{"component": "clause", "props": {"groups": [{"samples": [{"hash": "2PcpKXisCWq", "uri": "/contracts/2PcpKXisCWq#processing-requirements", "label": "Data Sharing Agreement", "score": 32.7022476196, "published": true}, {"hash": "8VtYPNP7lPr", "uri": "/contracts/8VtYPNP7lPr#processing-requirements", "label": "Data Sharing Agreement", "score": 30.8582763672, "published": true}, {"hash": "9nBFAkqsfy2", "uri": "/contracts/9nBFAkqsfy2#processing-requirements", "label": "Data Sharing Agreement", "score": 30.335439682, "published": true}], "snippet": "\u200c\n1. BCRC receives external files from a data sharing partner through a dedicated T-1 line (AT&T Global Network Services [AGNS]), HTTPS, or Secure File Transfer Protocol (SFTP).\n2. The input files are checked to ensure they are in the correct format.\n3. A check is performed to detect and bypass duplicate files.\n4. Records are edited for required fields and data format.\n5. Records received are matched to the exiting BCRC tables.\n6. Transactions are created to add new records that were received, update existing records or delete records that were not received on the input file.\n7. Transactions are sent to the Medicare Beneficiary Part D Database (MBD).\n8. Results from MBD are used to create the response files.\n9. Beneficiary Part D eligibility/enrollment information will be retrieved and added to the response files.\n10. Response files are transmitted to the DSA partner.", "snippet_links": [{"key": "data-sharing", "type": "clause", "offset": [41, 53]}, {"key": "network-services", "type": "clause", "offset": [104, 120]}, {"key": "secure-file-transfer-protocol", "type": "definition", "offset": [140, 169]}, {"key": "to-ensure", "type": "clause", "offset": [209, 218]}, {"key": "duplicate-files", "type": "clause", "offset": [296, 311]}, {"key": "required-fields", "type": "clause", "offset": [339, 354]}, {"key": "data-format", "type": "clause", "offset": [359, 370]}, {"key": "add-new", "type": "definition", "offset": [463, 470]}, {"key": "received-on", "type": "clause", "offset": [555, 566]}, {"key": "input-file", "type": "definition", "offset": [571, 581]}, {"key": "medicare-beneficiary", "type": "definition", "offset": [615, 635]}, {"key": "part-d", "type": "definition", "offset": [636, 642]}, {"key": "response-files", "type": "clause", "offset": [702, 716]}, {"key": "enrollment-information", "type": "clause", "offset": [752, 774]}], "size": 12, "hash": "dbb29db9b376b595c4795df8d75def49", "id": 1}, {"samples": [{"hash": "gcGHKhAnUGz", "uri": "/contracts/gcGHKhAnUGz#processing-requirements", "label": "Paypal Online Payment Services Agreement", "score": 36.3120117188, "published": true}, {"hash": "cEW20TnA6kE", "uri": "/contracts/cEW20TnA6kE#processing-requirements", "label": "Paypal Online Card Payment Services Agreement", "score": 33.7178115845, "published": true}, {"hash": "goyDQIHIrcZ", "uri": "/contracts/goyDQIHIrcZ#processing-requirements", "label": "Online Card Payment Services Agreement", "score": 33.5794868469, "published": true}], "snippet": "You agree to submit only any transactions for processing which represent a bona fide, permissible transaction free of liens, claims, and encumbrances other than ordinary sales taxes; as outlined in this Agreement and in the Card Company Rules, or which accurately describes the product or services being sold or the charitable donations being made. You authorize PayPal to submit transactions to and receive settlement from American Express and to disclose transaction and merchant information to American Express to perform analytics and create reports, and for any other lawful business purposes, including commercial marketing communications purposes and important transactional or relationship communications. You also agree to ensure data quality and that any Data is processed promptly, accurately and completely, and complies with the Card Companies\u2019 technical specifications. You agree not to process transactions or receive payments on behalf of any other party or redirect payments to any other party. You agree not to bill or collect from any cardholder for any purchase or payment on the card unless you have the right to do so under the Card Company Rules.", "snippet_links": [{"key": "to-submit", "type": "definition", "offset": [10, 19]}, {"key": "bona-fide", "type": "clause", "offset": [75, 