C. Benefits and Care Management

GUIDANCE DOCUMENTS FORMS AND TEMPLATES
Cost Sharing Approach (Feb. 4, 2019 | v1.0) BCM001-J Institute of Mental Disease (IMD) Report (Jan. 30, 2019 | v1.0)
SMAC Rate File Layout for Generic Drugs (Feb. 4, 2019 | v1.0) BCM002-J Medical Prior Authorization Monthly Report (Jan. 30, 2019 | v1.0)
  BCM003-J Pharmacy Benefit Determination/Prior Authorization Report (Jan. 30, 2019 | v1.0)
  BCM004-J Antipsychotic Safety Monitoring Report for Members through Age 17 (Jan. 30, 2019 | v1.0)
  BCM005-J Pharmacy DUR Program Report 1 (Jan. 30, 2019 | v1.0)
 

BCM005-J Pharmacy DUR Program Report 2 (Jan. 30, 2019 | v1.0)

  BCM005-J Pharmacy DUR Program Report 3 (Jan. 30, 2019 | v1.0)
  BCM005-J Pharmacy DUR Program Report 4 (Jan. 30, 2019 | v1.0)
  BCM006-J Pharmacy Financial Arrangements Attestation (Jan. 30, 2019 | v1.0)
  BCM007-J EPSDT Reports (Jan. 30, 2019 | v1.0)
  BCM008-J NEMT Utilization and Expenditures (Jan. 30, 2019 | v1.0)
  BCM009-J Care Management Beneficiary Dataset and Quality Measures Dataset (Jan. 30, 2019 | v1.0)
  BCM010-J Care Management Return on Investment (ROI) Report (Jan. 30, 2019 | v1.0)
  BCM011-J Prevention and Population Health Report (Jan. 30, 2019 | v1.0)
 

BCM012-J Tobacco Cessation Program Report (Jan. 30, 2019 | v1.0)

 

BCM013-J Opioid Misuse and Prevention Program Report
(Jan. 30, 2019 | v1.0)

 

BCM015-J Psychotropic Medications for Youth Report (Jan. 30, 2019 | v1.0)

  BCM016-J CMARC & CMHRP Correction Action Plan Report (Jan. 30, 2019 | v1.0)
  BCM017-J Care Management for At-Risk Children (CMARC) Performance Report (Jan. 30, 2019 | v1.0)
  BCM018-J Care Management for High-Risk Pregnancies (CMHRP) Performance Report (Jan. 30, 2019 | v1.0)
  BCM019-J Care Needs Screening Report (Jan. 30, 2019 | v1.0)
  BCM020-J Local Health Department (LHD) Payment Report (Jan. 30, 2019 | v1.0)
  BCM021-J Advanced Medical Home (AMH) Tier Status Change (Jan. 30, 2019 | v1.0)
  BCM022-J Advanced Medical Home (AMH) Payment Report (Jan. 30, 2019 | v1.0)
 

BCM023-J AMH Quality Measures Report (Jan. 1, 2019 | v1.0)

  BCM025-J Hospice Duration Report (Jan. 30, 2019 | v1.0)
  BCM026-J Nursing Facility Transitions Report (Feb. 20, 2019 | v1.0)
  BCM027-J ABD Screening for Care Management (Feb. 20, 2019 | v1.0)
  BCM028-J LTSS Care Planning Trends (Jan. 30, 2019 | v1.0)
  BCM029-J LTSS Care Management Intervention (2019 | v1.0)
  BCM030-J LTSS Care Management Ratio (Feb. 20, 2019 | v1.0)
  BCM031-J LTSS/CDSA Report (Feb. 11, 2019 | v1.0)
  BCM038-J Admission & Readmission Summary Report (Feb. 11, 2019 | v1.0)
  BCM041-J Medical Prior Authorization Layout (Feb. 28, 2019 | v1.0)
  BCM042-J Pharmacy Prior Authorizations Layout (Feb. 28, 2019 | v1.0)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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