ATTACHMENT 20 Minimum Required Reporting List: OEIBA Program Notes: Separate reports are required for HMO/Medicare Supplement and MAPD of business. All reports should be submitted electronically. Recon should be sent to: and by secure email or enforced TLS. DBC recipient reports should be sent by secure to: EGIDVendorReporting@omes.ok.gov Recipient Report Frequency Report Name Due Date Tab Attachment 21: MAPD File and Changes Reports EGID ftp 21a Weekly MAPD Disenrollment and Changes Wednesday following the week being reported “MAPD Changes” 21b Monthly MAPD full file 10th of same month “MAPD Full File” Attachment 22: Premium Discrepancy Reports Recon 22a Monthly MAPD Premium discrepancy 30 days after the premium remittance “MAPD Premium” 22b Monthly HMO/MSP Premium discrepancy 60 days after the premium remittance “HMO.MSP Premium” Attachment 23: Member Services Reports DBC 23a Monthly Quarterly Annual Member Services Telephone Assistance 20th of following month 60 days following the close of the calendar quarter/year “Telephone” 23b Monthly Quarterly Annual MAPD Member Services Telephone Assistance 20th of following month 60 days following the close of the calendar quarter/year “MAPD Telephone” 23c Annual Member Satisfaction Survey Results 60 days following close of calendar year “Survey” 23d Annual MAPD Member Satisfaction Survey Results 60 days following close of calendar year “MAPD Survey” Attachment 24: HIPAA, FWA, and Grievance Reports DBC 24a Quarterly HIPAA Incident Report 60 days following the close of the calendar quarter “HIPAA” 24b Quarterly Waste, or Abuse Prevention Incident Report 60 days following the close of the calendar quarter “Fraud” 24c Quarterly Grievance Report 60 days following the close of the calendar quarter “Grievance” 24d Quarterly MAPD Grievance Report 60 days following the close of the calendar quarter “MAPD Grievance” Attachment 25: Utilization Reports DBC 25a Quarterly Annual Executive Summary of Findings 60 days following the close of the calendar quarter/year “Exec Summary”
25b Quarterly Annual Top Fifteen Medications by Dollars and Number of Scripts 60 days following the close of the calendar quarter/year “Top Rx” 25c Quarterly Annual Therapeutic Category 60 days following the close of the calendar quarter/year “Therapeutic” 25d Quarterly Annual Top Ten Health Providers by Dollars 60 days following the close of the calendar quarter/year “Providers Dollars” 25e Quarterly Annual Top Ten Health Providers by Utilization 60 days following the close of the calendar quarter/year “Providers Utilization” 25f Quarterly Annual Top Ten Diagnosis by Dollars and Utilization 60 days following the close of the calendar quarter/year “Top Dx” 25g Quarterly Annual Observations and Recommendations 60 days following the close of the calendar quarter/year “Observations” Attachment 26: Network Changes Summary DBC 26a Monthly Network Changes Summary 20th of following month “Network Changes” Attachment 27: Network Detailed Reports DBC 27a Quarterly Summary of Provider Network Changes 60 days following the close of the calendar quarter “Summary of Network Changes” 27b Quarterly Primary Care Physician Summary 60 days following the close of the calendar quarter “PCP Summary” 27c Quarterly Primary Care Physician Network 60 days following the close of the calendar quarter “PCP” 27d Quarterly Specialist Network 60 days following the close of the calendar quarter “Specialist” 27e Quarterly Pharmacy Network 60 days following the close of the calendar quarter “Pharmacy” 27f Quarterly Urgent Care Network 60 days following the close of the calendar quarter “Urgent Care” 27g Quarterly Hospital Network 60 days following the of the calendar quarter “Hospital” Attachment 28: Detailed Utilization Reports DBC 28a-28f Quarterly Detailed Utilization Reports 60 days following the close of the calendar quarter “High Cost Claims YTD” “Monthly Claims Exhibit” “High Level Summary YTD” “High Level Sum (Rolling 12)” “All Plans YTD” “All Plans (Rolling 12)” Attachment 29: MAPD Detailed Utilization Reports DBC 29a-29f Quarterly MAPD Detailed Utilization Reports 60 days following the close of the calendar quarter “High Cost Claims YTD” “Monthly Claims Exhibit” “High Level Summary YTD” “High Level Sum (Rolling 12)” “All Plans YTD” “All Plans (Rolling 12)”