Report                                             Description of Report
          Authorization Timeliness              Timeliness in passing authorization data to fiscal agent; timeliness in correcting 
                                                authorization info errors; Accuracy in passing authorization data to fiscal agent, and 
                                                Accuracy in importing claims data from fiscal agent.  1)  98% shall occur timely which 
                                                means prior to the start of business the day following production of the authorization 
                                                files  2) The error rate shall be less than 2% as a percentage of total authorization 
                                                records transmitted  3) 98% of errors shall be corrected within 2 business days of date 
                                                identified  4)  Contractor will load 98% of all monthly full files within 2 business days and 
                                                all daily update files within 1 business day with an error rate of 2% or less  5) 98% 
                                                accuracy rate on data elements processed from the provider add/change reports 
                                                Quarterly random sample with 95% confidence level
          Average Speed of Answer (ASA)         Average number of seconds to answer all calls with a live person coming into the call 
                                                center including after hours calls and authorization lines, measured by the selection of a 
                                                menu option (e.g.crisis queue).   
          Call Abandonment Rate (CAR)           Total number and percentage of calls abandoned coming into the call center including 
                                                after hours calls.  Measured by each hour of the day and average for the month. 
          Calls Answered with in 30 Seconds     Total number and the percentage of calls coming into the call center answered within 30 
                                                seconds.
          Number and Percentage of calls        Total number of telephone calls placed on hold and average length of time on hold.
          placed on hold and average length of 
          time on hold for Clinical Services.
          Number and Percentage of calls        Total number of telephone calls placed on hold and average length of time on hold.
          placed on hold and average length of 
          time on hold for Customer Services.
          Higher Levels of Care Timeliness       Number and percentage of cases that met the required timeframe broken out by 
          Summary for Initial Auths - With &     approved, denied, partially denied, suspended or terminated.  For those cases which 
          Without Peer Review                    did not meet the goal, the report shall include average time frame for completion.   
                                                 (Without Peer Review - 60 minutes: Psych IP , General IP, IP Detox, Obs Beds, PRTF, 
                                                 PHP/Day Tx, and IOP.  With Peer Review - 120 minutes: Psych IP, General IP; 180 
                                                 minutes: IP detox; 1 business day: PHP, IOP, PRTF, and Crisis Stabilization)  Summary 
                                                 Report that identifies the number and percentage of cases requiring higher levels of 
                                                 care and whether they are meeting the required timeframe for UM decision 
                                                 communication.  
          Lower Levels of care Timeliness        Number and percentage of cases that met the required timeframe broken out by 
          Summary for Initial Auths -With and    approved, denied, partially denied, suspended or terminated.  For those cases which 
          Without peer Review.                   did not meet the goal, the report shall include average time frame for completion.  
                                                 (Without Peer Review - 1 business day.  With Peer Review - 1 business day)  Summary 
                                                 Report that identifies the number and percentage of cases requiring lower levels of care 
                                                 and whether they are meeting the required timeframe for UM decision communication.  
          Higher levels of Care Timeliness       Number and percentage of cases that met the required timeframe broken out by 
          Report for Concurrent Reviews - With  approved, denied, partially denied, suspended or terminated.  For those cases which 
          and Without Peer Review                did not meet the goal, the report shall include average time frame for completion.  
                                                 (Without Peer Reveiw - 60 minutes: Psych IP , General IP, IP Detox, Res Detox, PHP, 
                                                 and IOP; 2 business days: Crisis Stabilization.  With Peer Review - 1 business day: 
                                                 Psych IP, General IP, IP detox, Res Detox; 2 business day: PHP, IOP, PRTF, and Crisis 
                                                 Stabilization)  Summary Report that identifies the number and percentage of concurrent 
                                                 review cases requiring higher levels of care and whether they are meeting the required 
                                                 timeframe for UM decision communication.  
          Lower levels of Care Timeliness        Number and percentage of cases that met the required timeframe broken out by 
          Report for Concurrent Reviews - With  approved, denied, partially denied, suspended or terminated.  For those cases which 
          and Without Peer Review                did not meet the goal, the report shall include average time frame for completion.  
                                                 (Without Peer Review - 2 business days.  With Peer Review -2 business days)  
                                                 Summary Report that identifies the number and percentage of concurrent review cases 
                                                 requiring lower levels of care and whether they are meeting the required timeframe for 
                                                 UM decision communication.  
          Timeliness of UM Decision Written      Summary report that identifies the timeliness of UM Decision Written Notification.  3.A 
          Notification - Authorization letter    summarizes authorization notification extract validity and completeness, i.e., the 
          extract                                percentage of authorization records that resulted in an appropriate notification record 
                                                 on the authorization notification extract.  (See contract language)
          Percent and number of NOAs and         Report consistent with attached template.  The number and percentage of NOAs and 
          Denials issued within 1 day.           Denials that were issued within three days of the decision.  NOAs and Denials reported 
                                                 separately.
