Eligibility/Enrollment Interface Sample Clauses
Eligibility/Enrollment Interface. The enrollment interface must provide eligibility data between TDH and HMOs.
(1) Provides benefit package data to HMOs in accordance with capitated services.
(2) Provides PCP assignments.
(3) Provides Member eligibility status data.
(4) Provides Member demographics data.
(5) Provides HMOs with cross-reference data to identify duplicate Members.
Eligibility/Enrollment Interface. The enrollment interface must provide eligibility data between TDH and HMOs.
(1) Provides benefit package data to HMOs in accordance with capitated services.
(2) Provides PCP assignments.
(3) Provides Member eligibility status data.
(4) Provides Member demographics data.
(5) Provides HMOs with cross-reference data to identify duplicate Members. Dallas Service Area Contract 95 10.9.5 Encounter/Claim Data Interface. The encounter/claim interface must transfer paid fee-for-service claims data to HMOs and capitated services/encounters from HMO, including adjustments. This file will include all service types, such as inpatient, outpatient, and medical services. TDH's agent will process claims for non-capitated services.
Eligibility/Enrollment Interface. The enrollment interface must provide eligibility data between HHSC and HMOs.
1. Provides benefit package data to HMOs in accordance with capitated services;
2. Provides PCP assignments;
3. Provides Member eligibility status data;
4. Provides Member demographics data; and
5. Provides HMOs with cross-reference data to identify duplicate Members.
Eligibility/Enrollment Interface. The enrollment interface must provide eligibility data between TDH and HMOs. 1999 Renewal Contract Bexar Service Area August 9, 1999
(1) Provides benefit package data to HMOs in accordance with capitated services.
(2) Provides PCP assignments.
(3) Provides Member eligibility status data.
(4) Provides Member demographics data.
(5) Provides HMOs with cross-reference data to identify duplicate Members.