834 Transactions Clause Samples

834 Transactions. (1) The Contractor shall submit the electronic 834 transactions monthly to the Florida Medicaid fiscal agent. The Contractor shall transmit the electronic 834 transactions to the Medicaid fiscal agent using the July 2012 Contract XT220 communications protocol through the secured internet site supplied by the fiscal agent. The Contractor is required to submit the electronic 834 transactions for every person who is to be enrolled or disenrolled during the reporting period. (2) The fiscal agent is authorized to process the enrollment input data as an electronic transaction in which payment is generated for each enrollee according to the established capitation rate. On specified dates each month, the Contractor will receive the remittance report accompanied by a payment warrant, check or electronic funds transfer statement. The amount of payment is determined by the number of enrollees enrolled in each capitation category and any adjustments that may apply. (3) Contractors must comply with all the federal requirements of administrative simplification, as documented in the National Electronic Data Interchange Transaction Set Implementation Guide for the Benefit Enrollment and Maintenance EDS X12N 834 Transaction, as well as the EDS/AHCA ANSI ASC X12N 834 Companion Guide. (4) The Contractor shall transmit the electronic 834 transactions monthly to the fiscal agent by the Wednesday preceding the second to the last Saturday of each month. The electronic 834 transactions must include all enrollments submitted from the CARES office, including “Medicaid Pending”, enrollments that did not process from the previous month and disenrollments requested by enrollees or their representative. These enrollments and disenrollments will be effective the first of the next month.