Common use of Encounter Data Accuracy Clause in Contracts

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. Effective October 1, 2023 this includes encounter data for ; and monthly medical home and care management fees, including AMH monthly medical home fees and care management fees, and CMHRP, CMARC and Healthy Opportunities per member per month paymentsvalue- based payments as specified in the Encounters Submission Guide. 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