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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
quarter

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.

Last Updated: 11/19/2019