Source: http://www.docstoc.com/docs/125018993/EW-LC-3Q2002-Charts
Timestamp: 2013-12-13 20:18:56
Document Index: 419662653

Matched Legal Cases: ['art\n8', 'art1', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 2', 'art 4', 'art 4', 'art 4', 'art 4', 'art 5', 'art 5', 'art 6', 'art 6', 'art 6', 'art 7', 'art 7', 'art 8', 'art 8', 'arts\n2001']

EW LC 3Q2002 Charts
Access to   Quality &amp;     BH-MCO      Info. to   Children Substance          SPMI
Sheet                              Title                           Services    Appropr. of   Functions   Stake-                Abuse
Services                  holders
1      Percentage of MA Eligables Enrolled by County
2aLC    Number of Members Authorized for Outpatient Mental
Health Services in the ten Counties, Rates Per 1000            X
2bLC    Number of Members Authorized for Mental Health
Inpatient Care Services in the ten Counties, Rates Per         X
2cLC    Number of Members Authorized for MH Partial
Hospitalization Services in the ten Counties, Rates Per        X
2dLC    Number of Members Authorized for D&amp;A Outpatient
Services in the ten Counties, Rates Per 1000                   X                                                             X
2eLC    Number of Members Authorized for D&amp;A Residential or
Hospital Based Detox Services in the ten Counties,             X                                                             X
2fLC    Number of Children and Adolescents (1-17) Authorized
for Behavioral Health Rehab Services in the ten                X                                                X
Counties, Rates Per 1000
2gLC    Number of Children and Adolescents (1-17) Authorized
for MH Outpatient Services in the ten Counties, Rates          X                                                X
2hLC    Number of Members with SPMI Authorized for Intensive
Case Management or Resource Coordination Services in           X                                                                        X
the ten Counties, Rates Per 1000
3aLC    Number of Person Denials, Number of Denial Events,
Disposition of Denial, Reason for Denial, Number of
Grievances and Grievances per Denial in the ten LC             X                                                X            X          X
X                                                X            X          X
Denial Notice and Case Audit Results
4aLC    Complaints by County
X             X            X
4bLC    Member Complaints Summary
4cLC    Member Complaints Graph                                        X             X            X
4dLC    Provider Complaints per 1000 members by County
Graph                                                          X             X
5aLC    Percentage of Involuntary Adult Inpatient Psychiatric
Admissions per 1000                                                          X                                                          X
5bLC    Adult Involuntary Admission to Psychiatric Inpatient
Services                                                                     X                                                          X
6aLC    Children Inpatient Psychiatric Readmissions at 30 days
6bLC    Adult Inpatient Psychiatric Readmissions at 30 days
6cLC    Readmissions to Inpatient Psychiatric Hospital within 30
days of discharge for children (0-17) and Adults                             X                                  X
7aLC    Racial Minorities Authorization for Services
7bLC    Minority Authorizations Chart
8aLC    Percent of Clean Claims Paid in 30 Days Graph
8bLC    Percent of Clean Claims Paid in 30 Days Chart
Chart1LC
HealthChoices Behavioral Health
YO         3%
PE         14%                         BK
10%                                                      DA
4%   LA
LE                                     12%        NH
LB                LA
5%               17%
LC PA HealthChoices Behavioral Health           Third    Quarter    2002
YEAR    QUARTER                                         Lehigh/Capital
2002        3        AD       BK      CU       DA         LA       LB       LE       NH      PE       YO        Sum
Population        5,983   34,714   8,941   23,353     34,705   10,134   30,954   19,029   3,476   27,556     198,845
Lehigh/Capital                                          Sum
AD       BK      CU       DA         LA       LB       LE       NH      PE       YO
2001         4       2,553   10,409   2,486   15,392     17,647      757   13,741    4,925   1,379   13,638     82,927
2002         1       3,930   14,915   3,736   17,812     23,158    2,768   18,769    8,630   1,911   17,580    113,209
2002         2       5,566   32,854   8,425   24,187     32,796    9,459   29,119   18,066   3,339   25,798    189,609
2002         3       5,983   34,714   8,941   23,353     34,705   10,134   30,954   19,029   3,476   27,556    198,845
Children (0 - 20y/o)
2001         4       1,549    6,160   1,428    9,425     10,945      367    8,416    2,493     770    7,984     49,537
2002         1       2,480    8,857   2,096   10,804     13,812    1,396   11,198    4,671   1,080   10,400     66,794
2002         2       3,552   19,884   4,909   14,626     19,748    5,636   17,356   10,285   1,914   15,446    113,356
2002         3       3,822   21,051   5,257   13,929     20,896    6,093   18,485   10,872   2,026   16,558    118,989
Author for graphing
LC PA Utilizations Per 1000 members         First            Quarter     2002
Inpatient Psych. (non-SMH)
Quarter-Year          AD            BK      CU        DA       LA        LB    LE     NH     PE     YO     MBH    CCBH   CBHNP Total Mean
4 - 2001             3.1           1.7     3.2       2.8      3.6       5.3   1.5    2.4    0.0    3.7    1.8     2.9    3.1       2.7
1 - 2002             1.8           2.4     3.5       4.2      6.0       2.9   4.3    4.2    5.2    4.3    4.3     3.2    4.9       4.2
4 - 2001             0.8           0.6     0.0       0.6      0.4       0.0   0.7    0.8    0.0    0.4    0.7     0.5    0.4       0.5
1 - 2002             0.3           0.4     0.8       0.7      0.9       0.0   0.5    1.5    0.5    0.9    0.8     0.6    0.7       0.7
Psychiatric Partial Hosp.
4 - 2001             3.5           3.3     0.8       5.5      2.2       1.3   9.4    15.6   2.2    4.5    11.0    3.9    3.4       5.3
1 - 2002             4.6           4.6     2.9       8.2      3.9       2.9   18.2   20.6   2.6    5.5    18.9    5.0    5.3       8.5
Psych. Outpatient
4 - 2001             43.1      43.5        14.5      32.7     35.9   22.5     42.0   32.1   9.4    59.0   39.4   51.4    31.9      39.8
1 - 2002             54.7      59.0        26.8      51.8     56.1   45.9     70.2   56.0   20.4   77.5   65.7   67.5    50.4      59.6
BH Rehab Svcs for Children (MH &amp; D/A)
4 - 2001             32.9      11.9        28.0      34.3     15.3   62.7     7.2    15.2   10.4   33.4   9.1    24.9    24.5      21.2
1 - 2002             35.1      24.0        32.9      39.0     22.7   53.0     13.3   24.4   21.3   36.7   16.6   31.4    30.8      27.6
Outpt D/A
4 - 2001             3.9           8.4     2.8       3.3      7.3       6.6   4.2    3.5    0.7    1.5    4.0     4.4    5.1       4.6
1 - 2002             3.8           9.5     3.7       3.8      8.3       1.8   5.4    3.7    3.1    2.3    4.9     5.4    5.8       5.4
Targeted MH Case MGMT (ICM&amp;RC)
4 - 2001             4.7           0.8     6.4       32.4     7.5    9.2      2.8    6.3    2.9    9.0    3.7     5.4    17.5      10.5
1 - 2002             5.1           1.3     15.3      37.7     11.4   18.8     6.1    12.6   11.0   11.9   8.2     6.8    21.6      13.6
Children&#39;s MH Outpatient
4 - 2001             29.7      27.3        9.8       29.8     30.3   13.6     16.8   14.8   7.8    42.3   16.3   35.2    27.8      27.6
1 - 2002             37.9      41.4        27.7      41.9     45.0   39.4     33.0   38.1   23.1   56.5   34.5   48.3    41.5      42.1
Utilization Data 2 2001
LC PA Sum of Utilizations                2001       2
Service Category           AD        BK       CU       DA       LA       LB       LE       NH       PE       YO       MBH       CCBH       CBHNP         Total Util
Inpatient Psych. (non-SMH)                      0        0        0        0        0        0        0        0        0        0         0          0           0         0
Inpatient D/A Detox                             0        0        0        0        0        0        0        0        0        0         0          0           0         0
Psychiatric Partial Hosp.                       0        0        0        0        0        0        0        0        0        0         0          0           0         0
Inpt. D/A Rehab.                                0        0        0        0        0        0        0        0        0        0         0          0           0         0
Res. Detox Rehab Half-way (non Hosp)            0        0        0        0        0        0        0        0        0        0         0          0           0         0
Psych. Outpatient                               0        0        0        0        0        0        0        0        0        0         0          0           0         0
BH Rehab Svcs for Children (MH &amp; D/A)           0        0        0        0        0        0        0        0        0        0         0          0           0         0
RTF Svcs for JCAHO                              0        0        0        0        0        0        0        0        0        0         0          0           0         0
RTF Svcs for Non-JCAHO                          0        0        0        0        0        0        0        0        0        0         0          0           0         0
Outpt D/A                                       0        0        0        0        0        0        0        0        0        0         0          0           0         0
Methadone/LAAM                                  0        0        0        0        0        0        0        0        0        0         0          0           0         0
