Attachment I: Part C Reporting Requirements Summary Chart

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Attachment I: Part C Reporting Overview
Measure
Type Plans Required to Report
Report Freq./
Level
Report
Period (s)
Data Due date (s)
1. Benefit Utilization
CCP, PFFS, 800 series, 1876 Cost, Demo, MSA 
CCP, PFFS, Demo, MSA, SNPs (includes all 800 series plans), Employer/Union Direct Contract
1/year
PBP
1/1-12/31
5/31/09 for CY 2007 data and 7/31/09 for CY 2008 data. After that, 5/31 of following year. 
8/31 of the following year.
2. Procedure Frequency
CCP, PFFS, 800 series, 1876 Cost, Demo, MSA
 CCP, PFFS, Demo, MSA (includes all 800 series plans) , Employer/Union Direct Contract
1/year
Contract
1/1-12/31
2/28 of following year
5/31 of following year
3. Serious Reportable Adverse Events 
CCP, PFFS, 800 series, 1876 Cost, Demo, MSA
CCP, PFFS, Demo, MSA (includes all 800 series plans) , Employer/Union Direct Contract
1/year
Contract
1/1-12/31
2/28 of following year
5/31 of following year
4. Provider Network Adequacy
CCP, 1876 Cost, Demo (includes all 800 series plans) CCP, PFFS, 800 series, 1876 Cost, Demo, MSA
2 1/year
Contract
1/1 -6/30
7/1-12/311/1-12/31
8/31
2/28 of following year
5. Grievances
CCP, PFFS, 1876 Cost, Demo, MSA (includes all 800 series plans) , Employer/Union Direct ContractCCP, PFFS, 800 series, 1876 Cost, Demo, MSA
4/Year
Contract
1/1-3/31
4/1-6/30
7/1-9/30
10/1-12/31
5/31
8/31
11/30
2/28 of following year
6. Organization Determinations/
Reconsiderations
CCP, PFFS, 1876 Cost, Demo, MSA (includes all 800 series plans) , Employer/Union Direct Contract
CCP, PFFS, 800 series, 1876 Cost, Demo, MSA
4/Year
Contract
1/1-3/31
4/1-6/30
7/1-9/30
10/1-12/31
5/31
8/31
11/30
2/28 of following year
7. Employer Group Plan Sponsors
CCP, PFFS, 1876 Cost, Demo, MSA (includes sponsors of individual plans and 800 series plans)
All individual MA plans and “800 series” MA Plans sponsored by employer groups 
2/year
PBP
1/1 -6/30
7/1-12/31
8/31
2/28 of following year
8. PFFS Plan Enrollment Verification Calls 
PFFSPFFS, 800 series
1/year
PBP
1/1-12/31
2/28 of following year

9. PFFS Provider Payment Dispute Resolution Process
PFFS (includes all 800 series plans) , Employer/Union Direct Contract
PFFS, 800 series
1/year
PBP
1/1-12/31
2/28 of following year
10. Agent Commission Structure
CCP, PFFS, 1876 Cost, Demo, MSA (includes all 800 series plans)
CCP, PFFS, 800 series, 1876 Cost, Demo, MSA
1/year
Contract
1/1-12/31
2/28 of following year
11. Agent Training and Testing
CCP, PFFS, 1876 Cost, Demo, MSACCP, PFFS, 800 series, 1876 Cost, Demo, MSA
1/year
Contract
1/1-12/31
2/28 of following year
12. Plan Oversight of Agents
CCP, PFFS, 1876 Cost, Demo, MSA (includes all 800 series plans)
CCP, PFFS, 800 series, 1876 Cost, Demo, MSA
4/Year
Contract
1/1-3/31
4/1-6/30
7/1-9/30
10/1-12/31
5/31
8/31
11/30
2/28 of following year
13. SNPS Care Management
SNPs (includes all 800 series plans)

1/Year/PBP
1/1-12/31
5/31 of following year