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Encounter data are detailed records of health care services or items that have been provided to MCO members. Encounter data are used for rate setting and program analysis.", "size": 7, "samples": [{"hash": "9BPw7edrNkG", "uri": "/contracts/9BPw7edrNkG#encounter-reporting", "label": "<<program>> Contract", "score": 24.515795674, "published": true}, {"hash": "gaZ4ZAIezJT", "uri": "/contracts/gaZ4ZAIezJT#encounter-reporting", "label": "Partnership Agreement", "score": 24.3538672142, "published": true}, {"hash": "3V0pSQAJVxV", "uri": "/contracts/3V0pSQAJVxV#encounter-reporting", "label": "Contract", "score": 24.1704312115, "published": true}], "snippet_links": [{"key": "reporting-of", "type": "clause", "offset": [19, 31]}, {"key": "encounter-data", "type": "definition", "offset": [32, 46]}, {"key": "health-services", "type": "definition", "offset": [68, 83]}, {"key": "health-care-services", "type": "definition", "offset": [124, 144]}, {"key": "rate-setting", "type": "definition", "offset": [222, 234]}, {"key": "program-analysis", "type": "clause", "offset": [239, 255]}], "hash": "eee2b6bce4c5be02900250be4ef73e42", "id": 2}, {"snippet": "the collection and reporting of encounter data to the Department of Health Services is submitted via the Long-Term Care Information Exchange System (IES). Encounter data are detailed records of services or items that have been provided to IRIS participants.", "size": 6, "samples": [{"hash": "fXymtZQpV8", "uri": "/contracts/fXymtZQpV8#encounter-reporting", "label": "Iris Provider Agreement", "score": 32.0955665034, "published": true}, {"hash": "XBkbPxAaYk", "uri": "/contracts/XBkbPxAaYk#encounter-reporting", "label": "Provider Agreement", "score": 31.107376807, "published": true}, {"hash": "7SOCrv2fzsp", "uri": "/contracts/7SOCrv2fzsp#encounter-reporting", "label": "Provider Agreement", "score": 30.0370660831, "published": true}], "snippet_links": [{"key": "reporting-of", "type": "clause", "offset": [19, 31]}, {"key": "encounter-data", "type": "definition", "offset": [32, 46]}, {"key": "health-services", "type": "definition", "offset": [68, 83]}, {"key": "term-care", "type": "clause", "offset": [110, 119]}, {"key": "exchange-system", "type": "definition", "offset": [132, 147]}, {"key": "records-of-services", "type": "clause", "offset": [183, 202]}], "hash": "6315bcd0bc460317a3964705a099f457", "id": 3}, {"snippet": "For HMO Members for which PPG receives Capitation under this Agreement. PPG shall provide FHS encounter data in accordance with the Operations Manual, via magnetic media for all Contracted Services provided to HMO Members during a calendar month within thirty (30) days of the end of the month in which such services are rendered. PPG shall also promptly provide FHS with all corrections to and revisions of such encounter data. FHS and PPG shall work in good faith to eliminate hard copy reports and transition to Electronic Data Interface (EDI) exchange of information.", "size": 6, "samples": [{"hash": "ivtXJEAGIPT", "uri": "/contracts/ivtXJEAGIPT#encounter-reporting", "label": "Provider Services Agreement (Prospect Medical Holdings Inc)", "score": 19.0, "published": true}, {"hash": "4Z9K9BLgxka", "uri": "/contracts/4Z9K9BLgxka#encounter-reporting", "label": "Provider Services Agreement (Prospect Medical Holdings Inc)", "score": 19.0, "published": true}], "snippet_links": [{"key": "hmo-members", "type": "clause", "offset": [4, 15]}, {"key": "this-agreement", "type": "clause", "offset": [56, 70]}, {"key": "encounter-data", "type": "definition", "offset": [94, 108]}, {"key": "in-accordance-with", "type": "definition", "offset": [109, 127]}, {"key": "operations-manual", "type": "clause", "offset": [132, 149]}, {"key": "services-provided", "type": "definition", "offset": [189, 206]}, {"key": "calendar-month", "type": "definition", "offset": [231, 245]}, {"key": "within-thirty", "type": "clause", "offset": [246, 259]}, {"key": "promptly-provide", "type": "clause", "offset": [346, 362]}, {"key": "in-good-faith", "type": "definition", "offset": [452, 465]}, {"key": "hard-copy", "type": "clause", "offset": [479, 488]}, {"key": "data-interface", "type": "definition", "offset": [526, 540]}, {"key": "exchange-of-information", "type": "clause", "offset": [547, 570]}], "hash": "a724588d2b0f6a76ed0695c84b399de6", "id": 4}, {"snippet": "Submission of encounters by a fiscal employer agent (FEA) to the Department, using the format and system specified by the Department. \u2026", "size": 2, "samples": [{"hash": "2XFqPhRIcLS", "uri": "/contracts/2XFqPhRIcLS#encounter-reporting", "label": "Contract for Services Modification", "score": 33.0974430377, "published": true}], "snippet_links": [{"key": "submission-of", "type": "clause", "offset": [0, 13]}, {"key": "by-the-department", "type": "clause", "offset": [115, 132]}], "hash": "51966f13c1078cd4dcf068ec342a96c2", "id": 5}, {"snippet": "\u200c\n2.17.1 The Contractor must meet any diagnosis and/or encounter reporting requirements that are in place for Medicare Advantage plans, as may be updated from time to time. Furthermore, the Contractor\u2019s Systems shall generate and transmit Encounter Data files to CMS according to additional specifications as shall be provided by CMS or the Department and updated from time to time. The Contractor shall maintain processes to ensure the validity, accuracy and completeness of the Encounter Data in accordance with the standards specified in this section. CMS and the Department will provide technical assistance to the Contractor for developing the capacity to meet encounter reporting requirements.", "size": 2, "samples": [{"hash": "jhDo7JA1cpy", "uri": "/contracts/jhDo7JA1cpy#encounter-reporting", "label": "Contract", "score": 26.1704312115, "published": true}], "snippet_links": [{"key": "the-contractor-must", "type": "clause", "offset": [9, 28]}, {"key": "reporting-requirements", "type": "clause", "offset": [65, 87]}, {"key": "in-place", "type": "definition", "offset": [97, 105]}, {"key": "medicare-advantage-plans", "type": "definition", "offset": [110, 134]}, {"key": "from-time-to-time", "type": "clause", "offset": [154, 171]}, {"key": "data-files", "type": "clause", "offset": [249, 259]}, {"key": "according-to", "type": "definition", "offset": [267, 279]}, {"key": "additional-specifications", "type": "clause", "offset": [280, 305]}, {"key": "the-contractor-shall", "type": "clause", "offset": [383, 403]}, {"key": "to-ensure", "type": "clause", "offset": [423, 432]}, {"key": "accuracy-and-completeness-of", "type": "clause", "offset": [447, 475]}, {"key": "in-accordance-with", "type": "definition", "offset": [495, 513]}, {"key": "the-standards", "type": "definition", "offset": [514, 527]}, {"key": "will-provide", "type": "clause", "offset": [578, 590]}, {"key": "assistance-to-the-contractor", "type": "clause", "offset": [601, 629]}], "hash": "cd2f211927442e97db79d37e43ca2d48", "id": 6}, {"snippet": "The Contractor must produce reports for the purposes of tracking, trending, reporting process improvement and monitoring submissions and revisions of encounters. The Contractor will submit these reports to AHCCCS as required per the AHCCCS Encounter Manual or as directed by AHCCCS and as further specified in Attachment F3,", "size": 1, "samples": [{"hash": "ioeJyiS8V0D", "uri": "/contracts/ioeJyiS8V0D#encounter-reporting", "label": "Intergovernmental Agreement", "score": 21.9746577264, "published": true}], "snippet_links": [{"key": "the-contractor-must", "type": "clause", "offset": [0, 19]}, {"key": "for-the-purposes-of", "type": "clause", "offset": [36, 55]}, {"key": "process-improvement", "type": "definition", "offset": [86, 105]}, {"key": "and-monitoring", "type": "clause", "offset": [106, 120]}, {"key": "the-contractor-will", "type": "clause", "offset": [162, 181]}, {"key": "reports-to", "type": "definition", "offset": [195, 205]}, {"key": "as-required", "type": "clause", "offset": [213, 224]}, {"key": "as-directed", "type": "definition", "offset": [260, 271]}], "hash": "2d280c6d2e62eb77c9b541cfa73a6243", "id": 7}, {"snippet": "Each Physician (and any Resident under the supervision of a Physician, using the supervising Physician\u2019s Practitioner Number) will submit Encounter Records to the Medical Services Plan/Health Insurance BC via Teleplan in accordance with the requirements, rules and procedures of the Medical Services Plan (MSP)/Health Insurance BC for the Services provided under this Contract and the Encounter Records will include the following information:", "size": 1, "samples": [{"hash": "2asc254ktd6", "uri": "/contracts/2asc254ktd6#encounter-reporting", "label": "Primary Care Network Agreement", "score": 31.7469051197, "published": true}], "snippet_links": [{"key": "under-the-supervision-of", "type": "definition", "offset": [33, 57]}, {"key": "supervising-physician", "type": "definition", "offset": [81, 102]}, {"key": "medical-services-plan", "type": "definition", "offset": [163, 184]}, {"key": "health-insurance", "type": "clause", "offset": [185, 201]}, {"key": "in-accordance-with", "type": "definition", "offset": [218, 236]}, {"key": "the-requirements", "type": "clause", "offset": [237, 253]}, {"key": "rules-and-procedures", "type": "clause", "offset": [255, 