Lab Studies by BH Doctors                       0        0        0        0        0        0        0        0        0        0         0          0           0         0
Clozapine &amp; Clozapine Support Svcs.             0        0        0        0        0        0        0        0        0        0         0          0           0         0
Crisis Intervention                             0        0        0        0        0        0        0        0        0        0         0          0           0         0
Family-Based MH Svcs                            0        0        0        0        0        0        0        0        0        0         0          0           0         0
Targeted MH Case MGMT (ICM&amp;RC)                  0        0        0        0        0        0        0        0        0        0         0          0           0         0
BH Rehab Svcs for Children (MR                  0        0        0        0        0        0        0        0        0        0         0          0           0         0
Psych. Rehab - Adult                            0        0        0        0        0        0        0        0        0        0         0          0           0         0
Other                                           0        0        0        0        0        0        0        0        0        0         0          0           0         0
TOTAL Unduplicated Clients                      0        0        0        0        0        0        0        0        0        0         0          0           0         0
Children&#39;s Outpatient                           0        0        0        0        0        0        0        0        0        0         0          0           0         0
LC PA Serviced Population                2001       2
Total Eligibles                           AD        BK       CU       DA       LA       LB       LE       NH       PE       YO       MBH       CCBH       CBHNP           Sum
All members                                                                                                                                0          0           0         0
Eligible Children 0-20                                                                                                                     0          0           0         0
Non-Hospital Detox (Proc. Code: W0126)          0        0        0        0        0        0        0        0        0        0     -         -           -                    -
Utilization Data 3 2001
LC PA Sum of Utilizations                2001       3
BH Rehab Svcs for Children (MR)                 0        0        0        0        0        0        0        0        0        0         0          0           0         0
LC PA Serviced Population                2001       3
Utilization Data 4 2001
LC PA Sum of Utilizations                2001        4
Service Category           AD         BK        CU        DA        LA        LB        LE        NH        PE        YO        MBH        CCBH       CBHNP       Total Util
Inpatient Psych. (non-SMH)                      8         18        8         43        63        4         21        12        0         50         33      76         118         227
Inpatient D/A Detox                             1         0         0         5         1         0         1         0         0         2          1           3         6         10
Psychiatric Partial Hosp.                       9         34        2         85        38        1     129           77        3         61     206        104         129         439
Inpt. D/A Rehab.                                1         0         0         1         1         0         0         0         0         0          0           1         2         3
Res. Detox Rehab Half-way (non Hosp)            3         11        4         13        14        0         15        8         0         10         23      24          31          78
Psych. Outpatient                              110       453        36    503       633           17    577       158           13    804        735        1367       1202        3304
BH Rehab Svcs for Children (MH &amp; D/A)           51        73        40    323       168           23        61        38        8     267            99     391         562        1052
RTF Svcs for JCAHO                              0         0         0         7         9         0         13        5         1         7          18          7       17          42
RTF Svcs for Non-JCAHO                          0         0         0         0         0         0         0         0         0         0          0           0         0         0
Outpt D/A                                       10        87        7         51    128           5         58        17        1         21         75     118         192         385
Methadone/LAAM                                  0         0         0         0         0         0         0         0         0         0          0           0         0         0
Lab Studies by BH Doctors                       0         0         0         1         1         0         0         0         0         0          0           0         2         2
Clozapine &amp; Clozapine Support Svcs.             0         3         0         4         15        0         1         0         0         6          1           9       19          29
Crisis Intervention                             0         0         3     118           92        1         7         11        0         4          18          4      214         236
Family-Based MH Svcs                            2         0         0         13        11        1         6         3         2         5          9           7       27          43
Targeted MH Case MGMT (ICM&amp;RC)                  12        8         16    498       133           7         38        31        4     123            69     143         658         870
BH Rehab Svcs for Children (MR)                 0         0         0         1         0         0         1         0         0         2          1           2         1         4
Psych. Rehab - Adult                            0         0         0         0         0         0         0         0         0         0          0           0         0         0
Other                                           3         2         4         10        11        0     519       171           0         5      690         10          25         725
TOTAL Unduplicated Clients                     176       632    102       1156      1030          52    1060      403           27    1117      1463        1925       2367        5755
Children&#39;s Outpatient                           46       168        14    281       332           5     141           37        6     338        178        552         638        1368
LC PA Serviced Population                2001        4
Total Eligibles                           AD         BK        CU        DA        LA        LB        LE        NH        PE        YO        MBH        CCBH       CBHNP         Sum
All members                                2553      10409      2486     15392     17647      757      13741      4925      1379     13638     18,666     26,600      37,661      82,927
Eligible Children 0-20                     1549       6160      1428      9425     10945      367       8416      2493      770       7984     10,909     15,693      22,935      49,537
Non-Hospital Detox (Proc. Code: W0126)        1          6         0         4         6        0          8         4        0          4        12         11          10                   33
Utilization Data 1 2002
LC PA Sum of Utilizations                2002        1
Inpatient Psych. (non-SMH)                      7         36        13        74    139           8         81        36        10        75     117        118         244         479
Inpatient D/A Detox                             0         2         2         3         3         0         3         1         0         7          4           9         8         21
Psychiatric Partial Hosp.                       18        69        11    146           91        8     341       178           5         96     519        183         261         963
Inpt. D/A Rehab.                                1         2         0         0         1         0         1         0         0         1          1           4         1         6
Res. Detox Rehab Half-way (non Hosp)            4         15        1         34        33        2         20        23        1         22         43      41          71         155
Psych. Outpatient                              215       880    100       923       1299      127       1317      483           39    1362      1800        2457       2488        6745
BH Rehab Svcs for Children (MH &amp; D/A)           87       213        69    421       313           74    149       114           23    382        263        682         900        1845
RTF Svcs for JCAHO                              7         3         2         12        31        4         46        24        2         16         70      26          51         147
Outpt D/A                                       15       141        14        67    192           5     101           32        6         41     133        197         284         614
Lab Studies by BH Doctors                       0         0         0         3         2         0         1         0         0         0          1           0         5         6
Clozapine &amp; Clozapine Support Svcs.             0         6         0         5         48        0         2         0         0         7          2       13          53          68
Crisis Intervention                             9         15        2     142       167           0         19        31        2         11         50      35         313         398
