Medicaid Managed Care

Procurement Library 2016

  1. Rhode Island Healthcare Transformation Program (ppt)
  2. Grievance and Appeals Process for Medicaid Managed Care
  3. Summary and Analysis of High Utilizers
  4. Analysis of High Utilizers Fact Pack
  5. Rules and Regs for the Utilization Review of Health Care Services
  6. Medicaid Managed Care Health Plan Financial Reporting Program
  7. Provisions for Stop Loss Claiming for Pharmacy Expenditure in Treatment of Enrollees with Hepatitis C
  8. RI Medicaid Managed Care Encounter Data Methodology, Thresholds and Penalties for Non-Compliance
  9. 837 Encounter Companion Guide Version 2.4
  10. NCPDP Encounter Companion Guide Version 2.1
  11. 834 Encounter Data Companion Guide Version 2.1
  12. Standard Companion Guide
  13. 277CA Companion Guide Version 1.3
  14. Medicaid Managed Care Enrollment, Cost, Utilization and Provider Expense
  15. Medicaid Managed Care Enrollment, Cost, Utilization and Provider Expense (xls)
  16. Medicaid Managed Care Providers
  17. RI 1115 Waiver Standard Terms and Conditions
  18. Medicaid Managed Care Final Rule
  19. EOHHS Guidelines for Marketing and Member Communications Materials for RI Medicaid Managed Care Program
  20. Managed Care Reporting Calendar and Template
  21. RI Medicaid Annual Expenditure Report
  22. RI EOHHS Transitioning to Alternative Payment Methodologies: Requirements for Medicaid Managed Care Organizations
  23. RI EOHHS Alternative Payment Methodology Reporting Template for Medicaid Managed Care Organizations
  24. Provisions for Separate Risk/Gain Share for Enrollees in an Integrated Health Home (IHH)








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