ODJFS Methods and Specifications for Data Quality and Performance Measures for the Covered Families and Children Medicaid Managed Care Program

Provider Agreement Effective July 1, 2011 to June 30, 2012

   Appendix H

•  Managed Care Provider Network File Specifications

   Appendix L

• ODJFS Methods for Encounter Data Quality Measures

• ODJFS Encounter Data Submission Specifications (Post-MITS Implementation):
  • ODJFS Encounter Data Submission Guidelines
  • ODJFS Encounter Data Submission Schedule
  • Ohio Companion Guide 837 Encounter Professional Claims
  • Ohio Companion Guide 837 Encounter Institutional Claims
  • Ohio Companion Guide 837 Encounter Dental Claims
  • Ohio Companion Guide Draft NCPDP 5.1 Pharmacy Encounter Claims
  • Ohio Companion Guide 277 Unsolicited Claim/Encounter Status Notification
  • Ohio Companion Guide 824 Application Advice

• ODJFS Care Management File and Submission Specifications
• ODJFS Appeal File and Submission Specifications
• ODJFS Grievance File and Submission Specifications 
• ODJFS Utilization Management Tracking Database: Prior Authorization File and Submission Specifications

   Appendix M

• ODJFS Methods for Members with Special Health Care Needs Performance Measures
• ODJFS Methods for the Consumer Satisfaction Performance Measure
• ODJFS Methods for MCP Self-Reported, Audited HEDIS Results