84]}, {"key": "permissible-transaction", "type": "definition", "offset": [86, 109]}, {"key": "free-of-liens", "type": "clause", "offset": [110, 123]}, {"key": "sales-taxes", "type": "definition", "offset": [170, 181]}, {"key": "in-this-agreement", "type": "clause", "offset": [195, 212]}, {"key": "card-company-rules", "type": "definition", "offset": [224, 242]}, {"key": "the-product", "type": "definition", "offset": [274, 285]}, {"key": "charitable-donations", "type": "clause", "offset": [316, 336]}, {"key": "american-express", "type": "definition", "offset": [424, 440]}, {"key": "to-disclose", "type": "definition", "offset": [445, 456]}, {"key": "merchant-information", "type": "definition", "offset": [473, 493]}, {"key": "business-purposes", "type": "clause", "offset": [580, 597]}, {"key": "commercial-marketing-communications", "type": "clause", "offset": [609, 644]}, {"key": "to-ensure", "type": "clause", "offset": [729, 738]}, {"key": "data-quality", "type": "clause", "offset": [739, 751]}, {"key": "technical-specifications", "type": "definition", "offset": [858, 882]}, {"key": "receive-payments", "type": "clause", "offset": [925, 941]}, {"key": "on-behalf-of", "type": "definition", "offset": [942, 954]}, {"key": "other-party", "type": "clause", "offset": [959, 970]}, {"key": "payments-to", "type": "definition", "offset": [983, 994]}, {"key": "right-to", "type": "definition", "offset": [1125, 1133]}], "size": 12, "hash": "a0fcc94cfd8fd0896b6cf4d1784e2359", "id": 2}, {"samples": [{"hash": "jBSH4NQA1Mm", "uri": "/contracts/jBSH4NQA1Mm#processing-requirements", "label": "Independent Consultant Agreement", "score": 25.1957569122, "published": true}], "snippet": "Scentsy will:\na. Process Personal Data (i) only for the purpose of providing, supporting and improving Scentsy\u2019s services (including to provide insights and other reporting), using appropriate technical and organisational security measures; and (ii) in compliance with instructions received from You. Scentsy will not use or Process Personal Data for any other purpose. Scentsy will promptly inform You in writing if it cannot comply with its requirements under this Agreement, in which case You may terminate the Agreement or take any other reasonable action, including suspending of data Processing operations;\nb. Inform You promptly if, in \u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2019s opinion, an instruction from You violates applicable Data Protection Requirements;\nc. Follow Your instructions regarding Personal Data (including with regard to the provision of notice and exercise of choice) You have stored with Scentsy;\nd. Take commercially reasonable steps to ensure that (i) persons employed by it and (ii) other persons engaged to perform on \u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2019s behalf comply with the terms of this Agreement;\ne. Ensure that its employees, authorized agents and any Subprocessors are required to comply with and acknowledge and respect the confidentiality of Personal Data, including after the end of their respective employment, contract or assignment;\nf. If it intends to engage Subprocessors to help it satisfy its obligations in accordance with this Agreement or to delegate all or Part of the Processing activities to such Subprocessors, (i) obtain the prior written consent of You to such subcontracting, such consent to not be unreasonably withheld; (ii) remain liable to You for the Subprocessors\u2019 acts and omissions with regard to data protection where such Subprocessors act on Scentsy\u2019s instructions; and (iii) enter into contractual arrangements with such Subprocessors binding them to provide the same level of data protection and information security to that provided for herein;\ng. Upon request, provide You with a summary of \u2587\u2587\u2587\u2587\u2587\u2587\u2587\u2019s privacy and security policies; and\nh. Inform You if Scentsy undertakes an independent security review.", "snippet_links": [{"key": "process-personal-data", "type": "definition", "offset": [17, 38]}, {"key": "for-the-purpose-of", "type": "definition", "offset": [48, 66]}, {"key": "to-provide", "type": "clause", "offset": [133, 143]}, {"key": "other-reporting", "type": "clause", "offset": [157, 