Encounter Data Submission Clause Samples
The Encounter Data Submission clause requires parties, typically healthcare providers or organizations, to submit detailed records of patient encounters to a designated entity, such as a health plan or regulatory body. This process involves collecting and transmitting information about services rendered, diagnoses, and procedures performed during patient visits, often in a standardized electronic format. By mandating timely and accurate data submission, the clause ensures compliance with reporting requirements, supports billing and reimbursement processes, and enables oversight of healthcare quality and utilization.
Encounter Data Submission. In accordance with the terms of this Contract and all applicable state and federal laws, the Contractor shall submit complete, accurate, and timely Encounter Data to the Department within thirty (30) Days of Claim adjudication. This includes all paid and denied Claims, corrected Claims, adjusted Claims, voided Claims, and zero dollars ($0) paid Claims processed by the Contractor or by its Subcontractors. The Contractor shall have a computer and data processing system sufficient to accurately produce the data, reports, and Encounter Files set in formats and timelines prescribed by the Department as defined in the Contract. The system shall be capable of following or tracing an Encounter within its system using a unique Encounter identification number for each Encounter. At a minimum, the Contractor shall electronically provide Encounter Files to the Department, on a weekly schedule. Encounter Files must follow the format, data elements and method of transmission specified by the Department. All changes to edits and processing requirements due to Federal or State law changes shall be provided to the Contractor in writing no less than sixty (60) Business Days prior to implementation, whenever possible. Other edits and processing requirements shall be provided to the Contractor in writing no less than thirty (30) Business Days prior to implementation. The Contractor shall submit electronic test data files as required by the Department in the format referenced in this Contract and as specified by the Department. The electronic test files are subject to Department review and approval before production of data. The Department will process the Encounter data through defined edit and audit requirements and reject Encounter data that does not meet its requirements. Threshold edits, those which will enable the Encounter File to be accepted, and informational editing, those which enable the Encounter to be processed, shall apply. The Department reserves the right to change the number of, and the types of edits used for threshold processing based on its review of the Contractor’s monthly transmissions. The Contractor shall be given thirty (30) Business Days’ prior notice of the addition/deletion of any of the edits used for threshold editing. The Contractor’s weekly electronic Encounter data submission is to include all adjudicated (paid and denied) Claims, corrected Claims and adjusted Claims processed by the Contractor. Contractor shall submit all Claims within thirt...
Encounter Data Submission. ▇▇▇ shall submit Medicare encounter data to AHCCCS in accordance with the requirements of Attachment 1: Chart of Deliverables AHCCCS has a data use Agreement with CMS to receive Medicare data for care coordination. This data will provide AHCCCS with information on services paid for by Medicare.
Encounter Data Submission. The Contractor shall have policies, procedures and mechanisms in place to support the encounter data reporting process described below and in the State fiscal agent’s Companion Guides. The Contractor shall strictly adhere to the standards set forth in the State fiscal agent’s Companion Guides, as may be amended from time to time, such as the file structure and content definitions (including any content definitions as may further be interpreted or defined by FSSA). The quality of Contractor’s encounter data submissions shall be subject to audit and validation. Contractor shall fully comply with all such audit and validation activities including, but not limited to, attending meetings, providing background information on encounter data submissions, providing access to systems, records, and personnel that can assist auditors with their work, and timely responding to all information requests from the State or its auditors. The Contractor technical meetings with FSSA and the Fiscal Agent provides a forum for Contractor technical support staff to participate in the development of the data exchange process and ask questions related to data exchange issues, including encounter data transmission and reporting issues. The Contractor shall report any problems it is experiencing with encounter data submissions and reporting at this monthly meeting and to its designated OMPP Contract Compliance Manager.
Encounter Data Submission. The Contractor must submit electronic encounter data to HCA for payment in accordance with the HCA Encounter Data Reporting Guide.
12.16.1.1. The Contractor must submit encounter data for individual Beneficiaries based upon provision of eligible Health Home Services.
12.16.1.2. HCA may change the Encounter Data Reporting Guide with ninety (90) calendar days' written notice to the Contractor.
12.16.1.3. The Contractor must incorporate any changes made by HCA to the Encounter Data Reporting Guide no later than ninety (90) days from the date of change.
Encounter Data Submission. The Encounter Reporting Submission is a monthly file submission. The file submission is due on the thirtieth day after the end of the month, or the first business day following the thirtieth day when the thirtieth day is not a business day. The Encounter Data Reporting Submission will be used to report member specific enrollment and disenrollment, utilization of services and expenditure in the benefit package, and member characteristic/demographics. Other member specific data may be required by the Department in the future. The Encounter Reporting Submission shall be reported on-line through the Encounter Reporting application. Mandatory versus voluntary requirements for encounter data reconciliation and certification are currently defined by line of business. Changes to these requirements are likely during the course of this contract. The MCO agrees to accommodate the mandated requirements in the encounter reporting implementation guide in the event that they are enforced for the MCO's line(s) of business during the course of this contract, if they are not already accommodating reconciliation and certification requirements for their line(s) of business.