Reporting Templates & Vendor Documents | mydss.mo.gov

Reporting Templates

Monthly Reports	Institution of Mental Disease (IMD) Services Report Grievance and Appeal Report: Member Issue Log (Open) Grievance and Appeal Report: Member Issue Log (Closed) Health Plan Hospital Services Reporting
Quarterly Reports	Private Duty Nursing Quarterly Report Instructions PDN Reporting Template CCBHO Claim Data Reporting Instructions CCBHO Claim Data Template Call Center Report Care Management Member Journey Report SMHK Care Management Member Journey Report Care Management Self Report (Pregnancy Only) Complaint, Grievance, and Appeal Report: Provider Issues Log Disease Management Report Revised: 12/01/2022 Disease Management Summary Revised: 12/01/2022 Fraud, Waste, and Abuse Activities Report: Case Log Overpayments Due to Fraud Reporting Template IMD Services Report - Specialty Plan Prior - Authorizations and Denial Log Third Party Savings Reports Timeliness of Claims Adjudication Report Provider Network Adequacy Standards NEMT Utilization Report
Semi-Annual Reports	Health Plan Encounter Data Questionnaire
Annual Reports	FY2020 EPSDT Self Report Instructions Health Care Management Member Survey HEDIS Indicators by MO HealthNet Managed Care Health Plans Within Regions, Live Births located Parity Compliance Report Overpayments Due to Fraud Reporting Template Provider Preventable Conditions Subcontractor Oversight Annual Evaluation Report Trends in Missouri MO HealthNet Quality Indicators Healthcare Quality Data Reports Healthcare Quality Data Instructions Healthcare Quality Data Template - Statewide Healthcare Quality Data Template - Regional Quality Assessment and Improvement Evaluation Reports Quality Assessment and Improvement Evaluation Report Instructions Quality Assessment and Improvement Evaluation Report Attachment - 6 FQHC RHC CMHC LPHA Transaction Disclosure Health Plan Financial Reporting Form COA6 Expansion Instructions for MLR Report Template for MLR Report Ownership or Controlling Interest Disclosure
Miscellaneous Deliverables	Federally Qualified Health Clinic and Rural Health Clinic M-1 Instructions and Form Inpatient Certifications File Specifications Ownership or Controlling Interest Disclosure Additional Health Benefit Submission Member Incentive Template Provider Incentive Program Tool Provider & Subcontractor Disclosure Transaction Disclosure Policies and Procedures Requiring Prior Approval Medicare Resource Report
Reporting Requirements	Reporting Requirements

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