Enrollment and Monthly Capitation Reconciliation Sample Clauses

Enrollment and Monthly Capitation Reconciliation. The MCP shall maintain the integrity of its membership data through processing and loading of data contained for each individual in the daily HIPAA 834C (Daily Benefit Enrollment and Maintenance) files and reconciling the daily changes with the monthly HIPAA 834F (Monthly Benefit Enrollment and Maintenance) file. Discrepancies between the HIPAA 834C and 834F that have a negative impact on a member’s access to care shall be reported to ODM within one business day. Reconciliation for any discrepancies of enrollment(s)/Disenrollment(s) contained on the HIPAA 834 files and HIPAA 820 file, for the associated 834 files, is due and shall be submitted, no later than 60 calendar days after the issuance of the HIPAA 820 payment file.
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Enrollment and Monthly Capitation Reconciliation. The MCOP shall maintain the integrity of its membership data through reconciliation of the daily HIPAA 834C files (Daily Benefit Enrollment and Maintenance) and the monthly HIPAA 834F file (Monthly Benefit Enrollment and Maintenance) transactions pursuant to ODM instructions. Discrepancies between the HIPAA 834C and 834F that have a negative impact on a member’s access to care shall be reported to ODM within one business day. Reconciliation for any discrepancies between the HIPAA 834 and HIPAA 820 is due and shall be submitted, as instructed by ODM, no later than 60 calendar days after the issuance of the HIPAA 820.
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Enrollment and Monthly Capitation Reconciliation. The MCO must maintain the integrity of its membership data through processing and loading of data contained for each member in the HIPAA 834C daily enrollment files and reconciling the daily changes with the HIPAA 834F monthly enrollment file. The MCO must report discrepancies between the HIPAA 834C daily enrollment files and HIPAA 834F monthly enrollment file that have a negative impact on a member’s access to care to ODM within one business day. The MCO must submit reconciliation for any discrepancies of enrollments/disenrollments contained on the HIPAA 834 files, and HIPAA 820 monthly remittance advice for the associated HIPAA 834 files, to ODM no later than 60 calendar days after the issuance of the HIPAA 820 monthly remittance advice. The MCO must report discrepancies and reconciliation requests. The MCO must submit all reconciliation requests in the format specified by ODM. ODM may reject reconciliation requests submitted by the MCO after the initial 60 calendar day due date. ODM may process MCO reconciliation requests submitted after the initial 60 calendar day due date at ODM’s sole discretion. ODM will not accept MCO reconciliation requests for enrollment and/or payment beyond the last day of the 18th month after the capitation/enrollment month. ODM will always process reconciliations for ODM recoupment of capitation payments. ODM will not accept newborn reconciliations beyond the last day of the month in which the newborn turns 15 months of age where the MCO has not submitted a Medicaid billing ID as part of the reconciliation process.
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Enrollment and Monthly Capitation Reconciliation. 1. The OhioRISE Plan must maintain the integrity of its membership data through processing and loading of data contained for each member in the daily HIPAA 834C enrollment files and reconciling the daily changes with the HIPAA 834F monthly enrollment file.
Sample 1
Enrollment and Monthly Capitation Reconciliation. 1. The MCO must maintain the integrity of its membership data through processing and loading of data contained for each member in the HIPAA 834C daily enrollment files and reconciling the daily changes with the HIPAA 834F monthly enrollment file.
Sample 1

Related to Enrollment and Monthly Capitation Reconciliation

  • Account Reconciliation You will verify and reconcile any out-of-balance condition, and promptly notify the Credit Union of any errors within the time periods established in the Membership and Account Agreement after receipt of your account statement. If notified within such period, the Credit Union shall correct and resubmit all erroneous files, reports, and other data at the Credit Union's then standard charges, or at no charge, if the erroneous report or other data directly resulted from the Credit Union's error.

  • Interest Rates; Benchmark Notification The interest rate on a Loan denominated in dollars may be derived from an interest rate benchmark that may be discontinued or is, or may in the future become, the subject of regulatory reform. Upon the occurrence of a Benchmark Transition Event, Section 2.14(b) provides a mechanism for determining an alternative rate of interest. The Administrative Agent does not warrant or accept any responsibility for, and shall not have any liability with respect to, the administration, submission, performance or any other matter related to any interest rate used in this Agreement, or with respect to any alternative or successor rate thereto, or replacement rate thereof, including without limitation, whether the composition or characteristics of any such alternative, successor or replacement reference rate will be similar to, or produce the same value or economic equivalence of, the existing interest rate being replaced or have the same volume or liquidity as did any existing interest rate prior to its discontinuance or unavailability. The Administrative Agent and its affiliates and/or other related entities may engage in transactions that affect the calculation of any interest rate used in this Agreement or any alternative, successor or alternative rate (including any Benchmark Replacement) and/or any relevant adjustments thereto, in each case, in a manner adverse to the Borrower. The Administrative Agent may select information sources or services in its reasonable discretion to ascertain any interest rate used in this Agreement, any component thereof, or rates referenced in the definition thereof, in each case pursuant to the terms of this Agreement, and shall have no liability to the Borrower, any Lender or any other person or entity for damages of any kind, including direct or indirect, special, punitive, incidental or consequential damages, costs, losses or expenses (whether in tort, contract or otherwise and whether at law or in equity), for any error or calculation of any such rate (or component thereof) provided by any such information source or service.

  • Disenrollment 2.3.2.1. The Contractor shall:

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Enrollment The School shall maintain accurate and complete enrollment data and daily records of student attendance.

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