Care Management Program
Jump to topic
Care Coordination | Care Management | Grievances and Appeals | Health Services Management - Standard Medicaid | HEDIS Acute and Chronic Care Measures | HEDIS Behavioral Health Care Measures | HEDIS Preventive Care Measures | Member Experience of Care - Children | Member Services | Network Adequacy | Non-Emergent Medical Transportation (NEMT) | Provider ServicesBack to top
Care Coordination
Back to top
Care Management
Back to top
Grievances and Appeals
Back to top
Health Services Management - Standard Medicaid
- Medical Service, Equipment and Supply Post-Delivery Service Authorization Timely Determination Rate
- Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: New Routine Requests
- Medical Service, Equipment and Supply Service Authorization Timely Determination Rate: Urgent Requests
Back to top
HEDIS Acute and Chronic Care Measures
Back to top
HEDIS Behavioral Health Care Measures
Back to top
HEDIS Preventive Care Measures
Back to top
Member Experience of Care - Children
Back to top
Member Services
- Family and Friends Program NEMT Legs
- Member Communications: Calls Abandoned
- Member Communications: Calls Returned by the Next Business Day
- Member Communications: Reasons for Telephone Inquiries
- Member Communications: Speed to Answer Within 30 Seconds
- NEMT Legs Delivered
- NEMT Legs Delivered by Covered Medical Service Provider Type
- NEMT Request Authorization Approvals by Mode of Transportation
- Requests for Assistance Accessing MCO Designated Primary Care Providers by County
- Requests for Assistance Accessing non-MCO Designated Physician/APRN Specialists by County
- Results of Scheduled NEMT Legs by Outcome
- Scheduled NEMT Trips with Issues Impacting Delivery
- Timeliness of Scheduled and Delivered NEMT Legs
- Timeliness of Scheduled NEMT Legs from Nursing Facilities
- Timely Processing of Electronic NEMT Claims: Thirty Days of Receipt
Back to top
Network Adequacy
Back to top
Non-Emergent Medical Transportation (NEMT)
Back to top
Provider Services
- Average Pharmacy Claim Processing Time
- Claims Quality Assurance: Claims Financial Accuracy
- Claims Quality Assurance: Claims Payment Accuracy
- Claims Quality Assurance: Claims Processing Accuracy
- Interest Paid on Late Paid Claims
- NEMT Claims Quality Assurance: Claims Processing Accuracy
- NEMT Timely Claims Processing
- Professional and Facility Medical Claim Processing Results
- Provider Communications: Calls Abandoned
- Provider Communications: Calls Returned by Next Business Day
- Provider Communications: Reasons for Telephone Inquiries
- Provider Communications: Speed to Answer within 30 Seconds
- Timely Processing of All Clean Provider Claims: Ninety Days of Receipt
- Timely Processing of All Clean Provider Claims: Thirty Days of Receipt
- Timely Processing of Clean Electronic Provider Claims: Fifteen Days of Receipt
- Timely Processing of Clean Non-Electronic Provider Claims: Thirty Days of Receipt
- Timely Processing of Facility-to-Facility Transportation Claims: Thirty Days of Receipt