HealthCheck Provider Education System

HealthCheck Training

Trouble with this course?
e-mail us at healthcheck@ncemch.org

Post-Test

Overview

Health Supervision

Special Health Issues

Documentation

Go To Resources »

Documentation

Reporting

 

What the MCOs Report to DHCF

MCOs must report the following to DHCF:

  • Monthly, quarterly and annual enrollment reports using client encounter data
  • Feedback on operational issues, including system problems and overall enrollment problems

*

What DHCF Reports to the Federal Government

DHCF must report to CMS, by April 1 of each year, health screening information using Form CMS 416 (PDF) for children participating in the managed care and fee-for service programs for the year ending September 30 of the previous year.

See 1995 to 2007 National Data.

This data allows the federal government to analyze and compare the delivery of EPSDT services in the states.

 

The Role of the Primary Care Physician in the Reporting Process

The PCP must report certain data to the MCO to enable it to make required reports to DHCF.

DC's fiscal agent is responsible for reporting fee-for-service provider EPSDT procedure code data on or before March 1 of each year for inclusion in the annual CMS 416 Report.

The role of the PCP in documenting and reporting EPSDT services is crucial!

previous pagenext page

 

Decrease Font Size Increase Font Size Back to Top Print
District of Columbia Department of Health Care Finance Georgetown University Home Resources Training Contact