Family-Based MH Svcs                            7         6         0         24        22        9         20        13        3         16         33      29          58         120
Targeted MH Case MGMT (ICM&amp;RC)                  20        19        57    672       263           52    115       109           21    209        224        248        1065        1537
BH Rehab Svcs for Children (MR)                 0         0         0         1         1         1         1         0         0         0          1           0         3         4
Other                                           4         5         0         10        27        0     1088      406           0         5     1494         14          37        1545
TOTAL Unduplicated Clients                     312    1207      223       1693      1952      230       2242      1015          85    1821      3257        3340       4183        10780
Children&#39;s Outpatient                           94       367        58    453       621           55    370       178           25    588        548        1049       1212        2809
LC PA Serviced Population                2002        1
All members                                3930      14915      3736     17812     23158      2768     18769      8630      1911     17580     27,399     36,425      49,385      113,209
Eligible Children 0-20                     2480       8857      2096     10804     13812      1396     11198      4671      1080     10400     15,869     21,737      29,188      66,794
Non-Hospital Detox (Proc. Code: W0126)        1          4         1        10        17         0         6        12         1         9        18         14          29                   61
Chart 2aLC
LC PA HealthChoices Behavioral Health
Outpatient Mental Health Utilizations
Utilizations per 1000 members
CU                                                      2 - 2001
LA                                      3 - 2001
LB                             4 - 2001
County                          NH               1 - 2002
PE                            Quarter
Chart 2bLC
Inpatient Utilizations
LA                                       3 - 2001
LE                       4 - 2001
County                                                    Quarter
NH               1 - 2002
Chart 2cLC
Partial Hospital Utilizations
County               LB
LE                        4 - 2001
NH                1 - 2002              Quarter
Chart 2dLC
Outpatient Drug and Alcohol Utilizations
CU                                                         2 - 2001
LA                                            3 - 2001
LB                               4 - 2001
County                     LE
NH                 1 - 2002
Chart 2eLC
Detox Utilizations
LA                                        3 - 2001
County                 LB
NH                1 - 2002       Quarter
Chart 2fLC
BH Rehab Utilizations for Children (MH &amp; D/A)
County                     LE                        4 - 2001
NH               1 - 2002          Quarter
Chart 2gLC
Children&#39;s MH Outpatient Utilizations
County                     NH
Chart 2hLC
Targeted MH Case Management (ICM &amp; RC) Utilizations
NH                1 - 2002          Quarter
Denials and Grievances
Number of Persons Denied                                                                         LC
Quarter Year                         AD         BK          CU          DA         LA        LB
4 - 2001                          0          0           0           0         0         0
1 - 2002                          0          0           0           0         0         0
2 - 2002                          6          6           14          32        18        16
3 - 2002                         22          35          30          82        55        25
Number of Services Denied                                LC                     Total                                LC
Disposition                        MBH        CCBH        CBHNP
Inpt. Psy
Different amount or duration approved                                                                          Psych Partia
56.82%      58.76%      31.54%      44.49%
Different service approved
40.91%      7.91%       7.53%       13.05%
Psych. Out
Reason for Denial                      MBH        CCBH        CBHNP                                  BH Child Reh
Not Medically Necessary                                                                                 MR BH Child
97.73%      84.75%      84.59%      86.76%
Member not eligible, service not covered
under the plan, recipient not covered for the
RTF Sv
0.00%       1.13%       0.72%       0.74%
2.27%       14.12%      14.70%      12.50%
Crisis Inter
Number of Services Denied by Disposition
Outpt D
2          59         170         231
Inpt.Detox
50         104          88         242
36          14          21          71
Inpt. D/A R
Number of Services Denied by Reason for Denial
86         150         236         472
0           2           2           4
2          25          41          68                        TOTA
Qrt.                                                                                    LC
Year                             AD          BK          CU          DA          LA           LB
4     Grievances                0           1           0           0           3            0
2001    Grievances per Denial   0.00%       0.00%       0.00%       0.00%       0.00%        0.00%
1     Grievances                0           4           0           4           3            0
2002    Grievances per Denial   0.00%       0.00%       0.00%       0.00%       0.00%        0.00%
2     Grievances                2           2           3           2           5            0
2002    Grievances per Denial   33.33%      33.33%      21.43%      6.25%       27.78%       0.00%
3     Grievances                4           12          2           4           3            1
2002    Grievances per Denial   18.18%      34.29%      6.67%       4.88%       5.45%        4.00%
Quarter Year                     LC                     Total
4 - 2001          MBH         CCBH        CBHNP
Number of Denials                   0           0           0           0
Grievances                          1           1           3           5
Grievances per Denial             0.00%       0.00%       0.00%       0.00%
1 - 2002          MBH         CCBH        CBHNP
Grievances                          6           4           7           17
2 - 2002          MBH         CCBH        CBHNP
Number of Denials                   32          23          84         139
Grievances                          18          9           11          38
Grievances per Denial             56.25%      39.13%      13.10%      27.34%
3 - 2002          MBH         CCBH        CBHNP
Number of Denials                   61         101         200         362
Grievances                16       27      10       53
Grievances per Denial   26.23%   26.73%   5.00%   14.64%
LC                                           Total
LE        NH       PE    YO
0         0        0      0          0
11        21       4      11        139
35        26       8      44        362
LC                        Number of Denial Events
Q4 - 01    Q1 - 02   Q2 - 02   Q3 - 02
Inpt. Psych.
0          0         15        21
Psych Partial Hosp.
0          0         6         5
Psych. Outpatient            0          0         4         18
BH Child Rehab Svcs            0          0         96       290
MR BH Child Rehab
RTF Svcs
0          0         9         24
Crisis Intervention          0          0         0         0
Family-Based MH Svcs
0          0         0         1
0          0         0         2
Inpt.Detox - Hosp.
Res. Detox
0          0         2         1
Inpt. D/A Rehab.
MH Case mgmt
Clozapine                0          0         0         0
TOTAL                    0          0          132       366
LC                                            Total
LE       NH        PE        YO
1           0     0          0          5
0.00%     0.00%    0.00%     0.00%       0.00%
5           1     0          0          17
11           7     1          5          38
100.00%   33.33%   25.00%    45.45%     27.34%
3        13       0         11          53
8.57%     50.00%   0.00%     25.00%     14.64%
ServGrp   4 - 2001   1 - 2002   2 - 2002   3 - 2002
01         0          0          15        21
02         0          0          0          2
03         0          0          6          5
04         0          0          0          0
05         0          0          2          1
06         0          0          4         18
07         0          0          96        290
08         0          0          7         22
09         0          0          2          2
10         0          0          0          2
13         0          0          0          0
14         0          0          0          0
15         0          0          0          1
16         0          0          0          2
17         0          0          0          0
Denials Review Summary - Section Averages
Part A represents the percentage of total positive responses for required elements of the Denial Notice for all reviewed denials divided by
the total cases reveiwed for the quarter. Part B represents the percentage of total positive responses related to case documentation for
the denials divided by the total reviewed cases. Low numbers of cases may influence results.
0.6                                                                                                                                          PART A 3Q
PART B 3Q
Adams                York             Cumberland           Lancaster             Perry              Lehigh            MBH - ALL
Chart 4aLC
LC PA HealthChoices Member Complaints
Member Complaints        Qrt.       Qrt.   Qrt.   Qrt.                   Member Complaints            Qrt.   Qrt.   Qrt.   Qrt.                      Provider Complaints per      Qrt.   Qrt.   Qrt.   Qrt.
