MCM Provider Services & NEMT Report

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  • All rates in this report are at the Managed Care program level. 
  • Contract standards are noted when applicable. 
  • All measures default to the last 5 data points. 
  • Select the performance measure name for more information (e.g. charts, MCO rates, measure description)

Claims Processing Timeliness

  • The unit for professional and medical claims measures is percent. 
  • The unit for pharmacy claims measure is minutes.
  • Select the performance measure name for more information (e.g. charts, MCO rates, measure description).
Tables

Claims Processing Accuracy

  • Measure unit = Percent
  • Select the performance measure name for more information (e.g. charts, MCO rates, measure description).
Tables

Claims Processing Results

  • Measure unit = Percent.
  • Select the performance measure name for more information (e.g. charts, MCO rates, measure description).
Tables
Months Measures (Export)
Measure Name Apr 2025 May 2025 Jun 2025 Jul 2025 Aug 2025 Contract Requirement Year
Professional and Facility Medical Claim Processing Results: A. Paid 80.6 81.3 82.0 84.4 83.4
Professional and Facility Medical Claim Processing Results: B. Suspended 6.3 5.1 5.1 2.9 2.9
Professional and Facility Medical Claim Processing Results: C. Denied 13.1 13.6 12.9 12.7 13.7

Provider Communications

  • Unit measure = percent.
  • Select the performance measure name for more information (e.g. charts, MCO rates, measure description)
Tables
Months Measures (Export)
Measure Name Feb 2019 Mar 2019 Apr 2019 May 2019 Jun 2019 Apr 2025 May 2025 Jun 2025 Jul 2025 Aug 2025 Contract Requirement Year
Provider Communications: Reasons for Telephone Inquiries 100.0 99.9 99.8 99.9 100.1
Provider Communications: Voice Mails Returned by Next Business Day ‡ ‡ ‡ ‡ ‡
Provider Communications: Calls Abandoned 0.7 0.6 0.7 0.8 0.6 80.0 SFY 2025
Provider Communications: Speed to Answer within 30 Seconds 96.1 96.0 95.5 95.1 95.2 5.0 SFY 2025

‡ Data has been suppressed due to small sample size.

NEMT Utilization

  • The unit for NEMT measures is percent of different submeasures.  The detail for submeasures can be found by selecting the performance measure name.  
  • Select this link for more information on requests delivered by Mode of Transportation.
  • An additional measure for the delivery of scheduled trips on time can be found at this link.
Tables
Quarters Measures (Export)
Measure Name Jun 2018 Sep 2018 Dec 2018 Mar 2019 Jun 2019 Dec 2020 Mar 2021 Jun 2021 Sep 2021 Dec 2021 Sep 2023 Dec 2023 Mar 2024 Jun 2024 Sep 2024 Dec 2024 Mar 2025 Jun 2025 Contract Requirement Year
NEMT Legs Delivered by Covered Medical Service Provider Type 100.0 100.1 100.2 99.9 100.0
NEMT Request Authorization Approvals by Mode of Transportation 99.6 98.7 99.1 99.0 99.9
NEMT Requests Delivered by Mode of Transportation 100.0 100.0 100.0 100.0 100.1
Non-Emergent Medical Transportation Contracted Transportation & Wheelchair Van Provider Scheduled Trip Member Cancellations by Reason for Member Cancellation for Contracted Providers 100.1 100.0 100.0 100.0 100.0
Results of Scheduled NEMT Legs by Outcome 99.9 100.0 100.1 100.0 100.0

Provider Network

  • Unit = Per 1,000 member months.
  • Select the performance measure name for more information (e.g. charts, MCO rates, measure description)
Tables
Quarters Measures (Export)
Measure Name Jun 2024 Sep 2024 Dec 2024 Mar 2025 Jun 2025 Contract Requirement Year
Requests for Assistance Accessing MCO Designated Primary Care Providers by County 0.6 0.7 0.7 0.8 0.8
Requests for Assistance Accessing non-MCO Designated Physician/APRN Specialists by County 1.6 1.8 1.6 1.6 1.2

Report generated on Oct 21 2025 at 18:13