Medicaid Component Reconciliation Sample Clauses

Medicaid Component Reconciliation. 4.6.1.1 Within thirty (30) days after the 820 Payment File is made available, the Contractor shall notify the Department of any discrepancies, including Enrollees who the Contractor believes are in its Demonstration Plan and not on the 820 Payment File, Enrollees included on the 820 Payment File who the Contractor believes have not been enrolled with Contractor, and Enrollees included on the 820 Payment File who the Contractor believes are in a different rate cell. The Contractor and the Department will work together to resolve these discrepancies. Payments to the Contractor will be adjusted for retroactive disenrollment of Enrollees, changes to Enrollee information that affect the Capitation rates (e.g., eligibility classification), monetary sanctions and penalties imposed in accordance with Section 5.3.14, rate changes in accordance with Section 4.3.3, or other miscellaneous adjustments provided for herein. Adjustments shall be retroactive no more than eighteen (18) months, unless otherwise agreed to by the Contractor and the Department. Notwithstanding the foregoing, any adjustment for retroactive disenrollment of Enrollees shall not exceed two (2) months except in instances of the death of an Enrollee or when the Enrollee moves out of the State. The Department will make retroactive enrollments only in accordance with Section 2.3.1.7.
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Related to Medicaid Component Reconciliation

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