Reporting and Reimbursement
Fraud and Abuse Reporting Requirements - This link provides descriptions of fruad and abuse, and information on reporting contacts.
Below are the final FY20 compliance review documents as of October 25, 2019 (unless otherwise indicated):
- Updated FY20 Timeline April - August (Changes due to COVID-19)
- August 2020 Updated Timeline
- FY20 Community Health Worker (CHW) Ratio Template
- FY20 Compliance Review Timeline - outlines items MHP's must submit each month to Michigan Department of Health and Human Services (MDHHS) for review.
- FY20 Dental Provider Directory Template
- FY20 MHP Compliance Review Tables - various tables for MHP's to use and submit to MDHHS based on the compliance review timeline.
- FY20 Health Plan Meeting Schedule - plans must have representation at each of the meetings listed, including CEO, bi-monthly, operations, Clinical Advisory Council, Quality Improvement Directors and Maternal Child Health.
- Healthy Michigan Plan (HMP) Grievance and Appeal (GAP) Report
- HMP GAP Report Instructions
- FY20 Appendix 3 - reporting requirements for Medicaid Health Plans - from contract. Lists reports separate from compliance review.
- FY20 Appendix 14 - Medicaid Health Plan Provider Network Standards - from contract. This appendix is referenced in some compliance review items.
- File Transfer Application (FTP) MILogin Instructions - submissions must be sent via the FTP.
- Health Plan Abortion Report (MSA-128) - due to MDHHS annually.
- Certification for Induced Abortion (MSA-4240) - must be completed by physician for any service rendered and submitted to MDHHS by MHP with a Health Plan Abortion Report (MSA-128).
- Health Plan Data Certification and Attestation (MSA-2012) - due annually.
- Health Plan Profile (MSA-126) - due annually.
- Health Plan Malpractice Litigation Report (MSA-129) - due annually.
- Item 5.6 Common Formulary Guidelines - specifications about data required for submission of the 5.6 Common Formulary compliance review item.
- FY19 MCO Third Party Liability Reporting Template - (October version) - due quarterly 2019.
- Section 6 Items: