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SANDHILLS CENTER
<br />A LOCAL MANAGEMENT ENTITY - MANAGED CARE ORGANIZATION
<br />MANAGING MENTAL HEALTH, INTELLECTUAL/DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES
<br />910.673.9111 ■ (FAX) 910.673.6202 ■ WWW.SANDHILLSCENTER.ORG ■ VICTORIA WHITT, CEO
<br />Operations Report
<br />1915 (b)(c) Medicaid Waiver Operation
<br />December 2012, January 2013, February 2012, March 3013
<br />Customer Services
<br />December
<br />2012
<br />January
<br />2013
<br />February
<br />2013
<br />March
<br />2013
<br />Medicaid Eligibles and Fundin
<br />2,012
<br />2,632
<br />2,565
<br />3,187
<br />Medicaid Eligibles
<br />81,969
<br />83,827
<br />85,354
<br />85,526
<br />PMPM Payment
<br />$10,127,551
<br />10,261,813
<br />10,498,641
<br />$10,519
<br />- Administration
<br />1,265,944
<br />1,282,727
<br />1,312,330
<br />1,314,961
<br />- Risk Reserve
<br />202,551
<br />205,236
<br />209,973
<br />210,394
<br />- Service Allocation
<br />8,659,056
<br />8,773,850
<br />8,896,338
<br />8,994,335
<br />Customer Services
<br /># of Calls Received
<br />2,012
<br />2,632
<br />2,565
<br />3,187
<br /># of Authorization Requests Approved
<br />1,178
<br />74.0%
<br />1,581
<br />77.3%
<br />1,589
<br />83.6%
<br />1,839
<br />80.5%
<br />Average Speed to Answer
<br />4.7sec
<br />5.07 sec
<br />6.00 sec
<br />6.50 sec
<br />Abandonment Rate
<br />2.00%
<br />4.90%
<br />5.80%
<br />5.70%
<br />Blockage Rate
<br />0.00%
<br />0.00%
<br />0.00%
<br />0.00%
<br /># of Service Requests
<br />220
<br />395
<br />421
<br />287
<br /># of Emergent Appointments
<br />69
<br />113
<br />140
<br />87
<br /># of Urgent Appointments
<br />48
<br />115
<br />115
<br />79
<br /># of Routine Appointments
<br />103
<br />167
<br />166 1
<br />121
<br />Care Management/Utilization
<br />Management
<br /># of Authorization Requests Received
<br />1,591
<br />2,046
<br />1,901
<br />2,283
<br /># of Authorization Requests Approved
<br />1,178
<br />74.0%
<br />1,581
<br />77.3%
<br />1,589
<br />83.6%
<br />1,839
<br />80.5%
<br /># of Administrative Denials Issued
<br />394
<br />24.76%
<br />419
<br />20.5%
<br />260
<br />13.7%
<br />385
<br />16.9%
<br /># of Medical Necessity Denials Issued
<br />19
<br />1.2%
<br />46
<br />2.2%
<br />52
<br />2.7%
<br />59
<br />2.6%
<br /># of Appeals Received
<br />5
<br />15
<br />6
<br />5
<br />% of Urgent Prospective Requests
<br />Reviewed within timeframe
<br />100%
<br />98.1%
<br />98.8%
<br />100%
<br />% of Urgent Concurrent Requests
<br />Reviewed within timeframe
<br />100%
<br />100%
<br />96.1%
<br />98.4%
<br />% of Routine Prospective Requests
<br />Reviewed within timeframe
<br />97.4%
<br />98.6%
<br />99.6%
<br />100%
<br />% of Routine Concurrent Requests
<br />Reviewed within timeframe
<br />98.6%
<br />99.2%
<br />99.8%
<br />100%
<br />P.O. Box 9, West End, NC 27376
<br />URA
<br />Serving Anson, Guilford, Harnett Hoke, Lee, Montgomery, Moore, Randolph, & Richmond Counties ACCREMUD
<br />MAL711 CALL CLN F.R
<br />Available 24 hours a day at 1 -800- 256 -2452 HEALTH NQTMORK
<br />HF TH UnUZAT70N MAN"EMENT
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