{"text_format":"1","workbook":"xlsx","n_sheets":21,"sheets":["Table of Contents","PrintWorkbook","Setup","GL Summary Helper","Grievance Log","Lists","Grievance Summary Totals","Grievance Type Codes","Appeal Log","NOABD Log","NOABD-Appeal Summary","Grievance Log Dictionary","Instructions","Grievance Type Codes OLD","Appeal Log Dictionary","NOA-ABD-Appeal Summary Dict.","NOA-ABD Dictionary","NOA-ABD-Appeal Categories","NOABD Categories","Grievance Log Outstanding","Appeal Log Outstanding"],"not_rendered":{"charts":0,"images":6,"macros":1,"external_links":0,"defined_names":87,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Table of Contents","index":0,"n_rows":11,"n_cols":2,"rows_kept":11,"cut":false,"hidden":false,"merged":[]}
["Table of Contents","Tab1"]
["Setup","Tab2"]
["Grievance Log","Tab3"]
["Grievance Summary Totals","Tab4"]
["Grievance Type Codes","Tab5"]
["Appeal Log","Tab6"]
["NOABD Log","Tab7"]
["NOABD-Appeal Summary","Tab8"]
["NOABD Categories","Tab9"]
["Grievance Log Outstanding","Tab10"]
["Appeal Log Outstanding","Tab11"]

{"sheet":"PrintWorkbook","index":1,"n_rows":13,"n_cols":18,"rows_kept":13,"cut":false,"hidden":true,"merged":[]}
["Worksheet","Header",null,null,null,null,null,null,null,null,null,null,null,null,null,"LH","CH","RH"]
["Instructions",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"LF","CF","RF"]
["Grievance Log Dictionary"]
["Grievance Log"]
["Grievance Type Codes"]
["Grievance Summary Totals"]
["Appeals Dictionary "]
["Appeal Log"]
["NOA-ABD-Appeal Summary Dict."]
["NOA-ABD-Appeal Summary"]
["NOA-ABD Dictionary"]
["NOA-ABD Log"]
["NOA-ABD-Appeal Categories"]

{"sheet":"Setup","index":2,"n_rows":17,"n_cols":14,"rows_kept":17,"cut":false,"hidden":false,"merged":[[14,2,14,3],[16,2,18,8],[10,2,12,8],[2,2,2,3],[4,2,4,3],[6,2,6,3],[8,2,8,3],[2,7,2,8]]}
[]
[]
[null,"Select CCO:",null,null,null,null,null,"Table of Contents",null,null,null,null,null,{"$f":"Header01 & CCO & Header02 & ContractYear & Header03","v":"CCO____ Contract Year: ___"}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"VLOOKUP(RptPeriod,tblReportPeriod[],2,FALSE)","v":{"$error":"#N/A"}}]
[null,"Enter Contract Year:"]
[]
[null,"Select Report Period:"]
[]
[null,"Enter Enrollment Number:"]
[]
[null,null,"For the enrollment number, CCOs will use their enrollment numbers from the 834 information.  The enrollment number is an average over the three months of the quarter."]
[]
[]
[]
[null,"Enter Total # of Prior Authorizations (PAs) Received this Quarter"]
[]
[null,null,"For the Total # of PAs, include all PAs received for Physical Health, Behavioral Health, Pharmacy and Dental services"]

{"sheet":"GL Summary Helper","index":3,"n_rows":19,"n_cols":24,"rows_kept":19,"cut":false,"hidden":true,"merged":[]}
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Table of Contents"]
["CLIENT ID","Receipt Date","Grievance Type \n(See TAB Grievance Type Codes)       ","Service Type \n(See last section in TAB Grievance Type Codes)","Date of Resolution","Provider","Clinic","Resolution","# Days to Resolution","Outstanding (Y/N)","Actual Days Resolved","Within 5 Days","6 To 30 Days","Over 30 Days",null,"Logs will appear blank and will expand as data is entered"]
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{"sheet":"Lists","index":5,"n_rows":52,"n_cols":20,"rows_kept":52,"cut":false,"hidden":true,"merged":[]}
["Grievance Type",null,"ServiceType",null,"YesNo",null,"Month","Quarter","EndOfQuarter",null,"CCO",null,"ActionCategory",null,"ActionSubCategory",null,"Report Period","Period Header",null,"Formulas"]
["A.a",null,1,null,"Y",null,1,"Q1",{"$f":"DATE(YEAR(NOW()),3,31)","v":"2022-03-31"},null,"Advanced Health",null,"a",null,1,null,"Jan-Mar","REPORT PERIOD:     OCT-DEC ___      JAN-MAR _X_     APR-JUN___      JUL-SEP___",null,"#=IFERROR(IF(DATEDIF(B4,E4,\"d\")<=7,NETWORKDAYS(B4,E4),DATEDIF(B4,E4,\"d\")),\"\")"]
["A.b",null,2,null,"N",null,2,"Q1",{"$f":"DATE(YEAR(NOW()),3,31)","v":"2022-03-31"},null,"Advantage Dental Services",null,"b",null,2,null,"Apr-Jun","REPORT PERIOD:     OCT-DEC ___       JAN-MAR ___     APR-JUN_X_     JUL-SEP___",null,"#=IFERROR(IF(tblGrievanceLog[@['# Days to Resolution]]=0,1,IF(tblGrievanceLog[@['# Days to Resolution]]<=7,NETWORKDAYS(B4,E4),DATEDIF(B4,E4,\"d\"))),\"\")"]
["A.c",null,3,null,null,null,3,"Q1",{"$f":"DATE(YEAR(NOW()),3,31)","v":"2022-03-31"},null,"Allcare",null,"c",null,3,null,"Jul-Sep","REPORT PERIOD:     OCT-DEC ___       JAN-MAR ___     APR-JUN___      JUL-SEP_X_"]
["A.d",null,4,null,null,null,4,"Q2",{"$f":"DATE(YEAR(NOW()),6,30)","v":"2022-06-30"},null,"Capitol Dental Care",null,"d",null,4,null,"Oct-Dec","REPORT PERIOD:     OCT-DEC _X_      JAN-MAR ___      APR-JUN___      JUL-SEP___"]
["A.e",null,5,null,null,null,5,"Q2",{"$f":"DATE(YEAR(NOW()),6,30)","v":"2022-06-30"},null,"Cascade Health ",null,"e",null,5]
["A.f",null,6,null,null,null,6,"Q2",{"$f":"DATE(YEAR(NOW()),6,30)","v":"2022-06-30"},null,"Columbia Pacific",null,"f"]
["A.g",null,7,null,null,null,7,"Q3",{"$f":"DATE(YEAR(NOW()),9,30)","v":"2022-09-30"},null,"Eastern Oregon",null,"g"]
["A.h",null,8,null,null,null,8,"Q3",{"$f":"DATE(YEAR(NOW()),9,30)","v":"2022-09-30"},null,"Family Dental Care"]
["A.i",null,9,null,null,null,9,"Q3",{"$f":"DATE(YEAR(NOW()),9,30)","v":"2022-09-30"},null,"Health Share"]
["A.j",null,10,null,null,null,10,"Q4",{"$f":"DATE(YEAR(NOW()),12,31)","v":"2022-12-31"},null,"IHN"]
["A.k",null,11,null,null,null,11,"Q4",{"$f":"DATE(YEAR(NOW()),12,31)","v":"2022-12-31"},null,"Jackson Care"]
["A.l",null,12,null,null,null,12,"Q4",{"$f":"DATE(YEAR(NOW()),12,31)","v":"2022-12-31"},null,"Managed Dental Care Of Oregon"]
["A.m",null,13,null,null,null,null,null,null,null,"Oregon Dental Service (ODS)"]
["A.n",null,14,null,null,null,null,null,null,null,"PSCS-CG"]
["A.o",null,15,null,null,null,null,null,null,null,"PSCS-CO"]
["A.p",null,16,null,null,null,null,null,null,null,"PSCS-Lane"]
["IP.a",null,17,null,null,null,null,null,null,null,"PSCS-MP"]
["IP.b",null,18,null,null,null,null,null,null,null,"Trillium"]
["IP.c",null,19,null,null,null,null,null,null,null,"Umpqua"]
["IP.d",null,20,null,null,null,null,null,null,null,"Yamhill County"]
["IP.e",null,21]
["IP.f",null,22]
["IP.g",null,23]
["IP.h",null,24]
["IP.i"]
["IP.j"]
["IP.k"]
["IP.l"]
["IP.m"]
["CR.a"]
["CR.b"]
["CR.c"]
["CR.d"]
["CR.e"]
["CR.f"]
["CR.g"]
["CR.h"]
["CR.i"]
["CR.j"]
["CR.k"]
["CR.l"]
["QC.a"]
["QC.b"]
["QC.c"]
["QC.d"]
["QC.e"]
["QC.f"]
["QS.a"]
["QS.c"]
["CB.a"]
["CB.c"]

{"sheet":"Grievance Summary Totals","index":6,"n_rows":34,"n_cols":7,"rows_kept":34,"cut":false,"hidden":false,"merged":[]}
[]
[]
[null,"ACCESS - \"A\"","Counts",null,null,null,"Table of Contents"]
[null,"TOTAL:",{"$f":"tblGrievanceTypeA[[#Totals],[Totals]]","v":0}]
[null,"OUTSTANDING:",{"$f":"tblGrievanceTypeA[[#Totals],[Pendings]]","v":0}]
[null,"RESOLVED:",{"$f":"A_Resolved","v":0}]
[null,"INTERACTION WITH PROVIDER OR PLAN - \"IP\" ","Counts"]
[null,"TOTAL:",{"$f":"tblGrievanceTypeIP[[#Totals],[Totals]]","v":0}]
[null,"OUTSTANDING:",{"$f":"tblGrievanceTypeIP[[#Totals],[Pendings]]","v":0}]
[null,"RESOLVED:",{"$f":"IF(C9=\"\",\"\",C8-C9)","v":0}]
[null,"CONSUMER RIGHTS - \"CR\"","Counts"]
[null,"TOTAL:",{"$f":"tblGrievanceTypeCR[[#Totals],[Totals]]","v":0}]
[null,"OUTSTANDING:",{"$f":"tblGrievanceTypeCR[[#Totals],[Pendings]]","v":0}]
[null,"RESOLVED:",{"$f":"IF(C13=\"\",\"\",C12-C13)","v":0}]
[null,"Quality-of-Care - \"QC\"","Counts"]
[null,"TOTAL:",{"$f":"tblGrievanceTypeQC[[#Totals],[Totals]]","v":0}]
[null,"OUTSTANDING:",{"$f":"tblGrievanceTypeQC[[#Totals],[Pendings]]","v":0}]
[null,"RESOLVED:",{"$f":"IF(C17=\"\",\"\",C16-C17)","v":0}]
[null,"QUALITY OF SERVICE - \"QS\"","Counts"]
[null,"TOTAL:",{"$f":"tblGrievanceTypeQS6[[#Totals],[Totals]]","v":0}]
[null,"OUTSTANDING:",{"$f":"tblGrievanceTypeQS6[[#Totals],[Pendings]]","v":0}]
[null,"RESOLVED:",{"$f":"IF(C21=\"\",\"\",C20-C21)","v":0}]
[null,"CLIENT BILLING ISSUES - \"CB\"","Counts"]
[null,"TOTAL:",{"$f":"tblGrievanceTypeCB[[#Totals],[Totals]]","v":0}]
[null,"OUTSTANDING:",{"$f":"tblGrievanceTypeCB[[#Totals],[Pendings]]","v":0}]
[null,"RESOLVED:",{"$f":"IF(C25=\"\",\"\",C24-C25)","v":0}]
[null,"OTHER"]
[null,"OUTSTANDING:",{"$f":"GrievancePendingTotal","v":0}]
[null,"GRAND TOTAL",{"$f":"GrievanceGrandTotal","v":0}]
[null,"Enrollment Numbers:",{"$f":"EnrollmentNumber","v":0}]
[null,"Per 1000 members:",{"$f":"GrievancesPer1000Members","v":""}]
[null,"% Resolved within 5 Business Days",{"$f":"IFERROR(GrievancesResolvedWithin5Days/GrievanceGrandTotal,\"\")","v":""}]
[null,"% Resolved between 6 & 30 calendar days",{"$f":"IFERROR(GrievancesResolved6To30Days/GrievanceGrandTotal,\"\")","v":""}]
[null,"% Resolved past 30 calendar days",{"$f":"IFERROR(GrievancesResolvedOver30Days/GrievanceGrandTotal,\"\")","v":""}]

