UTILIZATION MANAGEMENT REPORTS. The CONTRACTOR shall comply with 8.307.14.13 NMAC related to Utilization and Quality Management Reporting, including monthly utilization review activity reports that provide service-specific data related to requests, approval, clinical denials, termination of care, reductions of care, administrative denials and “pends,” reports related to all Member and provider appeals, expedited appeals, and Fair Hearings. HSD and CONTRACTOR shall agree on reporting elements, formats, and submission templates by an agreed upon date that will allow CONTRACTOR sufficient time to program such reports.
Appears in 2 contracts
Sources: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement