Enrollee Complaints, Grievances, and Appeals Report Section IV. and XIV. 8 C 0127 Monthly SMMC SFTP Site Enrollee Complaints, Grievances, and Appeals Report Attestation N/A Marketing Agent Status Report Section IV. D.5.g. 9 C 0157 Variable/ Quarterly SMMC SFTP Site Marketing Agent Status Report Attestation N/A Marketing/Public/Educational Events Report Section I.A. and Section III.D.14 10 C Variable/ Monthly SMMC SFTP Site Marketing/Public/Educational Events Report 0159 Amendment to a reported event change 0160 Market/Public/Educational Events Report Attestation N/A Performance Measures Report Section VII. 11 C Annually SMMC SFTP Site Performance Measures Report- LTC & MMA 0141
Performance Measures Report Attestation N/A HEDIS Auditor Certification with Audit Review Table 0143 Interactive Data Submission System (IDSS) file 0144 Provider Complaint Report Section VI. and XIV. 12 C 0145 Monthly SMMC SFTP Site Provider Complaint Report Attestation N/A Provider Network File Section VI. and XIV. 13 C N/A W Choice Counseling Vendor SFTP Site Provider Network File Attestation N/A Quarterly Fraud & Abuse Activity Report Section VIII. and XIV. 14 S 0195 Quarterly MPI-MC SFTP Site Quarterly Fraud & Abuse Activity Report N/A Suspected/Confirmed Fraud and Abuse Reporting Section VIII. and XIV. 15 C N/A Variable Agency’s Online Electronic Data Entry Complaint Form
Enhanced Care Coordination Report Exhibit II-A, Section V.E.2. 19 C 0186 Monthly SMMC SFTP Site Enhanced Care Coordination Report Attestation N/A LONG-TERM CARE REPORTS Critical Incident Report- Individual Section VII. and XIV. 20 C 0118 Variable MCP Contract Manager via email Critical Incident Report- Individual Attestation N/A Case Management File Audit Report Exhibit II-B, Section V. and XIV. 21 C 0102 Quarterly SMMC SFTP Site Case Management File Audit Report Attestation N/A Case Management Monitoring and Evaluation Report Exhibit II-B, Section V. and XIV. 22 C Quarterly SMMC SFTP Site
Case Management Monitoring and Evaluation Report 0104 Case Management Monitoring and Evaluation Report Attestation N/A Annual Roll-Up (4th Quarter Only) 0106 Annual Roll-Up Attestation N/A Case Manager Caseload Report Exhibit II-B, Section V. and XIV. 23 C 0151 Monthly SMMC SFTP Site Case Manager Caseload Report Attestation N/A Denial, Reduction, Suspension or Termination of Services Report Exhibit II-B, Section V. and XIV 24 C 0125 Monthly SMMC SFTP Site Denial, Reduction, Suspension or Termination of Services Report Attestation N/A Enrollee Roster and Facility Residence Report Exhibit II-B, Section V. and XIV. 25 C 0129 Monthly SMMC SFTP Site Enrollee Roster and Facility Residence Report Attestation N/A
Missed Services Report Exhibit II-B, Section V. and XIV. 26 C 0131 Monthly SMMC SFTP Site Missed Services Report Attestation N/A Participant Direction Option (PDO) Roster Report Exhibit II-B, Section V. and XIV 27 C 0137 Monthly SMMC SFTP Site Participant Direction Option (PDO) Roster Report Attestation N/A Patient Responsibility Report Exhibit II-B, Section V. and XIV. 28 K 0139 Annually SMMC SFTP Site Patient Responsibility Report Attestation N/A Unable to Locate/Contact Enrollee Report Exhibit II-B, Section V.E.5 29 C 0176 Monthly SMMC SFTP Site Unable to Locate/Contact Enrollee Report Attestation N/A Case Manager and Provider Training Report Exhibit II-B, Section VIII. 30 C N/A Annually SMMC SFTP Site Case Manager and Provider Training Report Attestation N/A Provider Network and Qualifications Report Exhibit II-B, Section VI. 31 C N/A Quarterly SMMC SFTP Site Provider Network and Qualifications Report Attestation N/A
MANAGED MEDICAL ASSISTANCE REPORTS CHCUP (CMS-416) and FL- 80% Screening Exhibit II-A, Section V. and XIV. 32 F N/A Annually SMMC SFTP Site CHCUP (CMS-416) and FL- 80% Screening Attestation N/A ER Visits for Enrollees without PCP Appointment Report Exhibit II-A, Section V. and XIV. 33 C 0182 Annually SMMC SFTP Site ER Visits for Enrollees without PCP Appointment Report Attestation N/A Healthy Behaviors Report Exhibit II-A, Section V. and XIV. 34 C 0180 Quarterly SMMC SFTP Site Healthy Behaviors Report Attestation N/A Hernandez Settlement Agreement Survey Exhibit II-A, Section V. and XIV. 35 C 0168 Annually SMMC SFTP Site Hernandez Settlement Agreement Survey Attestation N/A Hernandez Settlement Ombudsman Log Exhibit II-A, Section V. and XIV. 36 C 0170 Quarterly SMMC SFTP Site