172]}, {"key": "technical-and-organisational-security-measures", "type": "clause", "offset": [193, 239]}, {"key": "compliance-with-instructions", "type": "clause", "offset": [253, 281]}, {"key": "in-writing", "type": "clause", "offset": [403, 413]}, {"key": "agreement-or", "type": "definition", "offset": [514, 526]}, {"key": "reasonable-action", "type": "clause", "offset": [542, 559]}, {"key": "processing-operations", "type": "clause", "offset": [590, 611]}, {"key": "in-\u2587", "type": "clause", "offset": [640, 644]}, {"key": "applicable-data-protection-requirements", "type": "definition", "offset": [695, 734]}, {"key": "your-instructions", "type": "definition", "offset": [746, 763]}, {"key": "with-regard-to", "type": "clause", "offset": [799, 813]}, {"key": "exercise-of", "type": "clause", "offset": [842, 853]}, {"key": "reasonable-steps", "type": "definition", "offset": [913, 929]}, {"key": "to-ensure", "type": "clause", "offset": [930, 939]}, {"key": "persons-employed-by", "type": "clause", "offset": [949, 968]}, {"key": "other-persons", "type": "clause", "offset": [981, 994]}, {"key": "terms-of-this-agreement", "type": "clause", "offset": [1050, 1073]}, {"key": "authorized-agents", "type": "clause", "offset": [1105, 1122]}, {"key": "confidentiality-of-personal-data", "type": "clause", "offset": [1205, 1237]}, {"key": "engage-subprocessors", "type": "clause", "offset": [1339, 1359]}, {"key": "in-accordance-with", "type": "clause", "offset": [1395, 1413]}, {"key": "to-delegate", "type": "clause", "offset": [1432, 1443]}, {"key": "processing-activities", "type": "clause", "offset": [1463, 1484]}, {"key": "consent-of", "type": "clause", "offset": [1537, 1547]}, {"key": "consent-to", "type": "definition", "offset": [1581, 1591]}, {"key": "acts-and-omissions", "type": "clause", "offset": [1671, 1689]}, {"key": "contractual-arrangements", "type": "clause", "offset": [1798, 1822]}, {"key": "provide-the", "type": "clause", "offset": [1863, 1874]}, {"key": "data-protection-and-information-security", "type": "clause", "offset": [1889, 1929]}, {"key": "upon-request", "type": "clause", "offset": [1962, 1974]}, {"key": "privacy-and-security-policies", "type": "clause", "offset": [2016, 2045]}, {"key": "independent-security-review", "type": "clause", "offset": [2090, 2117]}], "size": 9, "hash": "c11248e414feae2ca50634a84208d5dc", "id": 3}, {"samples": [{"hash": "lgC2eML2FnL", "uri": "/contracts/lgC2eML2FnL#processing-requirements", "label": "Flexible Payment Variable Annuity Contract (NML Variable Annuity Acct C of Northwestern Mut Life Ins Co)", "score": 19.0, "published": true}, {"hash": "gReHx3q7xSE", "uri": "/contracts/gReHx3q7xSE#processing-requirements", "label": "Flexible Payment Variable Annuity Contract (NML Variable Annuity Acct C of Northwestern Mut Life Ins Co)", "score": 19.0, "published": true}, {"hash": "fZM06CpF1GK", "uri": "/contracts/fZM06CpF1GK#processing-requirements", "label": "Flexible Payment Variable Annuity Contract (NML Variable Annuity Acct C of Northwestern Mut Life Ins Co)", "score": 19.0, "published": true}], "snippet": "On the effective date, the Company will process Purchase Payments and requested transfers or withdrawals received in the Home Office in good order. Good order means complete and accurate instructions are provided by the Owner in accordance with the Company\u2019s then current procedures. The Company also reserves the right to require a Contract Owner or other persons providing a signature in connection with a disbursement of proceeds or a change in ownership or beneficial rights under this Contract to provide a signature guarantee, unless expressly prohibited by applicable law, whenever required by the Company\u2019s then-effective procedures.", "snippet_links": [{"key": "on-the-effective-date", "type": "clause", "offset": [0, 21]}, {"key": "the-company-will", "type": "clause", "offset": [23, 39]}, {"key": "purchase-payments", "type": "clause", "offset": [48, 65]}, {"key": "requested-transfers", "type": "clause", "offset": [70, 89]}, {"key": "home-office", "type": "definition", "offset": [121, 132]}, {"key": "good-order", "type": "definition", "offset": [136, 146]}, {"key": "complete-and-accurate", "type": "clause", "offset": [165, 186]}, {"key": "by-the-owner", "type": "clause", "offset": [213, 225]}, {"key": "in-accordance-with", "type": "clause", "offset": [226, 