter.Report found at
https://www.surveymonkey.com/s/PCPCH
Report
Quality Strategy B 9 3/16/2015
K 3/16/2015
2015-2017 Transformation Plan Update(draft) Guidance will come out through the
Innovator Agents
B 8 3/31/2015
Data Period: Data from the prior calendar
year
Pharmacy Expense Reports
G 3/31/2015
Data period 7/1/2013 - 12/31/14
Hospital Network Adequacy Report
Fourth Quarter (2014) - Report L1 - General L 3/31/2015 Secure ASU FTP Site
Information and Certification
Fourth Quarter - Report L2 - Members Approaching L 3/31/2015 Secure ASU FTP Site
or Surpassing Stop-Loss Deductible
Fourth Quarter - Report L3 - Restricted Reserves L 3/31/2015 Secure ASU FTP Site
(include L3.1 and L3.2)
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REPORT MONITORING TOOL
Fourth Quarter - Report L7 - Quarterly Balance L 3/31/2015 Secure ASU FTP Site
Sheet of Corporate Activity
Fourth Quarter - Report L8 - Quarterly Statement of
Revenue, Expenses and Changes in Net Assets L 3/31/2015 Secure ASU FTP Site
Corporate Total and OHP Line of Business
Fourth Quarter - Report L8.1 - Adjusted and
Unadjusted Medical Loss Ratio, Net Worth L 3/31/2015 Secure ASU FTP Site
Requirements
Fourth Quarter - Report L9 - Cash Flow Analysis for L 3/31/2015 Secure ASU FTP Site
Corporate Activity/Indirect Method Corporate Total
Fourth Quarter - Report L10 - Corporate L 3/31/2015 Secure ASU FTP Site
Relationships of Contractors
Fourth Quarter - Report L12 - Financial Reporting L 3/31/2015 Secure ASU FTP Site
Related to Alternative Payment Arrangements
Fourth Quarter - Report L12.1 - Financial Reporting L 3/31/2015 Secure ASU FTP Site
Related to Flexible Services
Technology Plan Year Two Data B 9 4/1/2015 http://www.oregon.gov/oha/analytics/CCOData/Year%20Two%20Technology%20Plan%20and%20Data%20Submission%20Guidance%20Documentation.pdf
30 days following the end of each
PCPCH report (member assignment list) Q1, 2015 B 4 5/1/2015 quarter.Report found at
https://www.surveymonkey.com/s/PCPCH
Report
Grievance and Appeal Quarterly Summary (Q1), I 5/15/2015
2015
Grievance and Appeal Quarterly Log I 5/15/2015
First Quarter - Report L1 - General Information and L 5/31/2015 Secure ASU FTP Site
Certification
First Quarter - Report L2 - Members Approaching or L 5/31/2015 Secure ASU FTP Site
Surpassing Stop-Loss Deductible
First Quarter - Report L3 - Restricted Reserves L 5/31/2015 Secure ASU FTP Site
(include L3.1 and L3.2)
First Quarter - Report L7 - Quarterly Balance Sheet L 5/31/2015 Secure ASU FTP Site
of Corporate Activity
First Quarter - Report L8 - Quarterly Statement of
Revenue, Expenses and Changes in Net Assets L 5/31/2015 Secure ASU FTP Site
Corporate Total and OHP Line of Business
First Quarter - Report L8.1 - Adjusted and
Unadjusted Medical Loss Ratio, Net Worth L 5/31/2015 Secure ASU FTP Site
Requirements
First Quarter - Report L9 - Cash Flow Analysis for L 5/31/2015 Secure ASU FTP Site
Corporate Activity/Indirect Method Corporate Total
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REPORT MONITORING TOOL
First Quarter - Report L10 - Corporate Relationships L 5/31/2015 Submit Parts I, II and IV
of Contractors Secure ASU FTP Site
First Quarter - Report L12 - Financial Reporting L 5/31/2015 Secure ASU FTP Site
Related to Alternative Payment Arrangements
First Quarter - Report L12.1 - Financial Reporting L 5/31/2015 Secure ASU FTP Site
Related to Flexible Services
2015-2017 Transformation Plan Update (Final) K 6/10/2015
Community Health Improvement Plan (CHP) B 1 6/30/2015
APD MOU B 4 6/30/2015
Following the last day of each calendar
Audited Annual Financial Statements L 6/30/2015 year (prepared by independent accounting
firm)
Secure ASU FTP Site
Report L5 Audited Annual Balance Sheet of Following the last day of each calendar
Corporate Activity L 6/30/2015 year