4      1      2      3                                                   4      1      2      3                           1000 members               4      1      2      3
County         Complaint Categories    2001   2002   2002   2002          County        Complaint Categories    2001   2002   2002   2002          County        Complaint Categories       2001   2002   2002   2002
Adams        Provider Services - Access     1     0       0      1    Lebanon         Provider Services - Access     0      0      1      0    01     Adams       Provider Services - Access   0.39   0.00   0.00   0.17
Provider Customer Service      0     0       1      0                    Provider Customer Service      0      0      1      2    02      2553       Provider Customer Service    0.00   0.00   0.18   0.00
Provider Telephone Access      0     0       0      0                    Provider Telephone Access      0      0      0      0    03      3930       Provider Telephone Access    0.00   0.00   0.00   0.00
Provider Cultural              0     0       0      0                    Provider Cultural              0      0      0      0    04      5566       Provider Cultural            0.00   0.00   0.00   0.00
Provider Special Needs         0     0       0      0                    Provider Special Needs         0      0      1      0    05      5983       Provider Special Needs       0.00   0.00   0.00   0.00
Provider Quality of Care       0     0       1      1                    Provider Quality of Care       0      0      2      5    06                 Provider Quality of Care     0.00   0.00   0.18   0.17
BH-MCO Member Services         1     0       1      3                    BH-MCO Member Services         0      0      0      0    07      Berks      Provider Services - Access   0.10   0.27   0.06   0.03
BH-MCO Telephone Access        0     0       0      0                    BH-MCO Telephone Access        0      0      0      0    08      10409      Provider Customer Service    0.10   0.13   0.06   0.09
BH-MCO Cultural                0     0       0      0                    BH-MCO Cultural                0      0      0      0    09      14915      Provider Telephone Access    0.00   0.00   0.00   0.00
Transportation                 0     0       0      0                    Transportation                 0      0      0      0    10      32854      Provider Cultural            0.00   0.00   0.00   0.00
Physical Health                0     0       0      0                    Physical Health                0      0      0      0    11      34714      Provider Special Needs       0.00   0.00   0.00   0.00
Berks        Provider Services - Access     1      4      2      1    Lehigh          Provider Services - Access    1       1      5      7    01                 Provider Quality of Care     0.00   0.07   0.15   0.14
Provider Customer Service      1      2      2      3                    Provider Customer Service     1       6      4     21    02   Cumberland    Provider Services - Access   0.40   0.00   0.24   0.22
Provider Telephone Access      0      0      0      0                    Provider Telephone Access     0       1      1      0    03      2486       Provider Customer Service    0.00   0.27   0.00   0.34
Provider Cultural              0      0      0      0                    Provider Cultural             0       0      0      0    04      3736       Provider Telephone Access    0.00   0.00   0.12   0.00
Provider Special Needs         0      0      0      0                    Provider Special Needs        0       0      0      1    05      8425       Provider Cultural            0.00   0.00   0.00   0.00
Provider Quality of Care       0      1      5      5                    Provider Quality of Care      1      13     20     14    06      8941       Provider Special Needs       0.00   0.00   0.00   0.00
BH-MCO Member Services         1      0      3      1                    BH-MCO Member Services        1       3      5      0    07                 Provider Quality of Care     0.00   0.00   0.00   0.45
BH-MCO Telephone Access        0      0      0      0                    BH-MCO Telephone Access       0       0      0      2    08     Dauphin     Provider Services - Access   0.06   0.11   0.04   0.13
BH-MCO Cultural                0      0      0      0                    BH-MCO Cultural               0       0      0      0    09      15392      Provider Customer Service    0.06   0.28   0.29   0.09
Transportation                 0      0      0      0                    Transportation                0       1      1      0    10      17812      Provider Telephone Access    0.00   0.00   0.04   0.04
Physical Health                0      0      0      0                    Physical Health               0       0      1      0    11      24187      Provider Cultural            0.00   0.00   0.00   0.00
Cumberland   Provider Services - Access     1      0      2      2    Northampton     Provider Services - Access    0       0      4      3    01      23353      Provider Special Needs       0.00   0.00   0.00   0.00
Provider Customer Service      0      1      0      3                    Provider Customer Service     0       1      8     10    02                 Provider Quality of Care     0.00   0.11   0.12   0.21
Provider Telephone Access      0      0      1      0                    Provider Telephone Access     0       0      3      3    03    Lancaster    Provider Services - Access   0.06   0.09   0.24   0.03
Provider Cultural              0      0      0      0                    Provider Cultural             0       0      0      0    04      17647      Provider Customer Service    0.06   0.09   0.24   0.09
Provider Special Needs         0      0      0      0                    Provider Special Needs        0       0      0      1    05      23158      Provider Telephone Access    0.00   0.00   0.00   0.00
Provider Quality of Care       0      0      0      4                    Provider Quality of Care      0       2     19     16    06      32796      Provider Cultural            0.00   0.00   0.00   0.00
BH-MCO Member Services         0      1      0      0                    BH-MCO Member Services        0       0      3      1    07      34705      Provider Special Needs       0.00   0.00   0.00   0.00
BH-MCO Telephone Access        0      0      0      0                    BH-MCO Telephone Access       0       0      0      0    08                 Provider Quality of Care     0.06   0.17   0.06   0.06
BH-MCO Cultural                0      0      0      0                    BH-MCO Cultural               0       0      0      0    09    Lebanon      Provider Services - Access   0.00   0.00   0.11   0.00
Transportation                 0      0      0      0                    Transportation                0       0      0      0    10      757        Provider Customer Service    0.00   0.00   0.11   0.20
Physical Health                0      0      0      0                    Physical Health               0       0      0      1    11      2768       Provider Telephone Access    0.00   0.00   0.00   0.00
Dauphin      Provider Services - Access     1      2      1      3    Perry           Provider Services - Access     0      0      0      0    01      9459       Provider Cultural            0.00   0.00   0.00   0.00
Provider Customer Service      1      5      7      2                    Provider Customer Service      0      0      0      0    02     10134       Provider Special Needs       0.00   0.00   0.11   0.00
Provider Telephone Access      0      0      1      1                    Provider Telephone Access      0      0      0      0    03                 Provider Quality of Care     0.00   0.00   0.21   0.49
Provider Cultural              0      0      0      0                    Provider Cultural              0      0      0      0    04     Lehigh      Provider Services - Access   0.07   0.05   0.17   0.23
Provider Special Needs         0      0      0      0                    Provider Special Needs         0      0      0      0    05     13741       Provider Customer Service    0.07   0.32   0.14   0.68
Provider Quality of Care       0      2      3      5                    Provider Quality of Care       0      0      1      0    06     18769       Provider Telephone Access    0.00   0.05   0.03   0.00
BH-MCO Member Services         4      0      0      0                    BH-MCO Member Services         0      0      0      0    07     29119       Provider Cultural            0.00   0.00   0.00   0.00
BH-MCO Telephone Access        0      1      0      0                    BH-MCO Telephone Access        0      0      0      0    08     30954       Provider Special Needs       0.00   0.00   0.00   0.03
BH-MCO Cultural                0      0      0      0                    BH-MCO Cultural                0      0      0      0    09                 Provider Quality of Care     0.07   0.69   0.69   0.45
Transportation                 0      0      0      0                    Transportation                 0      0      0      0    10   Northampton   Provider Services - Access   0.00   0.00   0.22   0.16
Physical Health                0      0      0      0                    Physical Health                0      0      0      0    11       4925      Provider Customer Service    0.00   0.12   0.44   0.53
Lancaster    Provider Services - Access     1      2      8      1    York            Provider Services - Access     1      0      0      0    01       8630      Provider Telephone Access    0.00   0.00   0.17   0.16
Provider Customer Service      1      2      8      3                    Provider Customer Service      0      6      0      4    02      18066      Provider Cultural            0.00   0.00   0.00   0.00
Provider Telephone Access      0      0      0      0                    Provider Telephone Access      0      0      0      0    03      19029      Provider Special Needs       0.00   0.00   0.00   0.05
Provider Cultural              0      0      0      0                    Provider Cultural              0      0      0      0    04                 Provider Quality of Care     0.00   0.23   1.05   0.84
Provider Special Needs         0      0      0      0                    Provider Special Needs         0      0      0      0    05      Perry      Provider Services - Access   0.00   0.00   0.00   0.00
Provider Quality of Care       1      4      2      2                    Provider Quality of Care       1      2      7      4    06      1379       Provider Customer Service    0.00   0.00   0.00   0.00
BH-MCO Member Services         2      1      1      2                    BH-MCO Member Services         0      2      5      5    07      1911       Provider Telephone Access    0.00   0.00   0.00   0.00
BH-MCO Telephone Access        1      0      0      0                    BH-MCO Telephone Access        0      0      0      0    08      3339       Provider Cultural            0.00   0.00   0.00   0.00
BH-MCO Cultural                0      0      0      0                    BH-MCO Cultural                0      0      0      0    09      3476       Provider Special Needs       0.00   0.00   0.00   0.00
Transportation                 0      0      0      0                    Transportation                 0      0      0      0    10                 Provider Quality of Care     0.00   0.00   0.30   0.00
Physical Health                0      0      0      0                    Physical Health                0      0      0      0    11       York      Provider Services - Access   0.07   0.00   0.00   0.00
Total                                 24     66     136    136           13638      Provider Customer Service    0.00   0.34   0.00   0.15
17580      Provider Telephone Access    0.00   0.00   0.00   0.00
25798      Provider Cultural            0.00   0.00   0.00   0.00
27556      Provider Special Needs       0.00   0.00   0.00   0.00
Provider Quality of Care     0.07   0.11   0.27   0.15
Chart 4bLC
LC PA HealthChoices Behavioral Health -Complaints
Average Complaints per month
Quarter 4 2001                          Quarter 1 2002                 Quarter 2 2002                 Quarter 3 2002
Complaint              MBH    CCBH    CBHNP       LC        MBH      CCBH     CBHNP    LC     MBH    CCBH    CBHNP    LC     MBH        CCBH         CBHNP         LC
Provider   Service                0.7     1.3      1.7       3.7       2.7        4.0      4.0    10.7   7.0     1.7      9.3    18.0   13.7        3.0          5.3          22.0
Telephone Access       0.0     0.0      0.0       0.0       0.3        0.0      0.0    0.3    1.3     0.0      0.7    2.0    1.0         0.0          0.3          1.3
Special Needs          0.0     0.0      0.0       0.0       0.0        0.0      0.7    0.7    0.0     0.0      0.3    0.3    0.7         0.0          0.3          1.0
Quality of Care        0.3     0.3      0.3       1.0       5.0        1.0      2.0    8.0    13.0    4.3      2.7    20.0   10.0        3.3          5.3          18.7
BHMCO      Member Services        0.3     0.7      2.0       3.0       1.0        0.7      0.7    2.3    2.7     3.0      0.3    6.0    0.3         3.0          0.7          4.0
Telephone Access       0.0     0.0      0.3       0.3       0.0        0.0      0.3    0.3    0.0     0.0      0.0    0.0    0.7         0.0          0.0          0.7
Cultural               0.0     0.0      0.0       0.0       0.0        0.0      0.0    0.0    0.0     0.0      0.0    0.0    0.0         0.0          0.0          0.0
Other     Transportation         0.0     0.0      0.0       0.0       0.3        0.0      0.0    0.3    0.3     0.0      0.0    0.3    0.0         0.0          0.0          0.0
Pharmacy                                          0.0                                  0.0                            0.0                                          0.0
Lab                                               0.0                                  0.0                            0.0                                          0.0
Sum                    1.3     2.3      4.3       8.0       9.3        5.7      7.7    22.7   24.3    9.0      13.3   46.7   26.3        9.3          12.0         47.7
Provider Complaints per 1000 members
Quarter 3 2002   AD      BK       CU        DA         LA        LB        LE    NH     PE      YO
Services - Access      0.17   0.03      0.22      0.13      0.03      0.00      0.23   0.16   0.00   0.00
Customer Service       0.00   0.09      0.34      0.09      0.09      0.20      0.68   0.53   0.00   0.15
Telephone Access       0.00   0.00      0.00      0.04      0.00      0.00      0.00   0.16   0.00   0.00
Cultural               0.00   0.00      0.00      0.00      0.00      0.00      0.00   0.00   0.00   0.00
Special Needs          0.00   0.00      0.00      0.00      0.00      0.00      0.03   0.05   0.00   0.00
Quality of Care        0.17   0.14      0.45      0.21      0.06      0.49      0.45   0.84   0.00   0.15
EWP Complaints per month
Chart 4cLC
Chart 4dLC
Complaints per 1000 members
0.6                                                             Customer Service
0.3                                                             Quality of Care
AD BK
LA   LB
Chart 5aLC
Adult Involuntary Admissions per 1000 members
Adm per 1000 members
County                                  Quarter
Chart 5bLC
Adult Involuntary Admissions
Involuntary Adm                                               Lehigh/Capital
Quarter             Year         AD       BK      CU       DA     LA     LB      LE    NH    PE    YO    Total
4                 2001             2      3      2       15     13      0       6     1    0     12     54
1                 2002             0      9      3       13     28      3      10     4    3     15     88
2                 2002             6     38      3       27     48     22       8    11    3     31    197
3                 2002             4     46      9       29     41     25      14     8    1     50    227
Invol Adm per 1000 Per Qrt                                         Lehigh/Capital
4                 2001         2.0      0.7     1.9      2.5    1.9    0.0     1.1   0.4   0.0   2.1    1.6
1                 2002         0.0      1.5     1.8      1.9    3.0    2.2     1.3   1.0   3.6   2.1    1.9
2                 2002         3.0      2.9     0.9      2.8    3.7    5.8     0.7   1.4   2.1   3.0    2.6
3                 2002         1.9      3.4     2.4      3.1    3.0    6.2     1.1   1.0   0.7   4.5    2.8
Invol Adm per 1000 Per Qrt              Lehigh/Capital
Quarter             Year        MBH      CCBH CBHNP       Total   MAG   CCBHO CBHNP
4                 2001         0.9      1.6     2.0      1.6     7      17      30
1                 2002         1.2      1.6     2.5      1.9    14      24      50
2                 2002         1.0      3.0     3.3      2.6    19      75     103
3                 2002         1.1      3.7     3.2      2.8    22     100     105
Chart 6aLC
Children&#39;s Inpatient Readmissions at 30 Days
County                                              Quarter
Chart 6bLC
Adult Inpatient Readmissions at 30 Days
LB                            Quarter
County                                   YO
Chart 6cLC
Re-admissions for Inpatient Psychiatric Hospitalization
3        2002                                               Lehigh/Capital
Age 0 - 12       AD     BK     CU     DA       LA    LB      LE     NH      PE    YO    MBH   CCBH CBHNP   Total
Discharges        0      10     3      18     32     11      26     15       1    10    41     20   65     126
Readmit 1-7 days     0       0     0       2      3      0       1      1       0     0     2      0    5       7
Readmit 8-30 days    0       0     1       1      2      0       5      0       0     2     5      2    4      11
Age 13 - 17       AD      BK     CU     DA     LA     LB      LE     NH      PE    YO    MBH   CCBH CBHNP   Total
Discharges        2      12     7      19     31      7      31     24       2    19    55     33   66     154
Readmit 1-7 days     0       0     0       2      4      0       1      1       0     2     2      2    6      10
Readmit 8-30 days    0       1     0       0      3      0       3      1       0     1     4      2    3       9
Age 18+         AD      BK     CU     DA     LA     LB      LE     NH      PE    YO    MBH   CCBH CBHNP   Total
Discharges        20    203     27     127    184    69      205    108      8    191   313   414   415    1142
Readmit 1-7 days      3     17      2      10     10    10       23      7      1     15    30    35    33      98
Readmit 8-30 days     1     15      7      11     13    10       19     15      1     24    34    40    42     116
Summary Children                                               Lehigh/Capital
Quarter    Year       AD     BK     CU     DA      LA     LB     LE     NH       PE    YO   MBH   CCBH CBHNP   Total
4        2001       0%     0%     0%    12%     23%    67%     9%     0%       0%    0%    8%     0%  20%    14%
1        2002       0%     0%     0%    24%     14%    25%    13%    13%      50%    9%   13%     6%  18%    14%
2        2002      14%    10%    25%    19%     15%    17%    16%     7%       0%    0%   13%     5%  17%    13%
3        2002       0%     5%    10%    14%     19%     0%    18%     8%       0%   17%   14%    11%  14%    13%
Summary Adult                                                Lehigh/Capital
4       2001       0%     4%    15%    21%     20%     0%     3%    31%       0%   19%   11%    14%  20%    17%
1       2002       0%    11%    17%    16%     14%    44%    16%    13%      20%   13%   15%    12%  16%    15%
2       2002      12%    13%    12%    26%     18%    20%    19%    13%      20%   18%   17%    15%  20%    18%
3       2002      20%    16%    33%    17%     13%    29%    20%    20%      25%   20%   20%    18%  18%    19%
Chart 7aLC
LC PA HealthChoices Minority Authorizations
YEAR             2002     QUARTER               3
LC PA HealthChoices
80%                                                                                                                      Other or not volunteered by the
North American Indian or Alaska
Auths      Auths
Eligible   Eligible
Auths          Eligible
AD         BK         CU         DA         LA         LB         LE        NH          PE        YO
Chart 7bLC
LC PA HealthChoices Behavioral Health                                YEAR               QUARTER
Minority Authorizations                                              2002                   3
