Common use of Encounter Data Reporting Clause in Contracts

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. 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-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 o SBR – Other Subscriber Information o DMG – Subscriber Demographic Information o OI – Other Insurance Coverage Information  Loop 2330A – Other Subscriber Name o NM1 – Other Subscriber Name  Loop 2330B – Other Payer Name o NM1 – Other Payer Name o 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. 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 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.