          Complaints Meeting Turnaround Time  Total number of provider and member complaints received and the percent that were 
          (TAT) and Average Amount of Time to  responded to appropriately within 30 days or 45 days with an extension requested.  
          Resolve Complaints (in Days) by        Broken out by provider and member.  Second part reflects average time taken to 
          Quarter                                respond to complaints.   This report summarizes unduplicated complaints processed 
                                                 within the time period. In addition, it indicates the number of complaints received 
                                                 monthly and year to date and breaks out by the caller category.  The reports reflects 
                                                 total number of provider and member complaints resolved and the percent that were 
                                                 resolved within the time frame of 30, 45 and over 45 days.  This report also identifies 
                                                 the average amount of time taken to resolve complaints (measured in days).  This 
                                                 report indicates the number of complaints that remain open at the end of the time 
                                                 period.  (Current) indicates the number of complains that remain open at the time of the 
                                                 report run date.  The second grid summarizes unique complaints received by members 
                                                 identified as DCF at the time the complaint was received.
          Provider Appeals and Determination     Level 1: Total number of first level provider clinical appeals resolved by reason for 
          Timeliness                             appeal, during the reporting time period.  Number and percentage resolved timely.  
                                                 Number and percentage overturned.                 Level 2: Total number of second level 
                                                 provider clinical appeals resolved by reason for appeal, during the reporting time 
                                                 period.  Number and percentage resolved timely.  Number and percentage overturned.
          Member Appeals and Determination       Total number of member clinical appeals resolved by reason for appeal, during the 
          Timeliness                             reporting time period.  Number and percentage of member appeal determinations that 
                                                 met the 30 calendar day timeframe for routine appeals and the 3 day (5 day with a 
                                                 member meeting) timeframe for expedited appeals.  Number and percentage 
                                                 overturned.  Report all of above separately for routine and expedited appeals and 
                                                 combined.  
          Appeals - Administrative               Total number of administrative appeals resolved, by type of appeal for original denial, 
                                                 during the reporting time period.  Number and percentage resolved timely (7 day 
                                                 timeframe).  Number and percentage overturned.
          MIS Down time                          Down time for MIS and telecommunications systems (separately) measured in hours
          Total Number of Calls                  Total number of calls received by clinical queues, customer service queues,  and crisis 
                                                 queue in the identified reporting time frame.       
          Network Call Rerouting (NCR) Report    Report that documents each rerouting incident (including AVR transferred crisis calls) 
                                                 the answer time and the associated reason.
          Utilization Statistics Ages 0-21       Monthly authorization-based utilization statistics by level of care, comparing DCF 
                                                 involved members to the similar non-DCF involved age group, with quarterly and year-
                                                 to-date subtotals.   This report has the three versions: 1) All Providers  2) All Providers 
                                                 Excluding Solnit  3) Solnit Only
          Utilization Statistics with Summary    Monthly auth-based utilization statistics by LOC with summary.  Includes admissions, 
                                                 admissions/1000 member months, days/1000 member months, and average and 
                                                 Median LOS.   Each program will be reported in a separate report.  Monthly 
                                                 authorization-based utilization statistics by age group and level of care, with quarterly 
                                                 and year-to-date subtotals.   This report has the three versions: 1) All Providers  2) All 
                                                 Providers Excluding Solnit  3) Solnit Only
          Inpatient and  Residential Current     A listing of all  members in 24-hour care, indicating  status and reason for delay.  The 
          Daily Census Report                    electronic report shall be sortable by: name, ID, facility, facility type, local area, MCO, 
                                                 date of admission, length of stay, DX, DCF identifier, gender, race/ethnicity, provider, 
                                                 and program ID.  This is a Census Report.  
          Discharge Delay for inpatient levels of  Quarterly report showing statistics (e.g., total days in delay status, number of members 
          care                                   in delay status, average days in delay status) about occurrences of discharge delays by 
                                                 service class and provider.  Includes only those members who received service for IPD, 
                                                 IPF, IPM, residential detoxification, PRTF, Mental Health Group Home, or RTC at any 
                                                 time during the quarter, and were discharged during the quarter or still in care at the 
                                                 end of the quarter.  This report has the three versions: 1) All Providers  2) All Providers 
                                                 Excluding Solnit  3) Solnit Only
          Reasons for inpatient discharge delay  Quarterly report showing counts of occurrences of discharge delay reasons, by local 
          by local area                          area. Includes  members who received service for IPF and were discharged during the 
                                                 quarter or were still in care at the end of the quarter.  This report has the three versions: 
                                                 1) All Providers  2) All Providers Excluding Solnit  3) Solnit Only