| Case ID |
Date |
Points |
Issue Type |
Description |
| 20748 |
1/12/2023 |
10 |
Reporting |
Non-compliance with the Encounters Evaluation Guide and Data Quality Score Card (DQSC) for State Fiscal Year 2023, Quarter 1. |
| 20647 |
12/9/2022 |
10 |
Care Coordination |
Inappropriate CCC Plus Waiver enrollment. |
| 20488 |
8/3/2022 |
5 |
Other |
Use of inaccurate Level of Care (LOC) benefit information resulting in capitation overpayments. |
| 20190 |
2/1/2022 |
5 |
Reporting |
Non-compliance with the Encounters Evaluation Guide and Data Quality Score Card (DQSC) for State Fiscal Year 2023, Quarter 1. |
| 20083 |
11/17/2021 |
5 |
Other |
MCO granted approval for their Fiscal/Employer Agent (F/EA) to change Department of Social Services (DSS) Criminal Background Process without prior approval by Department of Medical Assistance Services (DMAS). |
| 20081 |
11/17/2021 |
10 |
Other |
Migration of online web portal and website platform without approval by DMAS. |
| 20080 |
11/17/2021 |
10 |
Financial |
Error in FICA tax processes by MCO's Fiscal/Employer Agent (F/EA) vendor. |
| 19707 |
5/4/2021 |
10 |
Care Coordination |
A technology-dependent member was authorized by Anthem to receive 8 hours of private duty nursing (PDN) per day, without documentation of a primary caregiver. The member was left alone without a trained primary caregiver who accepted responsibility for providing care whenever nursing was not in the home, and there was not a back-up plan when services were not rendered as planned. |
| 19488 |
6/17/2020 |
5 |
Claims |
Untimely claims payment. |
Virginia Medicaid