Anthem HealthKeepers Plus (Anthem)

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.