244]}, {"key": "the-company-also", "type": "definition", "offset": [284, 300]}, {"key": "right-to", "type": "definition", "offset": [314, 322]}, {"key": "contract-owner", "type": "definition", "offset": [333, 347]}, {"key": "other-persons", "type": "clause", "offset": [351, 364]}, {"key": "in-connection-with", "type": "clause", "offset": [387, 405]}, {"key": "disbursement-of-proceeds", "type": "clause", "offset": [408, 432]}, {"key": "change-in-ownership", "type": "definition", "offset": [438, 457]}, {"key": "beneficial-rights", "type": "clause", "offset": [461, 478]}, {"key": "under-this-contract", "type": "clause", "offset": [479, 498]}, {"key": "provide-a", "type": "definition", "offset": [502, 511]}, {"key": "signature-guarantee", "type": "clause", "offset": [512, 531]}, {"key": "applicable-law", "type": "definition", "offset": [564, 578]}, {"key": "by-the-company", "type": "clause", "offset": [598, 612]}], "size": 5, "hash": "654d2db1c0f96f761334d0c414cf4c04", "id": 4}, {"samples": [{"hash": "hTBD0keFR1p", "uri": "/contracts/hTBD0keFR1p#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "dFsL10KgbAi", "uri": "/contracts/dFsL10KgbAi#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "bYUtCgouXEp", "uri": "/contracts/bYUtCgouXEp#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}], "snippet": "The Claims Pricing function for the Fee for Service contracts the vendor has with providers of the MIS must have the capabilities to:\n1. Calculate payment amounts according to the fee schedules, per diems, rates, formulas, and rules established by the Contractor.\n2. Maintain access to pricing and reimbursement methodologies to appropriately price claims at the Contractor\u2019s allowable amount.\n3. Maintain flexibility to accommodate future changes and expanded implementation of co pays.\n4. Deduct Member liability amounts from payment amounts as defined by the Department.\n5. Deduct TPL amounts from payments amounts.\n6. Provide adjustment processing capabilities.", "snippet_links": [{"key": "claims-pricing", "type": "clause", "offset": [4, 18]}, {"key": "service-contracts", "type": "clause", "offset": [44, 61]}, {"key": "the-vendor", "type": "clause", "offset": [62, 72]}, {"key": "with-providers", "type": "clause", "offset": [77, 91]}, {"key": "payment-amounts", "type": "definition", "offset": [147, 162]}, {"key": "according-to", "type": "definition", "offset": [163, 175]}, {"key": "fee-schedules", "type": "definition", "offset": [180, 193]}, {"key": "per-diems", "type": "clause", "offset": [195, 204]}, {"key": "and-rules", "type": "clause", "offset": [223, 232]}, {"key": "by-the-contractor", "type": "clause", "offset": [245, 262]}, {"key": "access-to", "type": "definition", "offset": [276, 285]}, {"key": "pricing-and-reimbursement", "type": "clause", "offset": [286, 311]}, {"key": "allowable-amount", "type": "definition", "offset": [376, 392]}, {"key": "future-changes", "type": "clause", "offset": [433, 447]}, {"key": "member-liability", "type": "clause", "offset": [498, 514]}, {"key": "by-the-department", "type": "clause", "offset": [555, 572]}, {"key": "adjustment-processing", "type": "clause", "offset": [630, 651]}], "size": 5, "hash": "bee3223f06db2751f5779e941bc6f76c", "id": 5}, {"samples": [{"hash": "hTBD0keFR1p", "uri": "/contracts/hTBD0keFR1p#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "dFsL10KgbAi", "uri": "/contracts/dFsL10KgbAi#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "bYUtCgouXEp", "uri": "/contracts/bYUtCgouXEp#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}], "snippet": "The MIS must perform three types of financial processing: 1) payment processing; 2) adjustment processing;", "snippet_links": [{"key": "types-of", "type": "clause", "offset": [27, 35]}, {"key": "financial-processing", "type": "clause", "offset": [36, 56]}, {"key": "payment-processing", "type": "definition", "offset": [61, 79]}, {"key": "adjustment-processing", "type": "clause", "offset": [84, 105]}], "size": 5, "hash": "d0ccdb12b7293849cab30c827a99b005", "id": 6}, {"samples": [{"hash": "hTBD0keFR1p", "uri": "/contracts/hTBD0keFR1p#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "dFsL10KgbAi", "uri": "/contracts/dFsL10KgbAi#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "bYUtCgouXEp", "uri": "/contracts/bYUtCgouXEp#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}], "snippet": "The