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

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Agency For Health Care Administration Managed Care Organizations Administrative Staff File Review Tool File # Title Initials License Resume 1 2 3 4 5 6 7 Position Description Job Duties Training Experience 17 Case Management Y N N/A Y N Y N Y N Y N N/A Y N 18 QI Professional Y N N/A Y N Y N Y N Y N N/A Y N Total # Applicable Elements Total # Compliant Elements Total Percent Compliant # Applicable Files # Compliant Files Percent Compliant Managed Care Organizations Page 2 Administrative Staff File Review Tool F1_03_10 Florida Medicaid
Vendor Name: Review Period: Date of Review: Reviewer: Participating Vendor Staff Member: File # Case ID # Agency For Health Care Administration Managed Care Organizations Appeals File Review Tool 1 2 3 4 5 6 7 Date Appeal Received Standard or Expedited Appeal Acknowledged in Writing Assistance Given, if Requested (List type of assistance in comments) Enrollee Given Chance to Present Evidence Decision Maker Involved in Initial Determination* Decision Maker Has Appropriate Clinical Expertise 1 S E Y N N/A Y N N/A Y N Y N Y N 2 S E Y N N/A Y N N/A Y N Y N Y N 3 S E Y N N/A Y N N/A Y N Y N Y N 4 S E Y N N/A Y N N/A Y N Y N Y N 5 S E Y N N/A Y N N/A Y N Y N Y N 6 S E Y N N/A Y N N/A Y N Y N Y N 7 S E Y N N/A Y N N/A Y N Y N Y N 8 S E Y N N/A Y N N/A Y N Y N Y N 9 S E Y N N/A Y N N/A Y N Y N Y N 10 S E Y N N/A Y N N/A Y N Y N Y N 11 S E Y N N/A Y N N/A Y N Y N Y N 12 S E Y N N/A Y N N/A Y N Y N Y N 13 S E Y N N/A Y N N/A Y N Y N Y N 14 S E Y N N/A Y N N/A Y N Y N Y N 15 S E Y N N/A Y N N/A Y N Y N Y N 16 S E Y N N/A Y N N/A Y N Y N Y N 17 S E Y N N/A Y N N/A Y N Y N Y N 18 S E Y N N/A Y N N/A Y N Y N Y N 19 S E Y N N/A Y N N/A Y N Y N Y N 20 S E Y N N/A Y N N/A Y N Y N Y N 21 S E Y N N/A Y N N/A Y N Y N Y N Managed Care Organizations Page 1 Appeals File Review Tool F1_03_10 Florida Medicaid
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Attachment I Special Term and Condi
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Attachment II Special Term and Cond
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RICK SCOTT GOVERNOR 272 7 Mah an Dr
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• Encounter data • Systems issu
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Appendix A How to Become a Florida
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How to Become a Florida Medicaid He
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Appendix B MCO Application Checklis
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4 5 6 7 8 9 10 Service Level(s) are
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19 b. Total number of employees; AP
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APPLICATION ITEM 25 3. In the past
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32 33 34 35 36 APPLICATION ITEM 10.
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APPLICATION ITEM C. Criminal Backgr
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APPLICATION ITEM 43 13. For medical
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46 47 APPLICATION ITEM 16. Indicate
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49 APPLICATION ITEM 19. Describe in
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51 52 53 54 55 56 APPLICATION ITEM
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Attachment III Special Term and Con
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RICK SCOTT GOVERNOR Regulatory Auth
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e. Complete a credentialing review
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RICK SCOTT GOVERNOR Regulatory Auth
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Compliance Monitoring Tool with Spe
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Standard I: Care Management/Continu
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Results for Standard I Care Managem
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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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Agency For Health Care Administrati
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Vendor Name: Review Period: Date of
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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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