Hernandez Settlement Ombudsman Log Attestation N/A PCP Appointment Report Exhibit II-A, Section V. and XIV. 37 C 0191 Annually SMMC SFTP Site PCP Appointment Report Attestation N/A Timely Access/PCP Wait Report Exhibit II-A, Section VI. and XIV. 38 C 0172 Annually SMMC SFTP Site Timely Access/PCP Wait Report Attestation N/A Supplemental HIV/AIDS Report Exhibit II-A, Section XIV. 39 C 0174 Monthly MDA SMMC SFTP Site Supplemental HIV/AIDS Report Attestation N/A Residential Psychiatric Treatment Report Exhibit II-A, Section V. 40 C 0188 Monthly SMMC SFTP Site Residential Psychiatric Treatment Report Attestation N/A MMA Physician Incentive Program (MPIP) Report Exhibit II-A, Section VIII.D 41 F 0194 SMMC SFTP Site MMA Physician Incentive Program (MPIP) Report Attestation N/A annually
COUNTY CODE TABLE COUNTY NAME COUNTY ID AHCA AREA/REGION DCF CIRCUIT Alachua 01 03 08 02 04 08 Bay 03 02 14 Bradford 04 03 08 Brevard 05 07 18 Broward 06 10 17 Calhoun 07 02 14 Charlotte 08 08 20 Citrus 09 03 05 Clay 10 04 04 Collier 11 08 20 Columbia 12 03 03 Desoto 14 08 12 Dixie 15 03 03 Duval 16 04 04 Escambia 17 01 01 Flagler 18 04 07 Franklin 19 02 02 Gadsden 20 02 02 Gilchrist 21 03 08 Glades 22 08 20 Gulf 23 02 14 Hamilton 24 03 03 Hardee 25 06 10 Hendry 26 08 20 Hernando 27 03 05 Highlands 28 06 10 Hillsborough 29 06 13 Holmes 30 02 14 Indian River 31 09 19 Jackson 32 02 02 Jefferson 33 02 14 Lafayette 34 03 03 Lake 35 03 05 Lee 36 08 20 Leon 37 02 02 Levy 38 03 08
Liberty 39 02 02 Madison 40 02 03 Manatee 41 06 12 Marion 42 03 05 Martin 43 09 19 Miami-Dade 13 11 11 Monroe 44 11 16 Nassau 45 04 04 Okaloosa 46 01 01 Okeechobee 47 09 19 Orange 48 07 09 Osceola 49 07 09 Palm Beach 50 09 15 Pasco 51 05 06 Pinellas 52 05 06 Polk 53 06 10 Putnam 54 03 07 Santa Rosa 57 01 01 Sarasota 58 08 12 Seminole 59 07 18 St. Johns 55 04 07 St. Lucie 56 09 19 Sumter 60 03 05 Suwannee 61 03 03 Taylor 62 02 03 Union 63 03 08 Volusia 64 04 07 Wakulla 65 02 02 Walton 66 01 01 Washington 67 02 14 REMAINDER OF PAGE INTENTIONALLY LEFT BLANK File Naming Convention Examples
Chapter 6: Claims Aging Report SMMC PLAN TYPES The following Managed Care Plans must submit this report: Plan Type Comprehensive LTC Plan MMA HMO MMA Capitated PSN MMA Specialty Plan MMA CMS Plan REPORT PURPOSE: The purpose of this report is to provide the Agency with assurance that claims are processed timely and payment systems comply with the federal and State requirements, whichever is more stringent. FREQUENCY & DUE DATES: This report is due monthly, within thirty (30) calendar days after the end of each month. SUBMISSION: Using the file naming convention described in Chapter 2, the Managed Care Plan must submit the following to the SMMC SFTP site: For the monthly submissions: The completed claims aging report template, which must be submitted as an XLSX file and named using the file naming convention as described in Chapter 2. A report attestation described in Chapter 2. INSTRUCTIONS: The Managed Care Plan must complete the monthly Claims Aging Report(s) using the report template provided on the Agency website (see the “Report Template” section of this chapter). Claims data must be Medicaid only.
MMA HMO MMA Capitated PSN MMA Specialty Plan MMA CMS Plan REPORT PURPOSE: The purpose of this report is to document Managed Care Plan reporting of instances of as required by the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) (Final Rule). 42 CFR 438.608(a)(7) requires the Managed Care Plan to report waste to the state Medicaid program integrity unit. Notwithstanding any other provision of law, failure to comply with these reporting requirements will be subject to sanctions. FREQUENCY & DUE The suspected/confirmed waste report is due quarterly, within fifteen (15) calendar days after the end of the quarter being reported. SUBMISSION: To comply with the Suspected/Confirmed Waste Reporting requirements, the Managed Care Plan must submit the following via the MPI SFTP site: The template provided with all required fields completed. The report attestation as described in Chapter 2. INSTRUCTIONS: The Managed Care Plan must report suspected or confirmed instances of waste relative to the Managed Care Plan’s contract and Florida Medicaid. All suspected or confirmed instances of waste under state and/or federal law are to be reported to MPI. In the template provided, on the tab “Summary of Waste” the Managed Care Plan should provide the following information relative to the quarter’s activities in waste recoveries: The reporting period for the report is being submitted; The Medicaid Health Plan name for which the report is being submitted; The Medicaid Health Plan Medicaid ID or IDs for which the report is being submitted; A summary, by quarter, of the instances of suspected/confirmed identified relative by the Managed Care Plan, broken into categories as provided on the template; A summary, by quarter, of the overpayment recoveries made relative to waste by the Managed Care Plan broken, into categories as provided on the template.