Sec. 10.09.57.08. Record Keeping and Reports

Latest version.

A. The PCP shall have an effective procedure for reporting to the Department the following information:

(1) The cost of operations;

(2) Patterns of utilization;

(3) The health status of enrollees;

(4) Information demonstrating that the PCP has a fiscally sound operation; and

(5) Complaints and grievances made by enrollees.

B. The PCP shall collect and submit to the Department service specific encounter data by service type in the format and at the frequency designated by the Department.

C. The PCP shall maintain adequate records to document that the services were delivered.

D. The PCP shall prepare and submit to the Department quarterly financial and quality assurance reports as specified by the Department.

                    
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