Encounter Data, General Requirements Sample Clauses
The 'Encounter Data, General Requirements' clause establishes the foundational obligations for collecting, maintaining, and submitting data related to patient encounters within a healthcare setting. It typically outlines the types of information that must be recorded, such as dates of service, diagnoses, and procedures, and may specify standards for data accuracy, timeliness, and format. By setting these requirements, the clause ensures that encounter data is reliable and consistent, which is essential for billing, quality reporting, and regulatory compliance.
Encounter Data, General Requirements. In accordance with Section 1903(m)(2)(A)(xi) of the Social Security Act, the Contractor agrees to maintain sufficient patient Encounter Data to identify the Provider who delivers Covered Services to Enrollees.
Encounter Data, General Requirements. (A) In accordance with Section 1903(m)(2)(A)(xi) of the Social Security Act, the Contractor agrees to maintain sufficient patient Encounter Data to identify the physician who delivers Covered Services to Enrollees.
(B) The Contractor shall transmit data to the Department using the HIPAA Transaction Standards for Health Care Claim data found in 45 CFR 162.1101 and 162.1102.
(C) The Contractor shall transmit and submit all data to the Department in accordance with the Department’s Encounter Records 837 Institutional Guide and the 837 Professional Companion Guide, as amended.
(D) The Contractor shall submit Encounter Data at least once per calendar month. The Encounter Data shall represent all Encounter Claim types (medical and institutional) received and adjudicated by the Contractor the previous month.
(E) The Department will edit Encounter Data in accordance with the 837 companion guide. Encounters with incomplete data or incorrect codes will be rejected.
Encounter Data, General Requirements. (A) In accordance with Section 1903(m)(2)(A)(xi) of the Social Security Act, the Contractor agrees to maintain sufficient patient Encounter Data to identify the Provider who delivers Covered Services to Enrollees.
(B) The Contractor shall transmit data to the Department using the HIPAA Transaction Standards for Health Care Claim data found in 45 CFR 162.1101 and 162.1102.
(C) The Contractor shall transmit and submit all Encounter data to the Department in accordance with the Department’s Encounter Records 837 Companion Guide and the 837 Professional Companion Guide, as amended and as applicable.
(D) The Contractor shall submit Encounter Data at least once per calendar month. The Encounter Data shall represent all Encounter Claim types received and adjudicated by the Contractor the previous month.
(E) The Department will edit Encounter Data in accordance with the 837 companion guide. Encounters with incomplete data or incorrect codes will be rejected.
(F) The Department will notify the Contractor of the status of rejected Encounter Data by sending a 277 Health Care Claim Status Response Transaction to the Contractor. The Contractor shall be responsible for reviewing 277 transactions and taking appropriate action when necessary.
(G) The Contractor shall submit corrections to all rejected encounters within 90 days of the date the Department sends notice that the Encounter is rejected. The Contractor shall submit corrected Encounter Data for all Encounters it discovers are incorrect within 90 days from the date of discovery.
(H) The Contractor shall submit Encounter Data for all services rendered to CHIP Enrollees under this Contract, including Encounters where the Contractor determined no liability exists. The Contractor shall submit Encounter Data even if the Contractor did not make any payment for a Claim, including Claims for services to CHIP enrollees provided under a Subcontract, capitation or special arrangement with another facility or program.
(I) If the Contractor discovers that services and/or costs of Excluded Providers have been included in the Encounter Data, the Contractor shall immediately notify the Department and correct the Encounter Data.