{"sheet":"Grievance Type Codes","index":7,"n_rows":61,"n_cols":4,"rows_kept":61,"cut":false,"hidden":false,"merged":[[2,2,2,3]]}
["Complaint categories and sub-categories",null,"Table of Contents"]
[]
["ACCESS",null,"SERVICE TYPE: Column D in the Grievance Log must have a Service type code."]
["A.a) Provider's office unresponsive, not available, difficult to contact for appointment or information. ",null,"1)   Durable Medical Equipment (DME)","12)  Alcohol & Drug/Substance Use Disorder (SUD)"]
["A.b) Plan unresponsive, not available, difficult to contact for appointment or information. ",null,"2)   Occupational Therapy (OT)","13)  Specialty Care"]
["A.c) Provider's office too far away, not convenient",null,"3)   Physical Therapy (PT)","14)  Long Term Care (LTC)"]
["A.d) Unable to schedule appointment in a timely manner. ",null,"4)   Hospital","15)  Primary Care Provider (PCP)"]
["A.e) Unable to be seen in a timely manner for urgent/emergent care ",null,"5)   Emergency Room (ER)","16)  Outpatient"]
["A.f) Provider's office closed to new patients. ",null,"6)   Ambulance/Medical Transportation","17)  Other"]
["A.g) Referral or 2nd opinion denied/refused by provider. ",null,"7)   Residential Rehabilitation","18)  Diagnostic Studies"]
["A.h) Referral or 2nd opinion denied/refused by plan.",null,"8)   Pharmacy","19)  Imaging"]
["A.i) Provider not available to give necessary care",null,"9)   Dental","20)  NEMT"]
["A.j) Eligibility issues ",null,"10) Mental Health","21)  Vision"]
["A.k) Female or male provider preferred, but not available ",null,"11) Pain Management","22)  CCO/ Plan"]
["A.l) NEMT not provided, late pick up w/missed appointment, no coordination of services ",null,null,"23)  Chiropractic"]
["A.m) Dismissed by provider as a result of past due billing issues ",null,null,"24)  Acupuncture"]
["A.n) Dismissed by clinic as a result of past due billing issues "]
["A.o) Verbal denial of service by Provider"]
["A.p) Verbal denial of service by Plan"]
["INTERACTION WITH PROVIDER OR PLAN "]
["IP.a) Wants to change providers; provider not a good fit. "]
["IP.b) Provider rude or inappropriate comments or behavior"]
["IP.c) Plan rude or inappropriate comments or behavior "]
["IP.d) Provider explanation/instruction inadequate/incomplete"]
["IP.e) Plan explanation/instruction inadequate/incomplete "]
["IP.f) Wait too long in office before receiving care "]
["IP.g) Member not treated with respect and due consideration for his/her dignity and privacy "]
["IP.h) Provider's office or/and provider exhibits language or cultural barriers or lack of cultural sensitivity, interpreter services not available."]
["IP.i) Plan's office or staff exhibits language or cultural barriers or lack of cultural sensitivity "]
["IP.j) Member has difficulty understanding provider due to language or cultural barriers. "]
["IP.k) Lack of communication and coordination among providers "]
["IP.l) Dismissed by provider (member misbehavior, missed appts. etc.) "]
["IP.m) Dismissed by clinic (member misbehavior, missed appts. Etc.) "]
["Consumer Rights"]
["CR.a) Provider's office has a physical barrier/not ADA compliant, prevents access to office, lavatory, examination room, etc."]
["CR.b) Concern over confidentiality."]
["CR.c) Member dissatisfaction with treatment plan (not involved, didn't understand, choices not reflected, not person centered, disagrees, tooth not restorable, preference for individual settings vs. group, treatment options not discussed) "]
["CR.d) No choice of clinical or clinician choice not available  "]
["CR.e) Fraud and financial abuse  "]
["CR.f) Provider/Plan bias barrier (age, race, religion, sexual orientation, mental/physical health, marital status, Medicare/Medicaid) "]
["CR.g) Complaint/appeal process not explained, lack of adequate or understandable NOA "]
["CR.h) Not informed of consumer (Member) rights "]
["CR.i) Member denied access to medical records (other than as restricted by law) "]
["CR.j) Did not respond to members request to amend inaccurate or incomplete information in the medical record (includes right to submit a statement of disagreement) "]
["CR.k) Advanced or Mental Health Directive not discussed, offered or followed. "]
["CR.l) Concern that a form of restraint or seclusion was used as a means of coercion, discipline, convenience or retaliation, as specified in other Federal regulations on the use of restraints and seclusion. Restraint or seclusion used other than to assure members immediate safety. "]
["Quality of Care"]
["QC.a) Received care, experienced an adverse outcome, complications, misdiagnosis or concern related to provider care. "]
["QC.b) Testing / assessment insufficient, inadequate or omitted "]
["QC.c) Concern about prescriber or medication or medication management issues (prescribed non-formulary medication, unable to get prescription filled or therapeutic alternative recommended by Provider or Plan) "]
["QC.d) Member neglect or physical, mental or psychological abuse "]
["QC.e) Provider office unsafe/unsanitary environment or equipment "]
["QC.f) Lack of appropriate individualized setting in treatment. "]
["Quality of Service"]
["QS.a) Delay in receiving or concern regarding quality of materials and supplies (DME) or dental "]
["QS.b) Lack of access to medical records or unable to make changes "]
["QS.c) Benefits not covered "]
["Client Billing Issues"]
["CB.a) Co-pays "]
["CB.b) Premiums "]
["CB.c) Member complaint about OHP clients receiving a bill, without signing a waiver "]

