Managed Care Organization (MCO) Reports

Provider Investigative Report

The terms of the Medicaid Managed Care/Family Health Plus/HIV Special Needs Plan/Health and Recovery Plan Model Contract, section 18.5(a)(viii)(F), require Managed Care Organizations (MCOs) to submit a Provider Investigative Report to the Office of the Medicaid Inspector General (OMIG) and the Department of Health (DOH) monthly.

The Provider Investigative Report informs OMIG and DOH of any Medicaid provider investigative, educational, or re-educational activities performed by the MCO or its subcontractors, including all overpayments recovered. In addition to reporting investigative activities, the MCO must also upload copies of all Medicaid-related settlement agreements.

This guidance has been updated and is current with the March 1, 2019, Medicaid Managed Care/Family Health Plus/HIV Special Needs Plan/Health and Recovery Plan Model Contract, and subsequent agreements.

Provider Investigative Report Submission Schedule

The Provider Investigative Report must be completed and submitted monthly. Each monthly report is due in accordance with the following submission schedule. Note: When the due date falls on a non-business day, the report is due on the following business day. 


For the Report Period (2024)

Report Submission Due Date



February 29



April 1



April 30



May 31



July 1



July 31



September 3



September 30



October 31



December 2



January 2



January 31

Comprehensive Provider Report Information and Submission Instructions

The Comprehensive Provider Report is a quarterly report identifying the value of claims, payments, referrals, orders, and prescriptions made for members of a Medicaid Managed Care (MMC) Plan. The March 1, 2014 Medicaid Managed Care Model Contract identifies the report requirements in section 18.5 a. xviii. Managed Care Plans submit the required reports quarterly via the NYS Health Commerce System.

The submission timeline is as follows:

Report Period Submission Due Date
Q1: January 1 - March 31 April 30
Q2: April 1 - June 30 July 31
Q3: July 1 - September 30 October 31
Q4: October 1 - December 31 January 31

Please download each of the three documents below by clicking the link.

Comprehensive Provider Report Date Dictionary - Defines the form and format of the Comprehensive Provider Report. Includes report terms and definitions, data element descriptions & examples, and file naming conventions.

V1.1 Released August 1, 2015

Comprehensive Provider Report Submission and Validation Guidance - Outlines the Comprehensive Provider Report submission process. Includes validation error code & description list. 

V1.1 Released August 1, 2015

Comprehensive Plan Total Summary File Template – Excel format template. Save a copy to populate with the Comprehensive Plan Total Summary File data each Quarter. 

V1.1 Released August 1, 2015

Any questions regarding the Comprehensive Provider Report should be sent via email to [email protected].