275]}, {"key": "services-provided-under-this-contract", "type": "clause", "offset": [339, 376]}], "hash": "f8487938c34335b9f01a7a7a2a6b3e65", "id": 8}, {"snippet": "General The Contractor must meet any diagnosis and/or encounter reporting requirements that are in place for Medicare Advantage plans and Medicaid managed care organizations including the EOHHS Encounter Data Set Request, as may be updated from time to time. Furthermore, the Contractor\u2019s Systems shall generate and transmit Encounter Data files according to additional specifications as may be provided by CMS or EOHHS and updated from time to time. The Contractor shall maintain processes to ensure the validity, accuracy and completeness of the Encounter Data in accordance with the standards specified in this section. CMS and EOHHS will provide technical assistance to the Contractor for developing the capacity to meet encounter reporting requirements.", "size": 1, "samples": [{"hash": "2MLhm3WZhi4", "uri": "/contracts/2MLhm3WZhi4#encounter-reporting", "label": "Three Way Contract for Capitated Model", "score": 27.0570884895, "published": true}], "snippet_links": [{"key": "the-contractor-must", "type": "clause", "offset": [8, 27]}, {"key": "reporting-requirements", "type": "clause", "offset": [64, 86]}, {"key": "in-place", "type": "definition", "offset": [96, 104]}, {"key": "plans-and", "type": "definition", "offset": [128, 137]}, {"key": "managed-care-organizations", "type": "clause", "offset": [147, 173]}, {"key": "data-set", "type": "clause", "offset": [204, 212]}, {"key": "from-time-to-time", "type": "clause", "offset": [240, 257]}, {"key": "data-files", "type": "clause", "offset": [335, 345]}, {"key": "according-to", "type": "definition", "offset": [346, 358]}, {"key": "additional-specifications", "type": "clause", "offset": [359, 384]}, {"key": "the-contractor-shall", "type": "clause", "offset": [451, 471]}, {"key": "to-ensure", "type": "clause", "offset": [491, 500]}, {"key": "accuracy-and-completeness-of", "type": "clause", "offset": [515, 543]}, {"key": "in-accordance-with", "type": "definition", "offset": [563, 581]}, {"key": "the-standards", "type": "definition", "offset": [582, 595]}, {"key": "will-provide", "type": "clause", "offset": [637, 649]}, {"key": "assistance-to-the-contractor", "type": "clause", "offset": [660, 688]}], "hash": "f8eefc9d22957472731bfa392b3da594", "id": 9}, {"snippet": "(See section 9) 7.5 Complaints and Appeals (See section 13)", "size": 1, "samples": [{"hash": "kIAoJO4Ix6R", "uri": "/contracts/kIAoJO4Ix6R#encounter-reporting", "label": "Managed Care Contract", "score": 21.9125591053, "published": true}], "snippet_links": [{"key": "section-9", "type": "clause", "offset": [5, 14]}, {"key": "complaints-and-appeals", "type": "clause", "offset": [20, 42]}, {"key": "section-13", "type": "definition", "offset": [48, 58]}], "hash": "b2c021afd4cbf97b7f5df86c2deecfea", "id": 10}], "next_curs": "ClwSVmoVc35sYXdpbnNpZGVyY29udHJhY3RzcjgLEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2IhxlbmNvdW50ZXItcmVwb3J0aW5nIzAwMDAwMDBhDKIBAmVuGAAgAA==", "clause": {"size": 54, "parents": [["definitions", "Definitions"], ["representations-and-duties-of-ppg", "Representations and Duties of PPG"], ["cms-and-eohhs", "CMS and EOHHS"], ["\u2587\u2587\u2587\u2587\u2587\u2587\u2587-duties", "\u2587\u2587\u2587\u2587\u2587\u2587'\u2587 DUTIES"], ["molina-subcontracts", "Molina Subcontracts"]], "title": "Encounter Reporting", "children": [["requirements", "Requirements"], ["", ""], ["calculation-of-gains-and-losses", "Calculation of Gains and Losses"], ["counterparts", "Counterparts"], ["claims-reporting", "Claims Reporting"]], "id": "encounter-reporting", "related": [["monthly-reporting", "Monthly Reporting", "Monthly Reporting"], ["encounter-data", "Encounter Data", "Encounter Data"], ["progress-reporting", "Progress Reporting", "Progress Reporting"], ["adverse-event-reporting", "Adverse Event Reporting", "Adverse Event Reporting"], ["management-reporting", "Management Reporting", "Management Reporting"]], "related_snippets": [], "updated": "2025-07-07T16:38:45+00:00", "also_ask": [], "drafting_tip": "", "explanation": "The Encounter Reporting clause requires parties to document and communicate specific interactions or events that occur during the course of an agreement or project. Typically, this involves submitting regular reports detailing incidents, meetings, or service activities, often within a set timeframe and in a prescribed format. By mandating systematic reporting, this clause ensures transparency, facilitates oversight, and helps address issues promptly as they arise."}, "json": true, "cursor": ""}}