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.
Comprehensive Provider Report Data Dictionary 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.
Comprehensive Provider Report Submission and Validation Guidance 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.
Comprehensive Plan Total Summary File Template V1.1 Released August 1, 2015
Any questions regarding the Comprehensive Provider Report should be sent via email to [email protected].