Heritage Health Plan Reporting Templates

Medicaid Related Assistance
Medicaid & Long-Term Care

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​This page contains form templates for the Heritage Health MCOs to complete & submit to DHHS.


Adult Core Measures.xlsAdult Core Measures1/25/2019 4:19 PM
Annual Electronic Attestation Acknowledgement.docxAnnual Electronic Attestation Acknowledgement1/25/2019 4:19 PM
Annual Program Integrity Confirmation.docxAnnual Program Integrity Confirmation1/25/2019 4:19 PM
Bi-weekly Tips Report.xlsBi-weekly Tips Report1/25/2019 4:19 PM
CAP 2018.xlsxCAP 20181/25/2019 4:19 PM
Certification Statement 2019.xlsxCertification Statement 20198/2/2019 3:04 PM
Child Core Measures.xlsxChild Core Measures1/25/2019 4:19 PM
Claims Payment Accuracy Guide.docxClaims Payment Accuracy Guide1/25/2019 4:19 PM
Claims Payment Accuracy.xlsClaims Payment Accuracy1/25/2019 4:19 PM
Compliance Officer Attestation.docxCompliance Officer Attestation1/25/2019 4:19 PM
Fraud Waste Abuse and Erroneous Payments Annual Plan.docxFraud Waste Abuse and Erroneous Payments Annual Plan1/25/2019 4:19 PM
Geographic Access Standards.xlsGeographic Access Standards1/25/2019 4:19 PM
HH Data Dictionary.docxHH Data Dictionary7/16/2019 8:53 AM
HH Key Staff Contact List.docxHH Key Staff Contact List1/25/2019 4:19 PM
Language Availability Report.xlsxLanguage Availability Report1/25/2019 4:19 PM
LB 1063 Children's Health and Treatment Act.xlsLB 1063 Children's Health and Treatment Act1/25/2019 4:19 PM
LB 1160.xlsxLB 11601/25/2019 4:19 PM
MCO Financial Report-Heritage Health CY19Q1.xlsxMCO Financial Report-Heritage Health CY19Q12/13/2019 3:32 PM
MCO Financial Report-Heritage Health CY19Q2.xlsxMCO Financial Report-Heritage Health CY19Q25/10/2019 1:22 PM
MCO Financial Report-Heritage Health CY19Q3.xlsxMCO Financial Report-Heritage Health CY19Q35/10/2019 1:23 PM
MCO Financial Report-Heritage Health CY19Q4.xlsxMCO Financial Report-Heritage Health CY19Q45/10/2019 1:24 PM
Member Advisory Committee Report.docxMember Advisory Committee Report1/25/2019 4:19 PM
Member-Provider Call Center.xlsMember-Provider Call Center1/25/2019 4:19 PM
Monthly Claims Report.xlsMonthly Claims Report1/25/2019 4:19 PM
Monthly FWA Detection Effort Report.xlsMonthly FWA Detection Effort Report1/25/2019 4:19 PM
Monthly FWA Report.xlsMonthly FWA Report1/25/2019 4:19 PM
MRO report.xlsxMRO report1/25/2019 4:19 PM
Network Development Plan Attestation.docxNetwork Development Plan Attestation1/25/2019 4:19 PM
Network Development Plan.docxNetwork Development Plan1/25/2019 4:19 PM
NF Skilled Stay Authorizations.xlsNF Skilled Stay Authorizations1/25/2019 4:19 PM
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