{"sheet":"Appeal Log","index":8,"n_rows":3,"n_cols":20,"rows_kept":3,"cut":false,"hidden":false,"merged":[[1,1,1,5],[1,6,1,16],[0,0,0,16]]}
[]
[null,"NOABD Associated with the Appeal",null,null,null,null,"Appeals",null,null,null,null,null,null,null,null,null,null,null,null,"Table of Contents"]
["Client ID","Date of Request of \nService / Item","Date of NOABD (or EOB - See instructions)","Action Category","Sub Category","Service Type","Date of Appeal Request","CCO Extension   Y/N","Expedited Granted  Y/N","Denied Service Upheld Y/N","Overturned at Appeal Y/N","Partial Denial Y/N","Date Member Withdrew Appeal ","Dismissed Late Filing Y/N","Invalid Waiver Y/N","Continuing Benefits \nProvided \nY / N","Date of NOAR","Completed","Days between Date of NOAR and Appeal Request Date","Logs will appear blank and will expand as data is entered"]

{"sheet":"NOABD Log","index":9,"n_rows":3,"n_cols":14,"rows_kept":3,"cut":false,"hidden":false,"merged":[]}
[]
["NOABD Log",null,null,null,null,null,null,null,null,null,null,null,null,"Table of Contents"]
["Client ID","Date of Request of \nService / Item","Date of NOABD (or EOB - See Dictionary for instructions)","Action Category","Sub Category","Service Type","# Days between Request and NOABD","CCO Extension   Y/N","Services Previusly Authorized Y/N","Expedited Granted  Y/N"]

{"sheet":"NOABD-Appeal Summary","index":10,"n_rows":37,"n_cols":6,"rows_kept":37,"cut":false,"hidden":false,"merged":[[0,0,0,4],[21,1,21,3],[0,5,1,5]]}
[null,null,null,null,null,"Table of Contents"]
[null,"NOABD TOTALS "]
["NOABDs issued in the quarter\nSummary of Action Categories"," Number of NOABDs per Category"]
["a) Denial or limited authorization of a requested service.",{"$f":"NOA_Summary_Total_A","v":0}]
["b) Single PHP service area, denial to obtain services outside the PHP panel",{"$f":"NOA_Summary_Total_B","v":0}]
["c) Termination, suspension or reduction of previously authorized covered services",{"$f":"NOA_Summary_Total_C","v":0}]
["d) Failure to act within the timeframes provided in § 438.408(b)",{"$f":"NOA_Summary_Total_D","v":0}]
["e) Failure to provide services in a timely manner, as defined by the State",{"$f":"NOA_Summary_Total_E","v":0}]
["f) Denial of payment, at the time of any  action affecting the claim.",{"$f":"NOA_Summary_Total_F","v":0}]
["g) Denial of a member's request to dispute a financial liability",{"$f":"NOA_Summary_Total_G","v":0}]
["Total",{"$f":"SUBTOTAL(109,Table9[[ Number of NOABDs per Category]])","v":0}]
[]
["Grievance System Report Summary - NOABD"]
["Timeframes","Percents"]
["% of NOABDs where timeframe was extended",{"$f":"IFERROR(NOA_CCO_Extension/NOACount,\"\")","v":""}]
["% of NOABDs (services not previously authorized) issued after 28 days (standard – 14 days with 14 day extension)",{"$f":"IFERROR(NOA_GreaterThan_28_Days/NOACount,\"\")","v":""}]
["% of NOABDs (services previously authorized) issued after 10 days",{"$f":"IFERROR(NOA_Svcs_Previously_Authorized_GreaterThan_10Days/NOACount,\"\")","v":""}]
["% of NOABDs issued after 17 days (expedited – 72 hours with extension up to 14 days)",{"$f":"IFERROR(NOA_Expedited_Over_17_Days/NOACount,\"\")","v":""}]
[]
["NOTE: These calculations are based on a 'Y' answer in columns H, I, and J."]
[]
[null,"Appeal Totals"]
["APPEAL\nSummary of Action Categories"," Appeals ","Overturned at Plan Level","Decision Outstanding"]
["a) Denial or limited authorization of a requested service.",{"$f":"Appeal_Summary_Total_A","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Overturned at Appeal Y/N],\"Y\",tblAppealsLog[Action Category],\"a\"),\"\")","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Date of Appeal Request],\"<>\"&\"\",tblAppealsLog[Date of NOAR],\"\",tblAppealsLog[Action Category],\"a\"),\"\")","v":0}]
["b) Single PHP service area, denial to obtain services outside the PHP panel",{"$f":"Appeal_Summary_Total_B","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Overturned at Appeal Y/N],\"Y\",tblAppealsLog[Action Category],\"b\"),\"\")","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Date of Appeal Request],\"<>\"&\"\",tblAppealsLog[Date of NOAR],\"\",tblAppealsLog[Action Category],\"b\"),\"\")","v":0}]
["c) Termination, suspension or reduction of previously authorized covered services",{"$f":"Appeal_Summary_Total_C","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Overturned at Appeal Y/N],\"Y\",tblAppealsLog[Action Category],\"c\"),\"\")","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Date of Appeal Request],\"<>\"&\"\",tblAppealsLog[Date of NOAR],\"\",tblAppealsLog[Action Category],\"c\"),\"\")","v":0}]
["d) Failure to act within the timeframes provided in § 438.408(b)",{"$f":"Appeal_Summary_Total_D","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Overturned at Appeal Y/N],\"Y\",tblAppealsLog[Action Category],\"d\"),\"\")","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Date of Appeal Request],\"<>\"&\"\",tblAppealsLog[Date of NOAR],\"\",tblAppealsLog[Action Category],\"d\"),\"\")","v":0}]
["e) Failure to provide services in a timely manner, as defined by the State",{"$f":"Appeal_Summary_Total_E","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Overturned at Appeal Y/N],\"Y\",tblAppealsLog[Action Category],\"e\"),\"\")","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Date of Appeal Request],\"<>\"&\"\",tblAppealsLog[Date of NOAR],\"\",tblAppealsLog[Action Category],\"e\"),\"\")","v":0}]
["f) Denial of payment, at the time of any  action affecting the claim.",{"$f":"Appeal_Summary_Total_F","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Overturned at Appeal Y/N],\"Y\",tblAppealsLog[Action Category],\"f\"),\"\")","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Date of Appeal Request],\"<>\"&\"\",tblAppealsLog[Date of NOAR],\"\",tblAppealsLog[Action Category],\"f\"),\"\")","v":0}]
["g) Denial of a member's request to dispute a financial liability",{"$f":"Appeal_Summary_Total_G","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Overturned at Appeal Y/N],\"Y\",tblAppealsLog[Action Category],\"g\"),\"\")","v":0},{"$f":"IFERROR(COUNTIFS(tblAppealsLog[Date of Appeal Request],\"<>\"&\"\",tblAppealsLog[Date of NOAR],\"\",tblAppealsLog[Action Category],\"g\"),\"\")","v":0}]
[]
["Grievance System Report Summary - Appeals"]
["Timeframes","Percents"]
["% denials overturned on appeal",{"$f":"IFERROR(Overturned_At_Appeal/AppealCount,\"\")","v":""}]
["% Notice of  Appeal Resolution issued after 30 days (standard)",{"$f":"IFERROR(NOAR_GreaterThan_30Days_After_AppealRequest/AppealCount,\"\")","v":""}]
["% Notice of  Appeal Resolution issued after 17 days (expedited)",{"$f":"IFERROR(Expedited_Appeals_GreaterThan_17Days/AppealCount,\"\")","v":""}]
["% of appeals where timeframe was extended",{"$f":"IFERROR(Appeal_Extension_Count/AppealCount,\"\")","v":""}]

