Topic Area
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Subject Line Language
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Regulatory Citation |
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Annual Reports
| Annual Report (insert 4-digit year)
e.g., Annual Report 2021 | 28 Pa. Code § 9.604(a) |
| Quarterly Reports | Quarterly Report (insert 4-digit year)-Q(insert quarter #)
e.g., Quarterly Report 2021-Q1 | 28 Pa. Code § 9.604(b) |
Certificate of Authority Application
(includes foreign HMOs)
| COA-(insert company name)
e.g., COA-ABC Company
| 28 Pa. Code §§ 9.631, 9.635 |
| Delegation of HMO operations | HMO-Delegation of Operations-(insert company name)
e.g., HMO-Delegation of Operations-ABC Company | 28 Pa. Code § 9.634 |
| Use of subnetworks – Approval Request | HMO-Subnetwork-(insert company name)
e.g., HMO-Subnetwork-ABC Company | 28 Pa. Code § 9.653 |
Annual Quality Assurance Plan
(for information only)
| QA Plan-(insert 4-digit year)-(insert company name)
e.g., QA Plan-2021-ABC Company
| 28 Pa. Code § 9.674(b)(9) |
Delegation of Medical Management
(for review and approval) | Med Management Delegation-(insert company name)
e.g., Med Management Delegation-ABC Company
| 28 Pa. Code § 9.675 |
Service Area Expansion
Note: Initial network adequacy filings and QHP network adequacy review filings are to be submitted as part of the applications with which they are associated.
| Service Area Expansion-(insert company name)
e.g., Service Area Expansion-ABC Company
| 28 Pa. Code § 9.679 |
Access for persons with disabilities
(for information only) | ADA Access-(insert company name)
e.g., ADA Access-ABC Company | 28 Pa. Code § 9.680 |
| Complaint Procedures | Complaint Procedures-(insert company name)
e.g., Complaint Procedures-ABC Company | 28 Pa. Code § 9.702(a)(6) |
| Grievance Procedures | Grievance Procedures-(insert company name)
e.g., Grievance Procedures-ABC Company | 28 Pa. Code § 9.702(a)(6) |
| External Grievance request | External Grievance Request-(insert company name)
e.g., External Grievance Request-ABC Company | 28 Pa. Code § 9.707(b)(2) |
Expedited External Review request
(in addition to fax or phone as outlined in reg) | EXPEDITED External Review-(insert company name)
e.g., EXPEDITED External Review-ABC Company | 28 Pa. Code § 9.709(h) |
| Provider Contracts | Provider Contract-(insert company name)
e.g., Provider Contract-ABC Company | 28 Pa. Code § 9.722(a) |
| Amended Provider Contracts | Amended Provider Contract-(insert company name)
e.g., Amended Provider Contract-ABC Company | 28 Pa. Code § 9.722(b) |
| IDS Notification and Contract approval | IDS Notification-(insert company name)
e.g., IDS Notification-ABC Company | 28 Pa. Code §§ 9.723(b), 9.724(b) & (c), 9.725 |
New CRE Application
Notes:
BMC will create a secure SharePoint site for applicants to upload their applications.
Mail checks for certification fees to the BMC at the address below.
| CRE Certification-(insert company name)
e.g., CRE Certification-ABC Company | 28 Pa. Code § 9.743
|
CRE Renewal
Notes:
The renewal application should be uploaded to the Company's assigned SharePoint.
Mail checks for certification fees to the BMC at the address below.
| CRE Renewal-(insert company name)
e.g., CRE Renewal-ABC Company | 28 Pa. Code § 9.748(b)
|
| Credentialing plan | Credentialing Plan-(insert company name)
e.g., Credentialing Plan-ABC Company | 28 Pa. Code § 9.761(b) |
| PPO Credentialing | PPO Application-(insert company name)
e.g., PPO Application-ABC Company | 31 Pa. Code Ch. 152 (§§ 152.4 & 152.6) |
| PPO Annual Reporting | PPO Annual Report-(insert year)
e.g., PPO Annual Report-2021 | 31 Pa. Code § 152.19 |
| NCQA Documents | NCQA -(insert company name)-(insert doc type)
e.g., NCQA-ABC Company-Final Corrective Action Report
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