Encounter Data Accuracy Clause Samples
Encounter Data Accuracy. As with data completeness, MCPs are responsible for assuring the collection and submission of accurate data to ODJFS. Failure to do so jeopardizes MCPs’ performance, credibility and, if not corrected, will be assumed to indicate a failure in actual performance.
Encounter Data Accuracy. Medical The PHP shall meet or exceed a ninety-eight percent (98%) approval acceptance rate for Medical claims. For purposes of this standard, medical encounters include 837-P encounters and 837-I encounters. Effective October 1, 2023 this includes encounter data for monthly medical home and care management fees, including AMH monthly medical home and care management fees, and CMHRP, CMARC and Healthy Opportunities per member per month payments. A paid claim submitted as an encounter which passes all validation edits (SNIP level 1-7 and State specific validations) and is accepted by the Department. Monthly $25,000 per month
Encounter Data Accuracy. Medical The PHP shall meet or exceed a ninety-eight percent (98%) approval acceptance rate for Medical claims. For purposes of this standard, medical encounters include 837-P encounters and 837-I encounters. A paid claim submitted as an encounter which passes all validation edits (SNIP level 1-7 and State specific validations) and is accepted by the Department. Monthly $25,000 per month
Encounter Data Accuracy. Pharmacy The PHP shall meet or exceed a ninety- eight percent (98%) approval acceptance rate for pharmacy claims. A paid claim submitted as an encounter which passes all validation edits (SNIP level 1-7 and State specific validations) and is accepted by the Department. Weekly $50,000 per week