{"sheet":"Grievance Log Dictionary","index":11,"n_rows":14,"n_cols":6,"rows_kept":14,"cut":false,"hidden":true,"merged":[]}
["Grievance Log Dictionary"]
["Worksheet ","Column Header","Required Y/N","Definition",null,"Table of Contents"]
["Column A","CLIENT ID","Y","Oregon Health Plan (OHP) identification number (Medicaid number, NOT an internal ID number for the member)"]
["Column B","Receipt Date","Y","Grievances are reported on the date the complaint was received. "]
["Column C","Grievance Type -  See tab Grievance Type Codes","Y","This is a data verified field - it will only accept the approved code in the correct format."]
["Column D","Service Type - See  last section in tab Grievance Type Codes","Y","This is a data verified field - it will only accept the approved code in the correct format."]
["Column E","Date of Resolution","Y*","Date the complaint was resolved/ if not resolved leave field blank. See Page 6 of the instructions for more information about Column E, and Page 7 of the instructions - Reporting OUTSTANDING grievances/complaints for additional information."]
["Column F","Provider","Y","Name of provider complaint is about:  Last name, First name"]
["Column G","Clinic","Y","Name of clinic or location complaint is about, if complaint is about the location, not an individual "]
["Column H","Resolution","Y","Summarize the resolution."]
["Column I","# Days to Resolution","Auto calculation","Auto calculation - this field will be autocalculated based on the time between the date in Column B and Column E"]
["Column J","Outstanding","Auto calculation","Auto calculation - this field will be autocalculated based on whether or not there is a date in Column E. …..See Page 7 of the instructions for Column J and Reporting OUTSTANDING grievances/complaints for additional information."]
[]
[null,"*Leave blank if grievance resolution is pending"]

{"sheet":"Instructions","index":12,"n_rows":17,"n_cols":4,"rows_kept":17,"cut":false,"hidden":true,"merged":[[15,0,15,1],[3,0,7,0],[11,0,12,0],[0,0,0,1],[2,0,2,1],[8,0,8,1],[10,0,10,1],[13,0,13,1]]}
[]
["General Instructions for Exhibit I Grievance and Appeal System reporting: ","Detailed instructions for submitting CCO contract Exhibit I Deliverables are provided as a separate document.  This document is posted along with the reporting tool on the website. See page 4 of the detailed instructions for additional information.",null,"Table of Contents"]
[]
["Grievance Log","Include all oral and written complaints and grievances. This includes all complaints and grievances collected from CCOs and their sub-contractors. "]
[null,"What is a grievance: Federal CFR 42 438.400(b)(7) Grievance means an expression of dissatisfaction about any matter other than an adverse benefit determination.  Grievances may include, but are not limited to, the quality of care or services provided, and aspects of interpersonal relationships such as rudeness of a provider or employee, or failure to respect the enrollee's rights regardless of whether remedial action is requested. Grievance includes an enrollee's right to dispute an extension of time proposed by the MCO, PIHP or PAHP to make an authorization decision. "]
[null,"Record each grievance on separate lines that can be identified by a grievance type code."]
[null,"Reporting is based on the received date of the grievance.  "]
[null,"Resolved means: When all aspects of the complaint have been resolved and the member has been notified."]
[]
["Appeal Log","Appeals are listed by the date they are received. The log must be fully filled out. OHA is not requiring the Hearings information to be submitted, however, CCOs must keep all hearings information with the Appeal Log as part of the CCOs \"Maintaining Records\" responsibility."]
[]
["NOA-ABD Log","The new rules go into effect on January 1, 2018 which changes the name of the Notice of Action (NOA) to Adverse Benefit Determination (ABD).  OHA has decided to refer to the acronym as NOA-ABD for this contract year. "]
[]
[]
["NOA-ABD-Appeal Summary","CCOs must report all NOAs-ABDs and appeals that were issued during the quarter. See page 11 of the instructions for additional information."]
[]
["Grievance System Report","Per the CCO Contract Exhibit I (9)(e). A Grievance System Report is due to the Contract Administration Unit 45 days following the end of each calendar quarter. The Contractor shall incorporate data collected from monitoring of its grievance system to analyze its Grievance System, including all grievances and appeals data reported by the CCO in the Grievance and Appeal Log. The analysis of the Grievance System shall demonstrate how the CCO uses data collected by the CCO and its sub-delegates, to maintain an effective process for monitoring, evaluating and improving the access, quality and appropriateness of services provided to members.  The Contractor shall address all sections in the Grievance System Report template provided by OHA. The Grievance System Report is a separate document from the Grievance and Appeals Log and is available at: http://www.oregon.gov/oha/HSD/OHP/Pages/CCO-Contract-Forms.aspx"]

