Managed Care Systems
- MCS Homepage
- Arbitration Services
- Enrollee Complaint and Appeal Options
- Essential Community Providers
- HMO Annual Reporting
- Health Plan Information
- HMO Licensure
- Mental Health Parity
- Provider Network Adequacy
- Quality, Financial and Enrollment Stats
- Contact Us
Health Plan Reports and Results
Listed below are four areas of public information submitted by HMOs and CBPs as required to maintain licensure. For more information or to view these documents click on the links below.
1. Quality Assurance - Aside from investigating individual complaints, the Department of Health uses the Quality Assurance Examination and Targeted Examination as two vehicles to ensure legal compliance.
2. Financial Reporting - HMOs and CBPs also need to show evidence of financial solvency and are required to submit annual and quarterly financial statements. A financial examination by the Department of Commerce is conducted at least every three years.
3. HEDIS - Each HMO and CBP compiles statistics on quality, access and other performance markers as determined by the NCQA. These statistics are compiled in the same manner by each plan and allows consistent comparison between plans or to measure improvements from year to year.
4. Enrollment - Each HMO and CBP submits enrollment information on a yearly basis. These reports also break down the enrollment populations by product and age.
For more information, email firstname.lastname@example.org.