Calendar of Required PPG Submissions
Provider Type
- Participating Physician Groups (PPG)
Documents to be Submitted |
Due Date |
|---|---|
Financial Statements (Annually Audited) |
150 days after close of fiscal year |
Financial Statements (Quarterly Updates) |
45 days after close of quarter |
Monthly Timeliness Reports (MTR) Claims |
15th calendar day after end of each month |
Medicare Part C - MTR (Quarter submission) MA & Cal MediConnect Claims |
15th calendar day following close of |
Monthly Timeliness Report (MTR) -(Quarter Submission) HMO Claims |
Last calendar day of month following close of quarter |
Monthly Encounter Data Submission |
Within 30 days of end of month of service |
Semi-annual Credentialing Report (CR) 1 |
August 15 |
Semi-annual Credentialing Report (CR) 2 |
February 15 |
Utilization Management (UM) Program Description |
February 15 |
Current Year UM Work Plan |
February 15 |
Prior Year UM Annual Evaluation Report |
February 15 |
Semi-Annual UM Report (1st and 2nd Quarter) |
August 15 |
Medicare Part C Report Quarterly |
January 15, April 15, July 15, and October 15 |
Cal MediConnect Part C Report Quarterly |
January 15, April 15, July 15, and October 15 |
Special Needs Program (for Duals and Chronic) Quarterly Case Management Report |
January 15, April 15, July 15, and October 15 |
Cal MediConnect Monthly Inpatient Admission Log |
15th calendar day after end of each month |
Cal MediConnect Case Management Log |
15th calendar day after end of each month |
Cal MediConnect Transition of Care Monthly Log |
15th calendar day after end of each month |
Cal MediConnect Health Risk Assessment (HRA) Completion Log (as applicable) |
15th calendar day after end of each month |
Notice of Medicare Non-Coverage (NOMNC) Monthly Log (Medicare Only) |
15th calendar day after the end of each month |
Cal MediConnect Care Plan monthly Log |
25th calendar day after the end of each month |
Cal MediConnect Care Coordinator to Member Ratio Quarterly Log |
February 15, May 15, August 15, and November 15 |
The plan does delegate responsibility for complex case management to those providers with a dual-risk contract who meet the requirement as delineated by the National Committee for Quality Assurance (NCQA). Although the plan does not delegate responsibility for QI functions, all PPGs are required to participate in and cooperate with QI activities, including Healthcare Effectiveness Data and Information Set (HEDIS®), access surveys, disease management, and other quality initiatives.
To access the current year UM/QI report templates, workplans and instruction, visit the Industry Collaboration Effort (ICE) website at www.iceforhealth.org.