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["ACCESS - \"A\"",null,null,"Table of Contents"]
["A.a) Provider's office unresponsive, not available, difficult to contact for appointment or information."]
["A.b) Plan unresponsive, not available, difficult to contact  for appointment or information."]
["A.c) Provider's office too far away, not convenient"]
["A.d) Unable to schedule appointment in a timely manner."]
["A.e) Unable to be seen in a timely manner for urgent/emergent care"]
["A.f) Provider's office closed to new patients."]
["A.g) Referral or 2nd opinion denied/refused by provider."]
["A.h) Referral or 2nd opinion denied/refused by plan."]
["A.i) Provider not available to give necessary care"]
["A.j) Eligibility issues"]
["A.k) Female or male provider preferred, but not available"]
["A.l) NEMT not provided, late pick up w/missed appointment, no coordination of services"]
["A.m) Dismissed by provider as a result of past due billing issues"]
["A.n) Dismissed by clinic as a result of past due billing issues"]
["INTERACTION WITH PROVIDER OR PLAN - \"IP\" "]
["IP.a) Wants to change providers; provider not a good fit."]
["IP.b) Provider rude or inappropriate comments or behavior"]
["IP.c) Plan rude or inappropriate comments or behavior"]
["IP.d) Provider explanation/instruction inadequate/incomplete"]
["IP.e) Plan explanation/instruction inadequate/incomplete"]
["IP.f) Wait too long in office before receiving care"]
["IP.g) Member not treated with respect and due consideration for his/her dignity and privacy"]
["IP.h) Provider's office or/and provider exhibits language or cultural barriers or lack of cultural sensitivity, interpreter services not available."]
["IP.i) Plan's office or staff exhibits language or cultural barriers or lack of cultural sensitivity"]
["IP.j) Member has difficulty understanding provider due to language or cultural barriers."]
["IP.k) Lack of communication and coordination among providers"]
["IP.l) Dismissed by provider (member misbehavior, missed appts. etc.)"]
["IP.m) Dismissed by clinic (member misbehavior, missed appts. Etc.)"]
["CONSUMER RIGHTS - \"CR\""]
["CR.a) Provider's office has a physical barrier/not ADA compliant, prevents access to office, lavatory, examination room, etc."]
["CR.b) Concern over confidentiality."]
["CR.c) Member dissatisfaction with treatment plan (not involved, didn't understand, choices not reflected, not person centered, disagrees, tooth not restorable, preference for individual settings vs. group, treatment options not discussed)"]
["CR.d) No choice of clinical or clinician choice not available "]
["CR.e) Fraud and financial abuse "]
["CR.f) Provider bias barrier (age, race, religion, sexual orientation, mental/physical health, marital status, Medicare/Medicaid)"]
["CR.g) Complaint/appeal process not explained, lack of adequate or understandable NOA"]
["CR.h) Not informed of consumer (Member) rights"]
["CR.i) Member denied access to medical records (other than as restricted by law)"]
["CR.j) Did not respond to members request to amend inaccurate or incomplete information in the medical record (includes right to submit a statement of disagreement)"]
["CR.k) Advanced or Mental Health Directive not discussed, offered or followed."]
["CR.l) Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in other Federal regulations on the use of restraints and seclusion. Restraint or seclusion used other than to assure members immediate safety."]
["Quality-of-Care - (QC)\nA concern that the care provided did not meet a professionally recognized standard of health care and a Member may have been exposed to serious harm as a result or may potentially be exposed to imminent future harm as a result of the quality of care provided. "]
["QC.a) Received appropriate care, but experienced an adverse outcome, complications, misdiagnosis or concern related to provider care."]
["QC.b) Testing / assessment insufficient, inadequate or omitted"]
["QC.c) Concern about prescriber or medication or medication management issues (prescribed non-formulary medication, unable to get prescription filled or therapeutic alternative recommended by Provider or Plan)"]
["QC.d) Member neglect or physical, mental or psychological abuse"]
["QC.e) Provider office unsafe/unsanitary environment or equipment"]
["QC.f) Lack of appropriate individualized setting in treatment."]
["QUALITY OF SERVICE - \"QS\""]
["QS.a) Delay in receiving or concern regarding quality of materials and supplies (DME) or dental"]
["QS.b) Lack of access to medical records or unable to make changes"]
["QS.c) Benefits not covered"]
["CLIENT BILLING ISSUES - \"CB\""]
["CB.a) Co-pays"]
["CB.b) Premiums"]
["CB.c) Billing OHP clients without a waiver"]
["MISCELLANEOUS\nUse to capture issues not related to quality"]
[]
[]
[]
[]
[]
[]
["Service Type\nDrop Down Menu\nNot required to use, but must address in the analysis."]
["1) DME                                                                                                                                  ","17) Other"]
["2) OT","18) Diagnostic Studies"]
["3) PT","19) Imaging"]
["4) Hospital","20) NEMT"]
["5) ER"]
["6) Ambulance / Medical Transportation"]
["7) Residential Rehabilitation"]
["8) Pharmacy"]
["9) Dental"]
["10) Mental Health"]
["11) Pain Management"]
["12) Alcohol & Drug (A&D)"]
["13) Specialty Care"]
["14) Long Term Care"]
["15) PCP"]
["16) Outpatient"]

{"sheet":"Appeal Log Dictionary","index":14,"n_rows":19,"n_cols":6,"rows_kept":19,"cut":false,"hidden":true,"merged":[]}
["Appeal Log Dictionary"]
["Worksheet ","Column Header","Required Y/N","Definition",null,"Table of Contents"]
["Column A","Appeal Log- Client ID","Y","Oregon Health Plan (OHP) identification number (Medicaid number, NOT an internal ID number for the member)"]
["Column B","Date of Request of \nService / Item","Y","Date the provider requested the service. See page 8 of the instructions for more information about what date is required."]
["Column C","Date of NOA-ABD, OR EOB","Y","Date of Notice of Action (NOA-ABD) or Explanation of Benefit (EOB) that is associated with the appeal in column G. EOBs must meet the same requirements as the NOA-ABD. See page 8 of the instructions for additional information."]
["Column D","Action Category","Y","See Tab 14 NOA-ABD-Appeal Categories. See tab NOA-ABD-Appeal Categories. This is a data verified field - it will only accept the approved code in the correct format. See page 8 of the instructions for an explanation of each Action Code."]
["Column E","Sub-Category","Y -  if action category is a, c, or f","See Tab 14 NOA-ABD-Appeal Categories. See tab NOA-ABD-Appeal Categories. This is a data verified field - it will only accept the approved code in the correct format. See page 9 of the instructions for an explanation of each sub-category."]
["Column F","Service Type",null,"See Tab 14 NOA-ABD-Appeal Categories. See tab NOA-ABD-Appeal Categories. This is a data verified field - it will only accept the approved code in the correct format."]
["Column G","Date of Appeal Request","Y","Date the appeal request was received at the plan"]
["Column H","CCO Extension","Y - if applicable","Select y if CCO extended the timeframe"]
["Column I","Expedited Granted ","Y - if applicable","Select y if an expedited appeal was granted"]
["Column J","Denied Service Upheld","Y - if applicable","Select y if denied service decision was upheld on appeal"]
["Column K","Overturned at Appeal","Y - if applicable","Select y if denied service decision was overturned on appeal"]
["Column L","Partial Denial ","Y - if applicable","Select y if the decision was a partial denial/partial approval"]
["Column M","Date Member Withdrew Appeal","Y - if applicable","Date member withdrew appeal if applicable"]
["Column N","Dismissed Late Filing","Y - if applicable","Select y if appeal denied due to late filing"]
["Column O","Invalid Waiver","Y - if applicable","Select y if invalid waiver was signed"]
["Column P","Continuing Benefits Provided","Y - if applicable","Select y  if continuing benefits were provided during appeal process"]
["Column Q","Date of NOAR","Y - if applicable","Enter the date the letter of appeal resolution was sent to the member.  If the appeal has not been resolved by the end of the quarter, leave the field blank. See page 10 of the instructions for Column Q and Reporting OUTSTANDING appeals for additional information."]