Provider Data Maintenance function must have the capabilities to:\n1. Transmit a provider enrollment file to the Department in a specified format;\n2. Maintain current and historical provider enrollment applications from receipt to final disposition (approval only);\n3. Maintain on-line access to all current and historical provider information, including Provider rates and effective dates, Provider program and status codes, and summary payment data;\n4. Maintain on-line access to Provider information with inquiry by Provider name, partial name characters, provider number, NPI, SSN, FEIN, CLIA number, Provider type and specialty, County, Zip Code, and electronic billing status;\n5. Edit all update data for presence, format, and consistency with other data in the update transaction;\n6. Edits to prevent duplicate Provider enrollment during an update transaction;\n7. Accept and maintain the National Provider Identification (NPI);\n8. Provide a Geographic Information System (GIS) to identify Member populations, service utilization, and corresponding Provider coverage to support the Provider recruitment, enrollment, and participation;\n9. Maintain on-line audit trail of Provider names, Provider numbers (including old and new numbers, NPI), locations, and status changes by program;\n10. Identify by Provider any applicable type code, NPI/TAXONOMY code, location code, practice type code, category of service code, and medical specialty and sub-specialty code which is used in the Kentucky Medicaid program, and which affects Provider billing, claim pricing, or other processing activities;\n11. Maintain effective dates for Provider membership, Enrollment status, restriction and on-review data, certification(s), specialty, sub-specialty, claim types, and other user-specified Provider status codes and indicators;\n12. Accept group provider numbers, and relate individual Providers to their groups, as well as a group to its individual member Providers, with effective date ranges/spans. A single group provider record must be able to identify an unlimited number of individuals who are associated with the group;\n13. Maintain multiple, provider-specific reimbursement rates, including, but not necessarily limited to, per diems, case mix, rates based on licensed levels of care, specific provider agreements, volume purchase contracts, and capitation, with beginning and ending effective dates for a minimum of sixty (60) months.\n14. Maintain provider-specific rates by program, type of capitation, Member program category, specific demographic classes, Covered Services, and service area for any prepaid health plan or managed care providers;\n15. Provide the capability to identify a Provider as a PCP and maintain an inventory of available enrollment slots;\n16. Identify multiple practice locations for a single provider and associate all relevant data items with the location, such as address and CLIA certification;\n17. Maintain multiple addresses for a Provider, including but not limited to: \uf0b7 Pay to; \uf0b7 Mailing, and \uf0b7 Service location(s).\n18. Create, maintain and define provider enrollment status codes with associated date spans. For example, the enrollment codes must include but not be limited to: \uf0b7 Application pending \uf0b7 Limited time-span enrollment \uf0b7 Enrollment suspended \uf0b7 Terminated-voluntary/involuntary\n19. Maintain a National Provider Identifier (NPI) and taxonomies;\n20. Maintain specific codes for restricting the services for which Providers may \u2587\u2587\u2587\u2587 to those for which they have the proper certifications (for example, CLIA certification codes);\n21. Maintain summary-level accounts receivable and payable data in the provider file that is automatically updated after each payment cycle;\n22. Provide the capability to calculate and maintain separate 1099 and associated payment data by FEIN number for Providers with changes of ownership, based upon effective dates entered by the Contractor;\n23. Generate a file of specified providers, selected based on the Department identified parameters, in an agreed upon Department approved format and media, to be provided to the Department on an agreed upon periodic basis; and\n24. Generate a file of provider 1099 information.