Secure ASU FTP Site
Report L6 Audited Financial Annual Statement of Following the last day of each calendar
Revenues, Expenses and Changes in Net Asset L 6/30/2015 year
Secure ASU FTP Site
SNRG Data Reporting C 6/30/2015 Data period 2012/2013 and 2014
Delivery System Network (DSN) Provider Narrative G 7/1/2015
Report
Delivery System Network (DSN) Provider Capacity G 7/1/2015
Report
Cooperative Agreement with Publically Funded G 7/1/2015
Program Report
Cooperative Agreement with Community Social and G 7/1/2015
Support Service & LTC Report
System of Care (SOC) Wraparound Annual Report Utilize tools to measure the Fidelity of
(includes outcomes of Fidelity tools) enhanced Wraparound services
B/M 7/1/2015 http://depts.washington.edu/wrapeval/W
FI.html
Transformation Plan Benchmark Report(year 2013- K 7/31/2015
2015)
30 days following the end of each
PCPCH report (member assignment list) Q2, 2015 B 4 8/1/2015 quarter.Report found at
https://www.surveymonkey.com/s/PCPCH
Report
CMS PIP Disclosure Form H 8/15/2015
Grievance and Appeal Quarterly Summary (Q2), I 8/15/2015
2015
Grievance and Appeal Quarterly Log I 8/15/2015
Due with the filing of the second quarter
Report L11 Disclosure of Compensation L 8/31/2015 Financial Report
Secure ASU FTP Site
Report L2 Members Approaching or Surpassing Due with the filing of the second quarter
Stop-Loss Deductible (Part II) L 8/31/2015 Financial Report
Secure ASU FTP Site
Second Quarter - Report L1 - General Information L 8/31/2015 Secure ASU FTP Site
and Certification
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REPORT MONITORING TOOL
Second Quarter - Report L2 - Members Approaching L 8/31/2015 Secure ASU FTP Site
or Surpassing Stop-Loss Deductible
Second Quarter - Report L3 - Restricted Reserves L 8/31/2015 Secure ASU FTP Site
(include L3.1 and L3.2)
Second Quarter - Report L7 - Quarterly Balance L 8/31/2015 Secure ASU FTP Site
Sheet of Corporate Activity
Second Quarter - Report L8 - Quarterly Statement
of Revenue, Expenses and Changes in Net Assets L 8/31/2015 Secure ASU FTP Site
Corporate Total and OHP Line of Business
Second Quarter - Report L8.1 - Adjusted and
Unadjusted Medical Loss Ratio, Net Worth L 8/31/2015 Secure ASU FTP Site
Requirements
Secondter - Report L9 - Cash Flow Analysis for L 8/31/2015 Secure ASU FTP Site
Corporate Activity/Indirect Method Corporate Total
Second Quarter - Report L10 - Corporate L 8/31/2015 Secure ASU FTP Site
Relationships of Contractors
Second Quarter - Report L12 - Financial Reporting L 8/31/2015 Secure ASU FTP Site
Related to Alternative Payment Arrangements
Second Quarter - Report L12.1 - Financial Reporting L 8/31/2015 Secure ASU FTP Site
Related to Flexible Services
Other Non-MedicalPolicy and Procedure(Flex) B 10/1/2015
30 days following the end of each
PCPCH report (member assignment list) Q3, 2015 B 4 11/1/2015 quarter.Report found at
https://www.surveymonkey.com/s/PCPCH
Report
I 11/15/2015
Grievance and Appeal Quarterly Summary (Q3)2015
Grievance and Appeal Quarterly Log I 11/15/2015
Third Quarter - Report L1 - General Information and L 11/30/2015 Secure ASU FTP Site
Certification
Third Quarter - Report L2 - Members Approaching L 11/30/2015 Secure ASU FTP Site
or Surpassing Stop-Loss Deductible
Third Quarter - Report L3 - Restricted Reserves L 11/30/2015 Secure ASU FTP Site
(include L3.1 and L3.2)
Third Quarter - Report L7 - Quarterly Balance Sheet L 11/30/2015 Secure ASU FTP Site
of Corporate Activity
Third Quarter - Report L8 - Quarterly Statement of
Revenue, Expenses and Changes in Net Assets L 11/30/2015 Secure ASU FTP Site
Corporate Total and OHP Line of Business
Third Quarter - Report L8.1 - Adjusted and
Unadjusted Medical Loss Ratio, Net Worth L 11/30/2015 Secure ASU FTP Site
Requirements
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