Encounter Data Reporting Sample Clauses

Encounter Data Reporting. In order to assess quality of care, determine utilization patterns and access to care for various health care services, the CMHSP shall submit encounter data containing detail for each recipient encounter reflecting all services provided by the CMHSP. Encounter records shall be submitted monthly via electronic media in the format specified by the MDHHS. Encounter level records must have a common identifier that will allow linkage between the MDHHS’s and the CMHSPs management information systems. Encounter data requirements are detailed in the Reporting Requirements attached to this contract. The CMHSP agrees to participate in the reporting of encounter data quality improvement data, Medicaid performance indicator data and sub element cost data consistent with PIHP Medicaid requirements.
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Encounter Data Reporting. A. The Contractor shall collect, process, format, and submit electronic encounter records for all services delivered to an enrollee. This requirement excludes services reimbursed directly to service providers by the Division on a fee-for-service basis. The Contractor shall capture all required encounter record elements using coding structures recognized by the Department. The Contractor shall process the encounter records, integrating any manual or automated systems to validate the adjudicated encounter records. The Contractor shall interface with any systems or modules within its organization to obtain the required encounter record elements. The Contractor shall submit the encounter records to the Department’s fiscal agent electronically according to specifications in the HMO Systems Guide, which may be periodically updated, and which is available at xxx.xxxxxx.xxx. The encounter data processing system shall have a data quality assurance plan to include timely data capture, accurate and complete encounter records, and internal data quality audit procedures. If DMAHS determines that changes to the encounter data processing system are required, the Contractor shall be given advance notice and time to make the change according to the extent and nature of the required change.
Encounter Data Reporting. In order to assess quality of care, determine utilization patterns and access to care for various health care services, affirm capitation rate calculations and estimates, the PIHP shall submit encounter data containing detail for each recipient encounter reflecting all services provided by the PIHP. Encounter records shall be submitted monthly via electronic media in the HIPAA-compliant format specified by MDCH. Encounter level records must have a common identifier that will allow linkage between MDCH’s and the PIHP’s management information systems. Encounter data requirements are detailed in the PIHP Reporting Requirements Attachment P.6.5.1.1 to this contract. The following ASC X12N 837 Coordination of Benefits loops and segments are required by MDCH for reporting services provided by and/or paid for by the PIHP and/or CMHSP. Loop 2320 – Other Subscriber Information SBR – Other Subscriber Information DMG – Subscriber Demographic Information OI – Other Insurance Coverage Information Loop 2330A – Other Subscriber Name NM1 – Other Subscriber Name Loop 2330B – Other Payer Name NM1 – Other Payer Name REF – Other Payer Secondary Identifier Submission of data for any other payer other than the PIHP and/or CMHSP is optional. Reporting monetary amounts in the ASC X12N 837 version 4010 is optional.
Encounter Data Reporting. A. Contractor shall maintain a MIS that collects and reports Encounter Data to DHCS in compliance with 42 CFR 438.242, and pursuant to applicable DHCS All Plan Letters (APL).
Encounter Data Reporting. The contractor shall collect, process, format, and submit electronic encounter data for all services delivered for which the contractor is responsible. The contractor shall capture all required encounter data elements using coding structures recognized by the Department. The contractor shall process the encounter data, integrating any manual or automated systems to validate the adjudicated encounter data. The contractor shall interface with any systems or modules within its organization to obtain the required encounter data elements. The contractor shall submit the encounter data to the Department's fiscal agent electronically, via diskette, tape, or electronic transmission, according to specifications in the Electronic Media Claims (EMC) Manual found in Section B.3.3 of the Appendices. The encounter data processing system shall have a data quality assurance plan to include timely data capture, accurate and complete encounter records, and internal data quality audit procedures. If DMAHS determines that changes are required, the contractor shall be given advance notice and time to make the change according to the extent and nature of the required change.
Encounter Data Reporting. The CONTRACTOR shall submit 100 percent of all required encounter data on a timely basis for submissions and necessary re-submissions as set forth in the contract, 2.12.(5).B. The submissions and required re-submissions shall have an error rate of five percent or less for at least seventy-five percent of the files.
Encounter Data Reporting electronic submission of encounter data from an PO to the Department. See Article XIV.B, Encounter Data, for requirements pertaining to the reporting of encounter data.
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Encounter Data Reporting. The PCO must record for internal use and submit to the Department Encounter Data. Encounter Data consists of a separate record each time a Member has an Encounter with a Health Care Provider. The PCO must have the ability to provide separate Physical Health and Behavioral Health encounters if required by the Commonwealth. A service rendered under this Agreement is considered an Encounter regardless of whether or not it has an associated Claim. The PCO shall only submit Encounter Data for Members enrolled in its PCO on the date of service and not submit any duplicate records. The Provider’s National Provider Identifier (NPI) and Master Provider Number (MPI) must be used when submitting required Encounter Data. The PCO must maintain appropriate systems and mechanisms to obtain all necessary data from its Providers to ensure its ability to comply with the Encounter Data reporting requirements. The failure of a Provider or Subcontractor to provide the PCO with necessary Encounter Data does not excuse the PCO's noncompliance. The PCO will be given a minimum of sixty (60) days notification of any new edits or changes that DPW intends to implement regarding Encounter Data.
Encounter Data Reporting. In order to assess quality of care, determine utilization patterns and access to care for various health care services, affirm capitation rate calculations and estimates, the PIHP shall submit encounter data containing detail for each recipient encounter reflecting all services provided by the PIHP. Encounter records shall be submitted monthly via electronic media in the HIPAA-compliant format specified by MDCH. Encounter level records must have a common identifier that will allow linkage between MDCH’s and the PIHP’s management information systems. Encounter data requirements are detailed in the PIHP Reporting Requirements Attachment P.6.5.1.2 to this contract.
Encounter Data Reporting. ‌ The PH-MCO must record for internal use and submit complete, timely, and accurate Encounter Data to the Department. The PH­ MCO shall only submit Encounter Data for Members on date of service and not submit any duplicate records. The PH-MCO must maintain appropriate systems and mechanisms to obtain all necessary data from its Health Care Providers needed to comply with the Encounter Data reporting requirements. The failure of a Health Care Provider or Subcontractor to provide the PH­ MCO with necessary Encounter Data shall not excuse the PH-MCO's noncompliance with this requirement. The PH-MCO will be given a minimum of sixty (60) days notification of any new edits or changes that the Department intends to implement regarding Encounter Data.
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