Reporting Obligations

The forms and processes below are intended for Medica network providers to use in responding to reporting obligations required by law, contract or accreditation standards (including those required by the National Committee for Quality Assurance, or NCQA^®).

These forms and processes do not necessarily constitute an all-inclusive list of reporting obligations. However, we want providers to be aware of some important items.

Top Requirements

Quality Complaint Reporting +

The state of Minnesota requires providers to report all quality complaints received at the clinic level to the enrollee's health plan. (Minnesota Statute 62D.123, Subd. 2 and Minnesota Rules 4685.1110 Subp.9) Complaints directed to the medical group are to be investigated and resolved by the medical group. Providers will also cooperate with Medica to resolve such complaints from members. Quality complaints are defined as concerns regarding access to services, communication/behavior, coordination of care, technical competence, and appropriateness of services affecting patient safety or comfort.

Medical groups must provide a written report to the Medica Quality Improvement Department on a quarterly basis. Please submit by the second Friday following the end of each quarter. Reporting is required even if no complaints are received during the quarter. Please see the Member Complaints section of your provider agreement, as well as the process and form at the links below.

Complaint Review Process
Quality Complaint Reporting form (PDF)

REV 9/2023

Serious Reportable Events +

Medica providers in all states are required to notify Medica immediately whenever a serious reportable event, also known as an adverse health event or “never event,” happens to a Medica member. The Serious Reportable Events policy describes reporting requirements and processes.

Serious Reportable Events policy (PDF)
Serious Reportable Events Identification Form (PDF)

In addition, Minnesota Statute 144.7065 requires Minnesota hospitals, freestanding outpatient surgical centers and regional treatment centers to report specific adverse health events to the Minnesota Department of Health (MDH). A complete list of reportable events can be found on the MDH website.

Further information about Minnesota state reporting requirements can be found in the Adverse Health Events section on the MDH website.

REV 9/2023

Termination of Health Services +

If a Medica network provider refuses to continue providing health care services to a member, the provider must notify Medica of his/her intention to discontinue treating the member. For more information on the provider refusal of care process, providers should reference Termination of Health Services by a Provider.

Termination of Health Services by a Provider

REV 9/2023