Encounter Data Submission and Processing Sample Clauses

Encounter Data Submission and Processing. (1) Contractor shall submit valid Encounter Data at least once per calendar month, on forms or formats specified by OHA and in accordance with OAR 410-141-3430 and OAR 943- 120-0100 through 943-120-0200. The Encounter Data submitted must represent 50 percent of all Encounter claim types received and adjudicated by Contractor during that calendar month, including the paid amounts regardless of whether the Provider is paid on a fee-for-service or capitated basis, or whether the Provider is in network (participating) or out of network (non-participating). (2) Contractor shall correct errors in Encounter Data if the Encounter Data cannot be processed because of missing or erroneous information. Corrective Action may be initiated if more than 10% of any Encounter Data submission cannot be processed because of missing or erroneous information. (3) To prevent Corrective Action, Contractor may submit documentation to OHA citing specific circumstances that delay Contractor’s timely submittal of Valid Encounter Data. OHA will review the documentation and make a determination within 30 days on whether the circumstances cited are Acceptable. These “Acceptable” circumstances may include, but are not limited to:
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Encounter Data Submission and Processing a. (1) Contractor shall submit Valid Encounter Data at least once per calendar month, including Encounter Pharmacy Data, in accordance with the AP Standard not later than the last day of the Final Submission Month. (2) Contractor shall submit valid Encounter Data on forms or formats specified by OHA and in accordance with OAR 410-141-3430 and OAR 943-120-0100 through 943-120-0200. (3) The Encounter Data submitted must represent no less than 50 percent of all Encounter claim types received and adjudicated by Contractor during that calendar month, including the paid amounts regardless of whether the Provider is paid on a fee-for-service or capitated basis, or whether the Provider is in network (participating) or out of network (non-participating). (4) Contractor shall correct errors in Encounter Data if the Encounter Data cannot be processed because of missing or erroneous information. Corrective Action will be initiated if more than 5% of any Encounter Data submission cannot be processed because of missing or erroneous information. (5) For purposes of this section, the AP Standard allows for Contractor delay of no more than 5% of non-pharmacy encounter claims for the Subject Month with prior notification to OHA. Contractor may submit documentation to OHA citing specific circumstances that will result in a delay to Contractor’s timely submittal of Valid Encounter Data. (6) If Contractor submits documentation of a delay in encounter claims submission, OHA will review the documentation and make a determination within 30 days on whether the circumstances cited are Acceptable and that a Corrective Action Plan is not necessary to remedy the deficiency. g. (7) These “Acceptable” circumstances may include, but are not limited to: (a) Member's failure to give the Provider necessary claim information;
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Related to Encounter Data Submission and Processing

  • Encounter Data Party shall provide encounter data to the Agency of Human Services and/or its departments and ensure further that the data and services provided can be linked to and supported by enrollee eligibility files maintained by the State.

  • Invoice Submission All invoices submitted by Contractor shall include the City Contract Number, an assigned Invoice Number, and an Invoice Date. City will provide Contractor with an invoice cover sheet. Invoice cover sheets are required to be accurately completed and submitted with each invoice. Contractor shall submit the original invoice, no more than once monthly, through the responsible City Project Manager at: City of Ocala Engineering Department, Attn: ▇▇▇▇ ▇▇▇▇▇▇▇▇, Address: ▇▇▇▇ ▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇. ▇▇▇, ▇▇▇▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇▇, E-Mail: ▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇.

  • Details of Data Processing (a) Subject matter: The subject matter of the data processing under this DPA is the Customer Data.

  • Updated Information Submission by Interconnection Customer The updated information submission by the Interconnection Customer, including manufacturer information, shall occur no later than one hundred eighty (180) Calendar Days prior to the Trial Operation. The Interconnection Customer shall submit a completed copy of the Electric Generating Unit data requirements contained in Appendix 1 to the LGIP. It shall also include any additional information provided to the Participating TO and the CAISO for the Interconnection Studies. Information in this submission shall be the most current Electric Generating Unit design or expected performance data. Information submitted for stability models shall be compatible with the Participating TO and CAISO standard models. If there is no compatible model, the Interconnection Customer will work with a consultant mutually agreed to by the Parties to develop and supply a standard model and associated information.

  • Ordering Guidelines and Processes 1.13.1 For information regarding Ordering Guidelines and Processes for various Network Elements, Combinations and Other Services, AFN should refer to the “Guides” section of the BellSouth Interconnection Web site, which is incorporated herein by reference, as amended from time to time. The Web site address is: http//▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/. 1.13.2 Additional information may also be found in the individual CLEC Information Packages, which are incorporated herein by reference, as amended from time to time, located at the “CLEC UNE Products” Web site address: ▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/guides/html/unes.html. 1.13.3 The provisioning of Network Elements, Combinations and Other Services to AFN’s Collocation Space will require cross-connections within the central office to connect the Network Element, Combinations or Other Services to the demarcation point associated with AFN’s Collocation Space. These cross- connects are separate components that are not considered a part of the Network Element, Combinations or Other Services and, thus, have a separate charge pursuant to this Agreement.