LC Numbers                                         AD                 BK                   CU               DA                 LA                   LB                    LE                   NH                  PE                    YO
Auths    Eligible    Auths Eligible       Auths Eligible   Auths Eligible   Auths    Eligible    Auths     Eligible      Auths Eligible       Auths Eligible       Auths Eligible       Auths Eligible
Black, not of Hispanic Origin                   23        344       231   3703            35     648      969 10352        250       3960        33          363        384   3087           149   1664            4       43          259   4635
Hispanic                                          2       479       645 13994              7     204      167   2531       430       8949       163        2420       2008 11763             930   5188            0       33          147   3500
North American Indian or Alaska Native            0          1        4      42            0      13        3      26         1         49         1          13          3      27            0      15           0        6            3      49
Asian or Pacific Islander                         2        23         2     377            3     157       18     510       15        691          4          99         13     548           17     228           0        2            9     269
White, not of Hispanic Origin                  322       5048     1317 14621             714   7300     1138    9050     1927       19072       953        7055       2344 12837           1551 10877            194    3346         1397 17628
Other or not volunteered by the recipient         3        87       193   1977            59     618       97     884      176       1984        16          184        109   2691            44   1057            3       46           87   1474
SUM                                            352       5982     2392 34714             818   8940     2392 23353       2799       34705      1170       10134       4861 30953           2691 19029            201    3476         1902 27555
LC Percentages
AD                   BK                 CU               DA                 LA                   LB                      LE                   NH                   PE                 YO
Auths     Eligible   Auths     Eligible   Auths Eligible   Auths Eligible   Auths     Eligible   Auths        Eligible   Auths     Eligible   Auths     Eligible   Auths     Eligible   Auths Eligible
Black, not of Hispanic Origin                6.5%      5.8%       9.7%     10.7%       4.3%    7.2%    40.5% 44.3%       8.9%      11.4%     2.8%          3.6%       7.9%      10.0%      5.5%      8.7%       2.0%       1.2%     13.6% 16.8%
Hispanic                                     0.6%      8.0%      27.0%     40.3%       0.9%    2.3%     7.0%   10.8%    15.4%      25.8%     13.9%        23.9%      41.3%      38.0%     34.6%     27.3%       0.0%       0.9%      7.7%   12.7%
North American Indian or Alaska Native       0.0%      0.0%       0.2%      0.1%       0.0%    0.1%     0.1%    0.1%     0.0%      0.1%      0.1%          0.1%       0.1%       0.1%      0.0%      0.1%       0.0%       0.2%      0.2%    0.2%
Asian or Pacific Islander                    0.6%      0.4%       0.1%      1.1%       0.4%    1.8%     0.8%    2.2%     0.5%      2.0%      0.3%          1.0%       0.3%       1.8%      0.6%      1.2%       0.0%       0.1%      0.5%    1.0%
White, not of Hispanic Origin               91.5%     84.4%      55.1%     42.1%      87.3% 81.7%      47.6% 38.8%      68.8%      55.0%     81.5%        69.6%      48.2%      41.5%     57.6%     57.2%      96.5%      96.3%     73.4% 64.0%
Other or not volunteered by the recipient    0.9%      1.5%       8.1%      5.7%       7.2%    6.9%     4.1%    3.8%     6.3%      5.7%      1.4%          1.8%       2.2%       8.7%      1.6%      5.6%       1.5%       1.3%      4.6%    5.3%
LC Numbers                                       MBH                 CCBH                CBHNP             TOTAL
Auths   Eligible     Auths Eligible       Auths Eligible   Auths Eligible
Black, not of Hispanic Origin                  533      4751        513   8682         1291 15366        2337 28799
Hispanic                                     2938     16951         794 17973            767 14137       4499 49061
North American Indian or Alaska Native            3       42          7      92            5     107       15     241
Asian or Pacific Islander                       30       776         13     669           40   1459        83    2904
White, not of Hispanic Origin                3895     23714       3036 37297           4926 45823       11857 106834
Other or not volunteered by the recipient      153      3748        283   3538           351   3716       787 11002
SUM                                          7552     49982       4646 68251           7380 80608       19578 198841
MBH                CCBH                 CBHNP            TOTAL
Black, not of Hispanic Origin                7.1%    9.5%        11.0% 12.7%          17.5% 19.1%      11.9% 14.5%
Hispanic                                    38.9%   33.9%        17.1% 26.3%          10.4% 17.5%      23.0% 24.7%
North American Indian or Alaska Native       0.0%    0.1%         0.2%  0.1%           0.1%   0.1%      0.1%   0.1%
Asian or Pacific Islander                    0.4%    1.6%         0.3%  1.0%           0.5%   1.8%      0.4%   1.5%
White, not of Hispanic Origin               51.6%   47.4%        65.3% 54.6%          66.7% 56.8%      60.6% 53.7%
Other or not volunteered by the recipient    2.0%    7.5%         6.1%  5.2%           4.8%   4.6%      4.0%   5.5%
LC PA HealthChoices Minority Utilizations
YEAR             2002       QUARTER                  1
Other or not volunteered by the
80%                                                                                                                                          recipient
20%                                                                                                                                          Hispanic
UtilsEligibleUtilsEligibleUtilsEligibleUtilsEligibleUtilsEligibleUtilsEligibleUtilsEligibleUtilsEligibleUtilsEligibleUtilsEligible
AD           BK          CU           DA            LA           LB          LE           NH           PE           YO
LC PA HealthChoices Behavioral Health                                 YEAR                QUARTER
Minority Utilizations                                                  2002                      1
LC Numbers                                          AD                   BK                  CU                    DA                  LA                      LB                      LE                    NH                   PE                      YO
Utils    Eligible     Utils   Eligible      Utils Eligible      Utils   Eligible   Utils    Eligible     Utils         Eligible     Utils   Eligible      Utils   Eligible      Utils  Eligible        Utils   Eligible
Black, not of Hispanic Origin                     24       273        100     1674           7      253         661     8308       155       2606          9               78       168     1932            55      657           2       24           225     3169
Hispanic                                           2       301        525     6613           7      109         207     2369       455       7148         25              688       964     8538          396     2931            0        5           222     2561
North American Indian or Alaska Native             0          1          2       21          0        3            4       23         2         28         0                 5         1        8            0        2           0        4              1       36
Asian or Pacific Islander                          1        10           1      146          3       99           10      310         9       410          0               25          8      312            8       81           0        4              7      159
White, not of Hispanic Origin                   282       3302        565     6168         192    3085          784     6478     1300       12395        194            1942      1059      7268          546     4783           81    1851          1323 11147
Other or not volunteered by the recipient          3        43          14      293         14      187           28      324        31       571          2               30         42      711           10      176           2       23             43      508
SUM                                             312       3930      1207 14915             223    3736        1694 17812         1952       23158        230            2768      2242 18769            1015      8630           85    1911          1821 17580
AD                    BK                  CU                  DA                    LA                    LB                         LE                    NH                    PE                  YO
Utils     Eligible    Utils     Eligible    Utils   Eligible    Utils   Eligible    Utils     Eligible    Utils        Eligible      Utils     Eligible    Utils     Eligible    Utils     Eligible    Utils   Eligible
Black, not of Hispanic Origin                7.7%       6.9%       8.3%      11.2%       3.1%     6.8%      39.0% 46.6%          7.9%       11.3%     3.9%           2.8%         7.5%       10.3%      5.4%       7.6%       2.4%        1.3%     12.4% 18.0%
Hispanic                                     0.6%       7.7%      43.5%      44.3%       3.1%     2.9%      12.2% 13.3%         23.3%       30.9%     10.9%         24.9%        43.0%       45.5%     39.0%      34.0%       0.0%        0.3%     12.2% 14.6%
North American Indian or Alaska Native       0.0%       0.0%       0.2%       0.1%       0.0%     0.1%       0.2%     0.1%       0.1%       0.1%      0.0%           0.2%         0.0%        0.0%      0.0%       0.0%       0.0%        0.2%      0.1%     0.2%
Asian or Pacific Islander                    0.3%       0.3%       0.1%       1.0%       1.3%     2.6%       0.6%     1.7%       0.5%       1.8%      0.0%           0.9%         0.4%        1.7%      0.8%       0.9%       0.0%        0.2%      0.4%     0.9%
