PPACA Report Sample Clauses

PPACA Report i. Within 45 calendar days of receipt of payment from the Department, the MCO shall return the entire Partnership PPACA Primary Care Report to the Department with the following fields completed by the MCO: a) Distributed to Provider by MCO (Y/N) b) Amount Distributed to Provider ii. The MCO should ▇▇▇▇ the Distributed to Provider by MCO field with a "Y" if the ACA Primary Care Rate Increase Fee Schedule amount was paid out to the listed provider. iii. The MCO should ▇▇▇▇ the Distributed to Provider by MCO field with an "N" if the amount was not paid out to the listed provider. The MCO shall return all payments not distributed to listed providers to the Department within 45 days of receipt of the payments from the Department. The only reasons why the funds should not be distributed is that the provider is no longer in business or the provider has a credible allegation of fraud against him/her. In cases of fraud, the MCO will be responsible for tracking the returned payments, by provider, and separately reporting that information to the Department. If the credible allegation of fraud is lifted it is the responsibility of the MCO to contact the Department to receive reimbursement for the returned funds. iv. The MCO must report in the Amount Distributed to Provider field the amount actually paid to the provider to comply with PPACA. v. At a minimum, the MCO will be required to forward all of the provider and payment information within the PPACA Primary Care Report specific to each provider that is receiving payment.