Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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APPLICATION ITEM 24 g. Copy of the following applicable documents: (1) AHCA Health Care Provider Certificate; (2) OIR Certificate of Authority; and (3) Florida Third party administrator (TPA) license (if PSN). Agency for Health Care Administration Internal Working Document MCO APPLICATION REVIEW CHECKLIST FOR Phase I INSTRUCTIONS (if applicable) AHCA Health Care Provider Certificate (HCPC) Confirm with BMHC Commercial Unit that the submitted AHCA Health Care Provider Certificate is legitimate. PSNs are not required to have HCPCs for Medicaid. However, they are required if they serve non-Medicaid population. OIR Certificate of Authority Confirm online at http://www.floir.com/CompanySearch/ PSNs are not required to have an OIR Certificate of Authority. However, they are required if they serve non-Medicaid population. For PSNs: Florida third party administrator (TPA) license If the PSN does not have a Florida TPA license, it must contract with an entity that does have one for claims processing. (See section X.D.) Confirm online at http://www.floir.com/CompanySearch/ Print website screen prints used for confirmation and keep with the checklist. LOCATION IN APPLICATION (Binder, Tab & Page #) Date Deficiencies identified/Date Deficiencies resolved Revisions as of 1/23/2012 Page 5 of 19 INITIALS & DATE COMPLETED
APPLICATION ITEM 25 3. In the past five years, has the applicant executed a contract with a federal, state, or local government entity, including current contracts? If yes, describe each contract, including the name of the government entity, name of the entity project officer (contact person for the contract), brief description of scope of work, address, telephone number, and beginning and ending dates of the contract. 26 4. If the applicant has ever defaulted on or voluntarily withdrawn from a contract or had a contract terminated, please describe each such contract, including the reason for the default, withdrawal or termination and the name of the government entity, name of the entity project officer, address, telephone number, and beginning and ending dates of the contract. 27 5. Describe, with specificity, the applicant’s experience in providing services identical or similar to the services required in the model Contract, if any. Identify the population served, the number of people enrolled with the applicant, and the types of services provided. 28 6. Submit documentation that the applicant has successfully tested all X12N transactions using Ramp Manager, which is an application that provides interactive, self-service tools for trading partners to test X12N transaction against the Florida Medicaid Companion Guides. Ramp Manager is hosted by EDIFECs in an environment customized for Florida Medicaid. Applicant must submit “Report View” test results for each type of pertinent X12 transaction. See the Ramp Manager information sheet provided in the application tool kit for more details. Agency for Health Care Administration Internal Working Document MCO APPLICATION REVIEW CHECKLIST FOR Phase I INSTRUCTIONS (if applicable) If the applicant had predecessor companies that had a Medicaid health plan contract, they should be included in the response. RED FLAG: If applicant reports default/termination of a contract, discuss with administrators. Review subcontractors and manager experience to determine if manage care experience is present. If no experience, make note. Check documentation to confirm there are screen shots of all pertinent X12 transactions. Compare to EDI form submitted by the applicant. LOCATION IN APPLICATION (Binder, Tab & Page #) Date Deficiencies identified/Date Deficiencies resolved Revisions as of 1/23/2012 Page 6 of 19 INITIALS & DATE COMPLETED
Page 3 and 4: Attachment I Special Term and Condi
Page 5 and 6: Attachment II Special Term and Cond
Page 7 and 8: RICK SCOTT GOVERNOR 272 7 Mah an Dr
Page 9 and 10: • Encounter data • Systems issu
Page 11 and 12: Appendix A How to Become a Florida
Page 13 and 14: How to Become a Florida Medicaid He
Page 15 and 16: Appendix B MCO Application Checklis
Page 17 and 18: 4 5 6 7 8 9 10 Service Level(s) are
Page 19: 19 b. Total number of employees; AP
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Page 25 and 26: APPLICATION ITEM C. Criminal Backgr
Page 27 and 28: APPLICATION ITEM 43 13. For medical
Page 29 and 30: 46 47 APPLICATION ITEM 16. Indicate
Page 31 and 32: 49 APPLICATION ITEM 19. Describe in
Page 33 and 34: 51 52 53 54 55 56 APPLICATION ITEM
Page 35 and 36: Attachment III Special Term and Con
Page 37 and 38: RICK SCOTT GOVERNOR Regulatory Auth
Page 39 and 40: e. Complete a credentialing review
Page 41 and 42: RICK SCOTT GOVERNOR Regulatory Auth
Page 43 and 44: Compliance Monitoring Tool with Spe
Page 45 and 46: Standard I: Care Management/Continu
Page 51 and 52: Results for Standard I Care Managem
Page 53 and 54: Standarrd II: Utilizatio on Managem
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Standard III: Eligibility, Enrollme
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Standard IV: Enrollee Services & En
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Results for Standard IV Enrollee Se
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Standard V: Provider Credentialing
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Standard VI: Provider Services CONT
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Standard VI: Provider Services CC-
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Standard VI: Provider Services CONT
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Standard VII: Provider Contracting
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AGENCY FOR HEALTHCARE ADMINISTRATIO
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Standard VIII: Quality Improvement
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Results for Standard IX Medical Rec
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Standard X: Access and Availability
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Results for Standard X Access and A
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Standard XI: Grievances and Appeals
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Standard XII: Administration and Ma
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Results for Standard XII Administra
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Standard XIII: Community Outreach C
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Results for Standard XIII Community
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Standard XIV: Covered Services AGEN
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Standard XV: Immunizations, Pregnan
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Vendor Name: Review Period: Date of
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Agency For Health Care Administrati
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File # Case ID # Agency For Health
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File # Case ID # 1 2 3 4 5 6 7 8 9
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13 14 15 Agency For Health Care Adm
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f. Posting of the Agency Summary of
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5. 6. 7. 8. 9. local WIC office to
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14 Agency For Health Care Administr
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8 providers Agency For Health Care
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Medical Loss Ratio The following dr
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RICK SCOTT GOVERNOR Better Health C
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Plan Name: AGENCY FOR HEALTH CARE A
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DRAFT ATTESTATION OF 201_ QUARTER E
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Draft MLR Reporting Schedule Health
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RICK SCOTT GOVERNOR PLAN TYPES: Bet
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Attachment V Special Term and Condi
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RICK SCOTT GOVERNOR Mission to Ensu
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• Obtaining data from the health
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RICK SCOTT GOVERNOR Mission to Ensu
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Attachment VI Special Term and Cond
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RICK SCOTT GOVERNOR Better Health C
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Letter to CMS - Medicaid Managed Care Policies - Agency for ...

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