Definition and Uses of Shadow Claims Sample Clauses

Definition and Uses of Shadow Claims. The MCO must submit a shadow claim to the State’s fiscal agent for every service rendered to an enrollee for which the MCO either paid or denied reimbursement. Shadow claims are reports of individual patient encounters with the MCO’s health care network. These claims contain fee-for-service equivalent detail as to procedures, diagnoses, place of service, units of service, billed amounts and rendering providers’ identification numbers and other detailed HOOSIER HEALTHWISE STATE/MCO CONTRACT CONTRACT ATTACHMENT 1: MCO SCOPE OF WORK claims data required for quality improvement monitoring and utilization analysis. The State also reserves the right to use these shadow claims to calculate future capitation rates. See Section 8.2 of this Attachment for a schedule of liquidated damages that OMPP may assign due to non-compliance with any of the reporting requirements outlined in this document.
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