Common use of Data Tape Clause in Contracts

Data Tape. A quarterly data tape shall be prepared that will contain the following data fields. The tape shall reflect claims and encounters entered during the quarter and shall be delivered to FHKC according to the time table listed below. PHP shall also provide quarterly tapes that reflect claims run-off once the contract between PHP and FHKC terminates. REQUIRED DATA FIELDS TO BE CAPTURED . Provider's name, address and tax I.D. number (and payee's group number if applicable) . Patient's name, address, social security number, I.D. number, birth date, and sex . Third party payor information, including amount(s) paid by other payor(s). . Primary and secondary diagnosis code(s) and treatment(s) related to diagnosis . Date(s) of service . Procedure code(s) . Unit(s) of service . Total charge(s) . Total payment(s) Additional required hospital fields include the following: . Date and type of admission (emergency, outpatient, inpatient, newborn, etc.) . For inpatient care: covered days and date of discharge EXHIBIT H (Continued) Specific pharmacy fields include: . Pharmacy name and tax I.D. number . Other payor information . Rx number and date filled . National drug code, manufacturer number, item number, package size, quantity, days supply . Prescriber's Florida Department of Professional Regulations number REQUIRED TAPE FORMAT SPECIFICATIONS The tape format is as follows: . 1600 BPI . EBCDIC

Data Tape. A quarterly data tape shall be prepared that will contain the following data fields. The tape shall reflect claims and encounters entered during the quarter and shall be delivered to FHKC according to the time table listed below. PHP INSURER shall also provide quarterly tapes that reflect claims run-off once the contract this Agreement between PHP INSURER and FHKC terminates. REQUIRED DATA FIELDS TO BE CAPTURED . - Provider's name, address and tax I.D. number (and payee's group number if applicable) ). - Patient's name, address, social security number, I.D. number, birth date, and sex sex. - Third party payor information, including amount(s) paid by other payor(s). . - Primary and secondary diagnosis code(s) and treatment(s) related to diagnosis diagnosis. - Date(s) of service service. - Procedure code(s) ). - Unit(s) of service service. - Total charge(s) ). - Total payment(s) ). Additional required hospital fields include the following: . - Date and type of admission (emergency, outpatient, inpatient, newborn, etc.) ). - For inpatient care: covered days and date of discharge discharge. AMERIGROUP FLORIDA, INC. Effective Date: October 1, 2005 EXHIBIT H G (ContinuedCONTINUED) Specific pharmacy fields include: . - Pharmacy name and tax I.D. number number. - Other payor information information. - Rx number and date filled filled. - National drug code, manufacturer number, item number, package size, quantity, days supply supply. - Prescriber's Florida Department of Professional Regulations number REQUIRED TAPE FORMAT SPECIFICATIONS The tape format is as follows: . 1600 BPI . EBCDICnumber.