Eligibility Transmission, Generally Sample Clauses
The 'Eligibility Transmission, Generally' clause defines the procedures and requirements for transmitting information related to eligibility, typically in the context of benefits, services, or insurance. It outlines how eligibility data must be communicated between parties, such as through electronic systems or standardized forms, and may specify timing, format, and security measures. This clause ensures that eligibility information is shared accurately and efficiently, reducing errors and delays in determining who qualifies for certain programs or services.
Eligibility Transmission, Generally. (A) The Department shall provide to the Contractor an Eligibility Transmission which is an electronic file that includes data on individuals the Department certifies as being Medicaid-eligible and who have been enrolled in the Contractor’s PMHP. The Eligibility Transmission will include new Enrollees, reinstated Enrollees, retroactive Enrollees, terminated Enrollees and Enrollees whose eligibility information results in a change to a critical field.
(B) The Eligibility Transmission will be in accordance with the Utah Health Information Network (UHIN) standard. The Contractor shall have the ability to receive and process the Eligibility Transmission.
(C) Critical fields found in the Eligibility Transmission shall include:
(1) Enrollee's case number;
(2) case name;
(3) eREP identification number;
(4) name;
(5) date of birth;
(6) date of death;
(7) social security number;
(8) gender;
(9) prevalent language;
(10) race;
(11) Capitation Rate Cell;
(12) pregnancy indicator;
(13) copayment/coinsurance indicators;
(14) eligibility start date;
(15) TPL coverage;
(16) county;
(17) address;
(18) phone number; and
(19) if applicable, the Enrollee’s Provider under the Restriction Program.
(D) The appearance of an individual’s name on the Eligibility Transmission, other than a deleted Enrollee, shall be evidence to the Contractor that the Department has determined that the individual is enrolled with the Contractor and qualifies for Medical Assistance under Title XIX of the Social Security Act.
Eligibility Transmission, Generally. (A) The Department shall provide to the Contractor an Eligibility Transmission which is an electronic file that includes data on individuals that the Department certifies as being Medicaid Eligible and who have been enrolled in Contractor’s Health Plan. The Eligibility Transmission will include new Enrollees, reinstated Enrollees, retroactive Enrollees, terminated Enrollees and Enrollees whose eligibility information results in a change to a critical field.
(B) Critical Fields found in the Eligibility Transmission shall include: Enrollee’s case number, case name, eREP identification number, name, date of birth, date of death, social security number, gender, prevalent language, race, Capitation Rate Cell, pregnancy indicator, co- payment/coinsurance indicators, (including those for Indians) eligibility start date, third party liability coverage, county, address, phone number, and if applicable, the Enrollee’s Provider under the Restriction Program.
(C) The Eligibility Transmission shall be designated as the “834 File” and shall be in accordance with the Utah Health Information Network (“UHIN”) standard.
(D) The appearance of an individual’s name on the 834 File, other than a deleted Enrollee, shall be evidence to the Contractor that the Department has determined that the individual is enrolled in the PMHP and qualifies for Medical Assistance under Medicaid Tile XIX.
(E) In addition to the monthly transmission of eligibility files, the Department shall send daily transmissions to report changes to the Contractor.
Eligibility Transmission, Generally. (A) The Department shall provide to the Contractor a daily Eligibility Transmission which is an electronic file that includes data on individuals that the Department certifies as being CHIP eligible and who have been enrolled in the Contractor’s Dental Plan. The Eligibility Transmission will include new Enrollees, reinstated Enrollees, retroactive Enrollees, terminated Enrollees and Enrollees whose eligibility information results in a change to a critical field.
(B) The Eligibility Transmission shall be in accordance with the Utah Health Information Network (UHIN) standard. The Contractor shall have the ability to receive and process the eligibility transmission.
(C) Critical Fields found in the Eligibility Transmission shall include: Enrollee’s case number, case name, eREP identification number, name, date of birth, date of death, social security number, gender, prevalent language, race, Capitation Rate Cell, pregnancy indicator, co- payment/coinsurance indicators, (including those for American Indians) eligibility start date, Third Party Liability, county, address, and phone number when such information is available.
(D) The appearance of an individual’s name on the Eligibility Transmission, other than a deleted Enrollee, shall be evidence to the Contractor that the Department has determined that the individual is enrolled in the Contractor’s Dental Plan and qualifies for assistance under Title XXI of the Social Security Act.
Eligibility Transmission, Generally. (A) The Department shall provide to the Contractor a daily Transmission which is an electronic file that includes data on individuals that the Department certifies as being Medicaid eligible and who have been enrolled in the Contractor’s Dental Plan. The Eligibility Transmission will include new Enrollees, reinstated Enrollees, retroactive Enrollees, terminated Enrollees and Enrollees whose eligibility information results in a change to a critical field.