Transition Monitoring Reports
In order to monitor service access and use, denials and timely payment of providers during the Managed Care transition period, NYS collects bi-weekly reports on claims information as well as monthly inpatient and quarterly outpatient utilization review denials from health plans. Summaries of claims information and utilization review denials are shared with health plans during scheduled round table meetings.
Service Access, Use and Denial Reporting Webinar
These presentations explain contents of denials reporting documents, transmission method, contact database, file-naming conventions, and submission of test files.
- Transition Reports Presentation (May 9, 2016)
- Transition Reports Webinar Questions and Answers (May 9, 2016)
- Transition Reports Presentation (September 18, 2015)
- Transition Reports Webinar Questions and Answers (September 18, 2015)
- Description of Monthly Denial Report - Attachment A
- Visual Guide for Inpatient Denial Monthly Reporting - Attachment A1
- Description of Quarterly Denial Report - Attachment B
- Visual Guide for Outpatient Denial Quarterly Reporting - Attachment B1
- Change Log to Specification and Visual Guide Documents
Please contact OMH Managed Care with any questions, comments or problems you may be experiencing with this site. If you would like to file a complaint about behavioral health managed care, please visit the Information on Filing a Complaint Page. Providers, if you have any questions about the managed care implementation, please complete and send a question form.