White, not of Hispanic Origin               90.4%      84.0%      46.8%      41.4%      86.1% 82.6%         46.3% 36.4%         66.6%       53.5%     84.3%         70.2%        47.2%       38.7%     53.8%      55.4%      95.3%       96.9%     72.7% 63.4%
Other or not volunteered by the recipient    1.0%       1.1%       1.2%       2.0%       6.3%     5.0%       1.7%     1.8%       1.6%       2.5%      0.9%           1.1%         1.9%        3.8%      1.0%       2.0%       2.4%        1.2%      2.4%     2.9%
LC Numbers                                         MBH                 CCBH                 CBHNP                TOTAL
Utils   Eligible      Utils   Eligible      Utils   Eligible    Utils   Eligible
Black, not of Hispanic Origin                   223      2589         349     5116          834 11269         1406 18974
Hispanic                                      1360     11469          749     9475          694 10319         2803 31263
North American Indian or Alaska Native             1       10            3       58            6       63         10      131
Asian or Pacific Islander                         16      393            9      315           22      848         47    1556
White, not of Hispanic Origin                 1605     12051        2170 20617            2551 25751          6326 58419
Other or not volunteered by the recipient         52      887           60      844           77    1135        189     2866
SUM                                           3257     27399        3340 36425            4184 49385         10781 113209
MBH                 CCBH                 CBHNP                TOTAL
Utils   Eligible      Utils  Eligible       Utils Eligible      Utils  Eligible
Black, not of Hispanic Origin                6.8%     9.4%        10.4% 14.0%           19.9% 22.8%         13.0% 16.8%
Hispanic                                    41.8%    41.9%        22.4% 26.0%           16.6% 20.9%         26.0% 27.6%
North American Indian or Alaska Native       0.0%     0.0%         0.1%    0.2%          0.1%   0.1%         0.1%    0.1%
Asian or Pacific Islander                    0.5%     1.4%         0.3%    0.9%          0.5%   1.7%         0.4%    1.4%
White, not of Hispanic Origin               49.3%    44.0%        65.0% 56.6%           61.0% 52.1%         58.7% 51.6%
Other or not volunteered by the recipient    1.6%     3.2%         1.8%    2.3%          1.8%   2.3%         1.8%    2.5%
Chart 8aLC
Percent of Clean Claims Paid at 30 Days
AD   BK   CU    DA       LA            LB    LE         NH   PE   YO
Chart 8bLC
LC PA Behavioral Health HealthChoices
% of Clean Claims Paid within 30 days
AD        BK      CU       DA       LA       LB        LE       NH       PE       YO
Apr-02   73.08%   89.21%   98.05%   98.30%   96.99%   97.19%    97.03%   96.91%   98.37%   93.50%
May-02   90.32%   93.47%   97.68%   95.39%   95.00%   95.61%    99.88%   99.95%   97.69%   94.82%
Jun-02   99.75%   99.05%   91.82%   98.45%   95.56%   91.76%   100.00%   99.98%   96.51%   99.62%
PA HealthChoices Lehigh/Cap
Provider Opinion Clinical Surveys
40%                                                     Very satisfied
CBHNP              BH-MCO
LC HealthChoices Behavioral Health
and Child Mental Health               Very satisfied   Satisfied   Neither   Less Dissatisfied   Very Dissatisfied
Overall Satisfaction          MBH        18.2%          54.5%       0.0%          27.3%               0.0%           100.0%
CCBH        0.0%          50.0%      16.7%          33.3%               0.0%           100.0%
CBHNP      66.7%           0.0%      16.7%          16.7%               0.0%           100.0%
Service Authorization         MBH        29.2%         52.1%       6.3%           12.5%               0.0%           100.0%
CCBH       14.8%         40.7%       18.5%          22.2%               3.7%           100.0%
CBHNP      50.0%         26.9%       15.4%           3.8%               3.8%           100.0%
Quality                       MBH        20.7%         50.6%       18.4%          9.2%                1.1%           100.0%
CCBH       14.8%         44.4%       24.1%          16.7%               0.0%           100.0%
CBHNP      28.8%         46.2%       13.5%           9.6%               1.9%           100.0%
Clinical Services             MBH        17.3%         51.9%       21.2%          9.6%                0.0%           100.0%
CCBH       15.2%         48.5%       18.2%          18.2%               0.0%           100.0%
CBHNP      33.3%         46.7%       13.3%           6.7%               0.0%           100.0%
Provider Relations            MBH        17.5%         52.4%       20.6%          9.5%                0.0%           100.0%
CCBH        6.1%         42.4%       33.3%          15.2%               3.0%           100.0%
CBHNP      32.7%         46.2%       19.2%           1.9%               0.0%           100.0%
Care Management               MBH        25.9%         51.9%       18.5%          1.9%                1.9%           100.0%
CCBH       14.7%         50.0%       26.5%          5.9%                2.9%           100.0%
CBHNP      54.5%         30.3%       15.2%          0.0%                0.0%           100.0%
Provider Satisfaction Survey Clinical                         Responses Service Type
Quarter - 3rd (D&amp;A Outpatient)                                                         No Experience Very satisfied Satisfied Neither Less Dissatisfied Very Dissatisfied
Timeliness of Authorizations                                      14    MBH                  3              4           4        1            2                 0
14    CCBH                 8              1           2        2            1                 0
14    CBHNP                8              4           1        0            0                 1
Authorizations Consistent with Service Request                    14    MBH                  3              4           6        0            1                 0
14    CCBH                 8              1           3        1            1                 0
14    CBHNP                8              2           2        1            1                 0
Ease of Authorization                                             14    MBH                  3              3           4        1            3                 0
14    CCBH                 8              0           2        1            2                 1
14    CBHNP                8              3           1        2            0                 0
Does the level of satisfaction with the ease of
authorization change depending on the County? If yes
indicate satsifaction with each county                                  N/A
Appropriateness of Medical Necessity Criteria                     14    MBH                  4              2           7        1            0                 0
14    CCBH                 8              0           4        1            1                 0
14    CBHNP                8              2           3        1            0                 0
Availability of Physician Review                                  14    MBH                 9               1           4        0            0                 0
14    CCBH                11              2           0        0            1                 0
14    CBHNP               12              2           0        0            0                 0
Timeliness of Calls Answered                                      14    MBH                  5              4           3        1            1                 0
14    CBHNP                8              2           2        2            0                 0
Does the level of satisfaction with the timeliness of calls
answered change depending on the county? If yes
indicate satisfaction with each county                                  N/A
Courtesy of Care Management Staff                                 14    MBH                  4              3           6        1            0                 0
14    CCBH                 8              1           3        2            0                 0
14    CBHNP                9              3           1        1            0                 0
Helpfulness of Care Management Staff                              14    MBH                  3              4           5        2            0                 0
Availability of Transportation                                    14    MBH                  11             1           2        0            0                 0
14    CCBH                 11             1           1        1            0                 0
14    CBHNP                11             1           2        0            0                 0
Does the level of satisfaction with the availability of
transportation change depending on the county? If yes
Consistency of Staff                                              14    MBH                  4              1           4        4            0                 1
14    CCBH                 8              1           3        1            0                 1
14    CBHNP                8              3           2        1            0                 0
Application of Medical Necessity Guidelines                       14    MBH                  7              1           5        1            0                 0
14    CCBH                 10             0           2        2            0                 0
14    CBHNP                9              4           1        0            0                 0
No Experience Very satisfied Satisfied Neither Less Dissatisfied Very Dissatisfied
Access of 2nd Opinion Review of Authorization Request     14   MBH          10             0            3       1            0                 0
14   CCBH         11             0            2       0            1                 0
14   CBHNP        11             2            1       0            0                 0
Availability of ER Services                               14   MBH           10             0           2        1            1                 0
14   CCBH          10             0           2        0            2                 0
14   CBHNP         11             1           1        0            1                 0
emergency services change depending on the county?