{"sheet":"NOA-ABD-Appeal Summary Dict.","index":15,"n_rows":11,"n_cols":6,"rows_kept":11,"cut":false,"hidden":true,"merged":[]}
["NOA-ABD Summary Dictionary",null,null,null,null,"Table of Contents"]
["Worksheet ","Column Header","Required Y/N","Definition"]
["Column A","Summary of Action Categories","Y","See Tab 14 NOA-ABD-Appeal Categories. Action Category a.-f. - See tab NOA-ABD-Appeal Categories"]
["Column B","# of NOAs/ABDs per Category","Y","This is the total number of NOAs/ABDs that were issued during the quarter.  These totals are auto calculated from Tab 13 the NOA-ABD Log."]
[]
["Appeals Summary"]
["Worksheet ","Column Header","Required Y/N","Definition"]
["Column A","Summary of Action Categories","Auto calculation ","See Tab 14 NOA-ABD-Appeal Categories. Action Category a.-f. - See tab NOA-ABD-Appeal Categories"]
["Column B","Appeals","Auto calculation ","This field is auto calculated from the Appeals Log Column G  and sorted by the a.-f. Action Categories."]
["Column C","Overturned at Plan Level","Auto calculation ","This field is auto calculated from the Appeals Log Column K  and sorted by the a.-f. Action Categories."]
["Column D","Decision Pending","Auto calculation ","This field is auto calculated from the Appeals Log Column Q and sorted by the a.-f. Action Categories."]

{"sheet":"NOA-ABD Dictionary","index":16,"n_rows":11,"n_cols":6,"rows_kept":11,"cut":false,"hidden":true,"merged":[]}
["NOA-ABD Log Dictionary"]
["Worksheet ","Column Header","Required Y/N","Definition",null,"Table of Contents"]
["Column A","Client ID","Y","Oregon Health Plan (OHP) identification number (Medicaid number, NOT an internal ID number for the member)"]
["Column B","Date of Request of \nService / Item","Y","Date the service or item was requested"]
["Column C","Date of NOA -OR- EOB (EOB must include Appeal/Hearing rights)","Y","Date of Notice of Action or Evidence of Benefit.  "]
["Column D","Action Category","Y","See Tab 14 NOA-ABD-Appeal Categories. See tab NOA-ABD-Appeal Categories. This is a data verified field - it will only accept the approved code in the correct format."]
["Column E","Sub Category","Y -  if action category is a, c, or f","See Tab 14 NOA-ABD-Appeal Categories. See tab NOA-ABD-Appeal Categories. This is a data verified field - it will only accept the approved code in the correct format."]
["Column F","Service Type","Y","See Tab 14 NOA-ABD-Appeal Categories. See tab NOA-ABD-Appeal Categories. This is a data verified field - it will only accept the approved code in the correct format."]
["Column G","Days to Resolution ","Y","Auto calculated field of number of days between Column B and Column C"]
["Column H","CCO Extension","Y","Select y if CCO extended the timeframe"]
["Column I","Expidited Granted","Y","Select y if an expedited appeal was granted"]

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["ACTION CATEGORIES (CFR Requirement):",null,null,"Table of Contents"]
["a) Denial or limited authorization of a requested service:"]
["b) Single PHP service area, denial to obtain services outside the PHP panel"]
["c) Termination, suspension, or reduction of previously authorized covered services"]
["d) Failure to act within the timeframes provided in § 438.408(b)"]
["e) Failure to provide services in a timely manner, as defined by the State"]
["f) Denial of payment at the time of any action affecting the claim"]
[]
["SUB CATEGORIES:  Note:  these are sub-categories for a, c, or f above. "]
["     (1) Treatment is not a covered service"]
["     (2) Requires PA and was not preauthorized (includes  non-panel provider requirement for PA)"]
["     (3) The service is not medically appropriate"]
["     (4) The service or item was received in an emergency care setting and does not qualify as an emergency service."]
["     (5) The Provider is not on the Contractor's panel and prior approval was not obtained (if such prior authorization would be required under OHP rules)"]
[]
["Service Type\nDrop Down Menu\nNot required to use, but must address in the analysis."]
["1) DME                                                                                                                                  ","17) Other"]
["2) OT","18) Diagnostic Studies"]
["3) PT","19) Imaging"]
["4) Hospital","20) NEMT"]
["5) ER"]
["6) Ambulance / Medical Transportation"]
["7) Residential Rehabilitation"]
["8) Pharmacy"]
["9) Dental"]
["10) Mental Health"]
["11) Pain Management"]
["12) Alcohol & Drug (A&D)"]
["13) Specialty Care"]
["14) Long Term Care"]
["15) PCP"]
["16) Outpatient"]

