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24-Hour Access to Care and Crisis Services 1-866-875-1757 Customer Services 1-855-250-1539 Prepared for December 2014 Provider Meeting.

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Presentation on theme: "24-Hour Access to Care and Crisis Services 1-866-875-1757 Customer Services 1-855-250-1539 Prepared for December 2014 Provider Meeting."— Presentation transcript:

1 24-Hour Access to Care and Crisis Services Customer Services Prepared for December 2014 Provider Meeting

2 Appointments Seen Within Timeframe Executed By: Kimberly Silas Executed On: 12/15/14 2 Report: LME ATR Ver II Source: SQL/Alpha Timeframe: Nov Nov 2014

3 Executed By: Kimberly Silas Executed On: 12/15/14 3 Report: LME ATR Ver II Source: SQL/Alpha Timeframe: May 2014 – Nov 2014 Member Service/LME ATR Ver. II

4 Executed By: Kimberly Silas Executed On: 12/15/14 4 Report: LME ATR Ver II Source: SQL/Alpha Timeframe May Nov 2014 Member Service/LME ATR Ver. II

5 Source: Grievance Log Timeframe: Jul 2014 – Nov 2014 Risk Management/Grievance Tracking Executed By: Barbara McQuery Executed On: 12/9/ Grievance - any expression of dissatisfaction about any matter other than a managed care action (i.e. UM appeal) filed by a member or by someone who has been authorized in writing to file on behalf of the member.

6 Risk Management/Grievance Tracking Top 3 Reasons for Grievances against/by/related to Providers Executed By: Barbara McQuery Executed On: 12/9/ Source: Grievance Log Timeframe: Nov 2014 Grievance - any expression of dissatisfaction about any matter other than a managed care action (i.e. UM appeal) filed by a member or by someone who has been authorized in writing to file on behalf of the member.

7 Internal Performance/ Utilization Management Average Days to Complete Service Authorization Requests Report: SAR Report (SQL) Source: Alpha MCS Medicaid Timeframe: Jan November 2014 Executed By: Dawn Mullins Executed On: 12/4/ Medicaid

8 Internal Performance/ Utilization Management Average Days to Complete Service Authorization Requests Report: SAR Report (SQL) Source: Alpha MCS Medicaid Timeframe: November, 2014 Executed By: Dawn Mullins Executed On: 12/8/ Medicaid

9 Internal Performance/ Utilization Management Average Days to Complete Service Authorization Requests Report: SAR Report (SQL) Source: Alpha MCS State Timeframe: Jan November 2014 Executed By: Dawn Mullins Executed On: 12/4/ STATE

10 Internal Performance/ Utilization Management Average Days to Complete Service Authorization Requests Report: SAR Report (SQL) Source: Alpha MCS State Timeframe: November, 2014 Executed By: Dawn Mullins Executed On: 12/8/ STATE

11 Internal Performance/ Utilization Management Medicaid Denials Report: SAR Approved and Denial Report (SQL) Source: Alpha MCS Medicaid Timeframe: Jan November 2014 Executed By: Dawn Mullins Executed On: 12/4/

12 Internal Performance/ Utilization Management State Denials Report: SAR Report (SQL) Source: Alpha MCS State Timeframe: Jan November 2014 Executed By: Dawn Mullins Executed On: 12/4/

13 Claims Processing/Claims Report: Claims Status Summary (SQL) Source: Alpha/Medicaid & State Funds Timeframe: Jan, 2014 – Nov, 2014 Executed By: Kimberly Silas Executed On: 12/1/

14 Claims Processing/Claims Denials Report: CoastalCare Claims Status Summary (SQL) Source: Alpha/State Funds Timeframe: Nov, 2014 Executed By: Kimberly Silas Executed On: 12/1/

15 Claims Processing/Claims Denials Report: CoastalCare Claims Status Summary (SQL) Source: Alpha/Medicaid Funds Timeframe: Nov, 2014 Executed By: Kimberly Silas Executed On: 12/1/

16 Source: Alpha, Appeals Log Timeframe: Nov 2014 Executed By: Barbara McQuery Executed On: 12/10/2014 Disability Type- Appeals Nov 2014 Disability Type Medicaid Frequency State Frequency MH41 SUD00 IDD120 Total161 Appeals Received

17 Risk Management/Fraud, Waste, and Abuse Report: Fraud, Waste, and Abuse Source: EthicsPoint Timeframe: Nov, 2014 Executed By: Anna Abbey Executed On: 12/2/14 17

18 Risk Management/Fraud, Waste, and Abuse Report: Fraud, Waste, and Abuse Source: EthicsPoint Timeframe: Nov, 2014 Executed By: Anna Abbey Executed On: 12/2/14 18

19 Consumers Served by Care Coordination Report: Caseload Assignment Source: Alpha MCS/SQL Timeframe Jan November 2014 Executed by: Dawn Mullins Executed on: 12/5/14 19 Totals are unduplicated by Care Coordination service (ie I/DD, MH/SUD, TCL), however, consumers may be in TCL as well as I/DD Care Coordination or MH/SUD Care Coordination.

20 Internal Performance/Provider Monitoring Executed By: Kimberly Silas Executed On: 12/2/14 20 Report: Provider Monitoring Tracking Source: Network Monitoring Tracking sheet Timeframe: July Nov 2014


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