STAR PLUS HMO Complaints Comparison 87,272 Amerigroup Members as of May 2011 complaints per 1000 = 0.60 - PowerPoint PPT Presentation

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STAR PLUS HMO Complaints Comparison 87,272 Amerigroup Members as of May 2011 complaints per 1000 = 0.60

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STAR+PLUS HMO Complaints Comparison 87,272 Amerigroup Members as of May 2011 complaints per 1000 = 0.60 STAR+PLUS HMO Complaints Comparison 58,137 Superior Members as ... – PowerPoint PPT presentation

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Title: STAR PLUS HMO Complaints Comparison 87,272 Amerigroup Members as of May 2011 complaints per 1000 = 0.60


1
STARPLUS HMO Complaints Comparison 87,272
Amerigroup Members as of May 2011complaints per
1000 0.60
2
STARPLUS HMO Complaints Comparison 58,137
Superior Members as of May 2011complaints per
1000 1.2
3
STARPLUS HMO Complaints Comparison 51,534
Molina Members as of May 2011complaints per
1000 2
4
STARPLUS HMO Complaints Comparison 57,836
Evercare Members as of May 2011complaints per
1000 1.2
5
STARPLUS HMO Complaints Comparison 696 Bravo
Members as of May 2011Operational Start Date
05/01/2011
6
STARPLUS HMO Complaints Comparison 45,877
Members in Bexar Service Area as of May
2011Complaints per 1000 0.6
7
STARPLUS HMO Complaints Comparison 91,648
Members in Harris Service Area as of May
2011Complaints per 1000 0.8
8
STARPLUS HMO Complaints Comparison 18,449
Members in Nueces Service Area as of May
2011Complaints per 1000 1.03
9
STARPLUS HMO Complaints Comparison 17,833
Members in Travis Service Area as of May
2011Complaints per 1000 1.3
10
STARPLUS HMO Complaints Comparison 81,668
Members in Dallas Expansion Area as of May
2011Complaints per 1000 1.7
11
Liquidated Damages STARPLUS Program FY 2011
Provider Name 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Totals
Amerigroup Texas, Inc. 76,075 76,075
Evercare of Texas L.L.C. 3,500 3,500
Molina Healthcare of Texas 500 500
Superior Health Plan 500 500
Bravo Health Plan 0 0
Totals 80,575 80,575
12
Liquidated Damages STARPLUS Program FY 2010
Provider Name 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Totals
Amerigroup Texas, Inc. 10,000.00 0.00 500.00 46,625.00 57,125.00
Evercare of Texas L.L.C. 1,700.00 13,500.00 25,500.00 25,500.00 66,200.00
Molina Healthcare of Texas 0.00 3,691.66 500.00 500.00 4,691.66
Superior Health Plan 12,500.00 400.00 0.00 0.00 12,900.00

Totals 24,200.00 17,591.66 26,500.00 72,625.00 140,916.66
13
Amerigroup FY 11Corrective Action Plan Status
as of 1st Quarter FY 2011
Service Area Issue CAP Status
Harris, Nueces, Travis Claims Processing Underperformance Acute and behavioral health appealed claims not adjudicated within 30 days Open- CAP issued Q4 FY 10
Bexar, Nueces and Tarrant Children of migrant farm workers reporting deficiencies  HHSC has determined Amerigroups collaborative efforts with organizations that work with migrants in the Nueces, Bexar and Tarrant Service areas were insufficient. Open CAP issued Q4 FY 10
14
Evercare FY 11Corrective Action PlanStatus as
of 1st Quarter FY 2011
Service Area Issue CAP Status
Harris PCP Error Rate at 31.1 Open CAP issued Q1 FY 11

15
Molina FY 11 Corrective Action PlanStatus as of
1st Quarter FY 2011
Service Area Issue CAP Status
Harris, Bexar Encounter Rejection Rate Noncompliant with standards. Open - Cap issued Q1 FY 10
16
Superior FY 11Corrective Action PlanStatus as
of 1st Quarter FY 2011
Service Area Issue CAP Status
Bexar, Nueces Claims Process Underperformance Acute appealed claims not adjudicated within 30 days. Open Issued Q3 FY 10
17
Bravo FY 11Corrective Action PlanStatus as of
1st Quarter FY 2011 Operational Start Date
05/01/2011
Service Area Issue CAP Status
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