If yes indicate satisfaction with each county                  N/A
Availability of Services for MISA                         14   MBH           6              2           3        1            2                 0
14   CCBH          9              1           2        1            1                 0
14   CBHNP         9              1           2        2            0                 0
Availability of Case Management                           14   MBH           3              2           7        2            0                 0
14   CCBH          8              2           2        2            0                 0
14   CBHNP         8              3           2        1            0                 0
Cultural Competency                                       14   MBH           8              1           5        0            0                 0
14   CCBH          10             1           2        0            1                 0
14   CBHNP         10             2           2        0            0                 0
Coordination with PH-MCOs                                 14   MBH           6              1           4        2            1                 0
14   CCBH          9              0           1        2            2                 0
14   CBHNP         8              1           1        2            1                 1
Availability of Children&#39;s Services                       14   MBH           10             1           2        0            1                 0
14   CCBH          11             0           1        1            1                 0
14   CBHNP         11             0           3        0            0                 0
Children services change depending on the county? If
yes indicate satisfaction with each county                     N/A
Level of Assistance Provided by BH-MCO in
Coordinating Services for Difficult /Complex Patients     14   MBH           4              1           6        3            0                 0
14   CCBH          9              0           4        0            1                 0
14   CBHNP         8              2           2        1            1                 0
Availability of Discharge Placement for D&amp;A               14   MBH           6              2           2        3            1                 0
14   CCBH          8              1           2        2            1                 0
Availability of Discharge Placements for Adult            14   MBH           7              1           5        1            0                 0
Mental Health Clients                                     14   CCBH          10             1           3        0            0                 0
14   CBHNP         11             1           2        0            0                 0
Clarity of Documentation Requirements                     14   MBH           3              3           5        2            0                 1
14   CCBH          8              0           3        3            0                 0
14   CBHNP         8              1           2        1            2                 0
Adequacy of Confidentiality Policy                        14   MBH           4              4           3        1            2                 0
14   CBHNP         8              1           5        0            0                 0
Adequacy of Pharmacy Formulary                            14   MBH           14             0           0        0            0                 0
14   CCBH          14             0           0        0            0                 0
14   CBHNP         14             0           0        0            0                 0
Ease of Formulary Exceptions Process                      14   MBH          14             0            0       0            0                 0
14   CCBH         14             0            0       0            0                 0
14   CBHNP        14             0            0       0            0                 0
Timeliness of Calls Answered                              14   MBH           8              2           4        0            0                 0
14   CCBH          11             0           2        1            0                 0
14   CBHNP         9              2           2        0            1                 0
Courtesy of Provider Relations Staff                      14   MBH           8              1           4        0            1                 0
14   CBHNP         9              3           2        0            0                 0
Helpfulness of Provider Relations Staff                   14   MBH           8              1           4        0            1                 0
14   CCBH          11             0           2        0            1                 0
14   CBHNP         9              2           1        2            0                 0
Knowledgeability of Provider Relations Staff              14   MBH           8              1           2        2            1                 0
14   CCBH          11             0           1        2            0                 0
14   CBHNP         9              2           3        0            0                 0
Usefulness of Provider Manual                             14   MBH           8              1           3        2            0                 0
Availability of On-going Training Opportunities           14   MBH           8              1           2        3            0                 0
14   CCBH          11             1           0        2            0                 0
Notification of Changes in the BH-MCO&#39;s Policies          14   MBH           8              1           1        1            3                 0
14   CCBH          11             1           1        0            1                 0
14   CBHNP         9              2           2        1            0                 0
Credentialing Process                                     14   MBH           9              1           4        0            0                 0
14   CCBH          11             0           1        0            1                 1
14   CBHNP         9              1           4        0            0                 0
Clarity of Provider Performance Specifications            14   MBH           9              1           4        0            0                 0
Clarity of BH-MCO&#39;s Quality Management Goals              14   MBH           8              1           3        2            0                 0
14   CCBH          11             0           0        2            1                 0
14   CBHNP         10             1           2        1            0                 0
Provider Forums for Feedback/Problem Solving              14   MBH           9              0           2        3            0                 0
14   CBHNP         11             0           2        1            0                 0
Overall Satisfaction                                      14   MBH           3              2           6        0            3                 0
14   CCBH          8              0           3        1            2                 0
14   CBHNP         8              4           0        1            1                 0
Does the level of overall satisfaction change depending
on the county? If yes indicate satisfaction with each
county                                                         N/A
40%                                                   Satisfied
Behavioral Health Rehabiliation
Services for Children (EPSDT)                Very satisfied   Satisfied   Neither   Less Dissatisfied
Overall Satisfaction                 MBH        30.0%         30.0%       20.0%          20.0%
CCBH       33.3%         33.3%        0.0%          16.7%
CBHNP      50.0%         16.7%       16.7%           0.0%
Claims                               MBH        46.9%         34.7%        4.1%           2.0%
CCBH       25.0%         42.9%       14.3%           7.1%
CBHNP      34.5%         37.9%       10.3%           0.0%
Provider Relations                   MBH        27.6%         32.8%       27.6%           6.9%
CCBH       25.7%         42.9%       22.9%           2.9%
CBHNP      33.3%         27.8%       22.2%          13.9%
Member Services Case Management      MBH        23.1%         38.5%       23.1%          15.4%
CCBH        0.0%         42.9%        0.0%          42.9%
CBHNP       0.0%         37.5%       12.5%          25.0%
Service Authorization                MBH        10.0%         50.0%       10.0%          30.0%
CCBH       33.3%         50.0%        0.0%          16.7%
CBHNP      50.0%         16.7%       16.7%          16.7%
0.0%          100.0%
16.7%          100.0%
12.2%          100.0%
10.7%          100.0%
17.2%          100.0%
5.2%          100.0%
5.7%          100.0%
2.8%          100.0%
14.3%          100.0%
25.0%          100.0%
Provider Satisfaction Survey Administrative        Total Responses
Quarter - 3rd (D&amp;A Outpatient)                                               No Experience Very satisfied Satisfied Neither Less Dissatisfied Very Dissatisfied
Clarity of Pre-certification Policies                    13          MBH           3             1            5        1            3                 0
13          CCBH          7             2            3        0            1                 0
13          CBHNP         7             3            1        1            1                 0
Consistency of Payment with Fee Schedule                 13          MBH           2              8            1        1            0                1
13          CCBH          7              3            1        1            0                1
13          CBHNP         7              3            2        0            0                1
Timeliness of Payment Receipt                            13          MBH           2              5            5        0            0                1
13          CCBH          7              1            4        0            0                1
13          CBHNP         7              2            2        1            0                1
Accuracy of Response to Claims Questions                 13          MBH           4              2            5        1            0                1
13          CCBH          8              1            2        0            2                0
13          CBHNP         7              1            3        1            0                1
Timeliness of Response to Inquires                       13          MBH           4              3            4        0            1                1
13          CCBH          8              1            2        2            0                0
13          CBHNP         7              2            3        0            0                1
Timeliness of Claims Complaints Resolution               13          MBH           4              5            2        0            0                2
13          CCBH          7              1            3        1            0                1
13          CBHNP         8              2            1        1            0                1
Availability of On-going Training Opportunities          13          MBH           4              3            1        4            0                1
13          CCBH          8              2            1        2            0                0
13          CBHNP         7              3            0        3            0                0
Notification of Changes in the BH-MCO&#39;s Policies         13          MBH           4              2            3        2            0                2
13          CCBH          7              2            2        2            0                0
13          CBHNP         7              3            1        1            1                0
Credentialling Process                                   13          MBH           2              4            5        1            1                0
13          CCBH          7              2            2        0            1                1
Clarity of Provider Performance Specifications           13          MBH           4              2            4        3            0                0
13          CBHNP         7              2            2        0            2                0
Clarity of BH-MCO&#39;s QM/ QA Goals                         13          MBH           2              2            5        2            2                0
13          CCBH          7              1            4        1            0                0
13          CBHNP         7              1            2        2            1                0
Provider Forums for Feedback/Problem Solving             13          MBH           4              3            1        4            1                0
13          CCBH          7              1            3        2            0                0
Timeliness of Complaint Resolution                       13          MBH           4              2            4        2            1                0
13          CCBH          9              0            2        0            2                0
13          CBHNP         8              0            2        1            1                1
Timeliness of Grievance Resolution                       13          MBH            9             1            1        1            1                0
13          CCBH          10             0            1        0            1                1
13          CBHNP         10             0            1        0            1                1
Overall Satisfaction with BH-MCO                         13          MBH           3              3            3        2            2                0
13          CBHNP         7              3            1        1            0                1
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