{"sheet":"NOABD Categories","index":18,"n_rows":33,"n_cols":4,"rows_kept":33,"cut":false,"hidden":false,"merged":[[3,0,10,0],[19,0,19,1]]}
["ACTION CATEGORIES ","EXPLANATION",null,"SUB CATEGORIES:  NOABDs listed in the Appeal Log and the NOABD Log with ABD Categories a, c, or f must also have a sub-category in Column E.  "]
["Required by the Code of Federal Regulations (CFR) ","Every Notice of Adverse Benefit Determination (NOABD) listed in the Appeal Log and the NOABD Log must have an Action Category in Column D. ",null,"1) Treatment is not a covered service "]
["42 CFR §438.400","Below are explanations for each category.",null,"2) Requires PA and was not preauthorized (includes non-panel provider requirement for PA) "]
["a) The denial or limited authorization of a requested service, including determinations based on the type or level of service, requirements for medical necessity, appropriateness, setting, or effectiveness of a covered benefit.     42 CFR §438.400(b)(1)","A member or member’s doctor requests a service and the MCE determines the member:",null,"3) The service is not medically appropriate   "]
[null,"·         cannot have the service;",null,"4) The service or item was received in an emergency care setting and does not qualify as an emergency service. "]
[null,"·         can have the service, but not the number or in the amount of the service requested (ex. A member requests 10 PT visits, but is only granted 5 PT visits or, a member requests 3 month supply of a medication, but they are only granted a 1 month supply); ",null,"5) The Provider is not on the Contractor's panel and prior approval was not obtained (if such prior authorization would be required under OHP rules)"]
[null,"·         the service requested is for a setting that the MCE believes is not appropriate (ex. A member requests to have a dental procedure in a hospital, but the MCE decides the member does not meet MCE criteria for a hospital dental procedure); "]
[null,"·         requested a service that is determined by the MCE to be experimental, investigative, or not medically necessary; "]
[null,"·         was/is not eligible for OHP at the time services were/are requested; "]
[null,"·         requested a service that is not a covered service; or"]
[null,"·         record is missing information necessary for the MCE to approve the requested service."]
["b) Denial of a member’s request to obtain services outside the managed care entity panel. Use this category when the MCE is denying a member's request to exercise his or her right, under §438.52(b)(2)(ii), to obtain services outside the network (42 CFR 438.400(b)(6).  ","When an MCE does not agree (approve) to let a member access services outside of the MCE provider network, this is an adverse benefit determination."]
["c) The reduction, suspension, or termination of a previously authorized service.   42 CFR  §438.400(b)(2)","When the MCE stops or decreases a service a member is already receiving, this is an ABD."]
["d) The failure of an MCE to act within the timeframes provided in §438.408(b)(1) and (2) regarding the standard resolution of grievances and appeals. 42 CFR §438.400(b)(5)","When the MCE fails to resolve a standard appeal within the required timeframes, this is an ABD, and the MCE must send the member a NOABD. Report any ABD by the MCE because the MCE failed to resolve a grievance or an appeal within the timelines required in the Contract and OAR (42 CFR 438.400(b)(5).  The member is considered to have exhausted the MCE appeals process and may request a hearing with OHA."]
["e) The failure to provide services in a timely manner, as defined by the State.  42 CFR §438.400(b)(4)","When a member has to wait longer than standard, urgent or emergency timeframes in the MCE Contract and OAR to get health care or receive a service, this is an ABD and the MCE must send the member an NOABD."]
["f) The denial, in whole or in part, of payment for a service. 42 CFR §438.400(b)(3)","a member has already received a service, but the MCE determines that it cannot pay for the service; this is an adverse benefit determination.  "]
["g)  Denial of a member's request to dispute a financial liability, including cost sharing, copayments, premiums, deductibles, coinsurance, and other member financial liabilities. Use this category for ABD issued by the MCE to deny a member’s request to dispute a financial liability (42 CFR 438.400(b)(7).  ","A member received a bill for services that they believe the MCE should have paid for, but didn’t. If the MCE investigates and determines that the member signed an ‘agreement to pay form’ and the member is required to pay, the MCE must send the member a NOABD."]
[]
[]
["SERVICE TYPE: Column F in the Appeal Log and the Notice of Adverse Benefit Determination (NOABD) Log must have       a Service type code."]
["1)   Durable Medical Equipment (DME)","12)  Alcohol & Drug/Substance Use Disorder (SUD)"]
["2)   Occupational Therapy (OT)","13)  Specialty Care"]
["3)   Physical Therapy (PT)","14)  Long Term Care (LTC)"]
["4)   Hospital","15)  Primary Care Provider (PCP)"]
["5)   Emergency Room (ER)","16)  Outpatient"]
["6)   Ambulance/Medical Transportation","17)  Other"]
["7)   Residential Rehabilitation","18)  Diagnostic Studies"]
["8)   Pharmacy","19)  Imaging"]
["9)   Dental","20)  NEMT"]
["10) Mental Health","21)  Vision"]
["11) Pain Management","22)  CCO/ Plan"]
[null,"23)  Chiropractic"]
[null,"24)  Acupuncture"]

{"sheet":"Grievance Log Outstanding","index":19,"n_rows":3,"n_cols":12,"rows_kept":3,"cut":false,"hidden":false,"merged":[]}
[]
[null,null,null,null,null,null,null,null,null,null,null,"Table of Contents"]
["CLIENT ID","Receipt Date","Grievance Type \n(See TAB Grievance Type Codes)       ","Service Type \n(See last section in TAB Grievance Type Codes)","Date of Resolution","Provider","Clinic","Resolution","# Days to Resolution","Outstanding (Y/N)",null,"Logs will appear blank and will expand as data is entered"]

{"sheet":"Appeal Log Outstanding","index":20,"n_rows":3,"n_cols":17,"rows_kept":3,"cut":false,"hidden":false,"merged":[[0,0,0,16]]}
["Outstanding Appeals"]
[]
["Client ID","Date of Request of \nService / Item","Date of NOABD (or EOB - See Dictionary for instructions)","Action Category","Sub Category","Service Type","Date of Appeal Request","CCO Extension   Y/N","Expedited Granted  Y/N","Denied Service Upheld Y/N","Overturned at Appeal Y/N","Partial Denial Y/N","Date Member Withdrew Appeal ","Dismissed Late Filing Y/N","Invalid Waiver Y/N","Continuing Benefits \nProvided \nY / N","Date of NOAR"]