\n25. Reports \u2013 Reports for Provider functions are as described in Appendix \u2587.", "snippet_links": [{"key": "data-maintenance", "type": "clause", "offset": [13, 29]}, {"key": "enrollment-file", "type": "definition", "offset": [93, 108]}, {"key": "the-department", "type": "clause", "offset": [112, 126]}, {"key": "final-disposition", "type": "definition", "offset": [234, 251]}, {"key": "access-to", "type": "definition", "offset": [289, 298]}, {"key": "provider-information", "type": "definition", "offset": [326, 346]}, {"key": "rates-and-effective-dates", "type": "clause", "offset": [367, 392]}, {"key": "status-codes", "type": "clause", "offset": [415, 427]}, {"key": "payment-data", "type": "definition", "offset": [441, 453]}, {"key": "to-provider", "type": "definition", "offset": [482, 493]}, {"key": "provider-name", "type": "definition", "offset": [522, 535]}, {"key": "type-and-specialty", "type": "definition", "offset": [617, 635]}, {"key": "zip-code", "type": "definition", "offset": [645, 653]}, {"key": "electronic-billing", "type": "clause", "offset": [659, 677]}, {"key": "other-data", "type": "definition", "offset": [753, 763]}, {"key": "the-national", "type": "clause", "offset": [894, 906]}, {"key": "provider-identification", "type": "clause", "offset": [907, 930]}, {"key": "geographic-information-system", "type": "definition", "offset": [951, 980]}, {"key": "service-utilization", "type": "clause", "offset": [1019, 1038]}, {"key": "provider-recruitment", "type": "clause", "offset": [1091, 1111]}, {"key": "audit-trail", "type": "definition", "offset": [1164, 1175]}, {"key": "provider-numbers", "type": "definition", "offset": [1195, 1211]}, {"key": "status-changes", "type": "clause", "offset": [1265, 1279]}, {"key": "type-code", "type": "definition", "offset": [1332, 1341]}, {"key": "taxonomy-code", "type": "definition", "offset": [1347, 1360]}, {"key": "service-code", "type": "definition", "offset": [1409, 1421]}, {"key": "specialty-code", "type": "definition", "offset": [1453, 1467]}, {"key": "medicaid-program", "type": "clause", "offset": [1498, 1514]}, {"key": "processing-activities", "type": "clause", "offset": [1576, 1597]}, {"key": "enrollment-status", "type": "definition", "offset": [1653, 1670]}, {"key": "review-data", "type": "clause", "offset": [1691, 1702]}, {"key": "other-user", "type": "definition", "offset": [1765, 1775]}, {"key": "provider-status", "type": "clause", "offset": [1786, 1801]}, {"key": "group-provider", "type": "definition", "offset": [1835, 1849]}, {"key": "individual-member", "type": "definition", "offset": [1934, 1951]}, {"key": "number-of", "type": "definition", "offset": [2066, 2075]}, {"key": "associated-with", "type": "definition", "offset": [2096, 2111]}, {"key": "the-group", "type": "clause", "offset": [2112, 2121]}, {"key": "reimbursement-rates", "type": "definition", "offset": [2164, 2183]}, {"key": "per-diems", "type": "clause", "offset": [2228, 2237]}, {"key": "case-mix", "type": "definition", "offset": [2239, 2247]}, {"key": "based-on", "type": "definition", "offset": [2255, 2263]}, {"key": "levels-of-care", "type": "definition", "offset": [2273, 2287]}, {"key": "provider-agreements", "type": "definition", "offset": [2298, 2317]}, {"key": "purchase-contracts", "type": "definition", "offset": [2326, 2344]}, {"key": "type-of", "type": "definition", "offset": [2489, 2496]}, {"key": "member-program", "type": "definition", "offset": [2509, 2523]}, {"key": "covered-services", "type": "definition", "offset": [2564, 2580]}, {"key": "service-area", "type": "definition", "offset": [2586, 2598]}, {"key": "prepaid-health-plan", "type": "definition", "offset": [2607, 2626]}, {"key": "managed-care", "type": "clause", "offset": [2630, 2642]}, {"key": "provide-the", "type": "clause", "offset": [2658, 2669]}, {"key": "practice-locations", "type": "clause", "offset": [2792, 2810]}, {"key": "relevant-data", "type": "clause", "offset": [2851, 2864]}, {"key": "the-location", "type": "clause", "offset": [2876, 2888]}, {"key": "clia-certification", "type": "definition", "offset": [2910, 2928]}, {"key": "multiple-addresses", "type": "clause", "offset": [2943, 2961]}, {"key": "not-limited", "type": "clause", "offset": [2992, 3003]}, {"key": "pay-to", "type": "definition", "offset": [3010, 3016]}, {"key": "for-example", "type": "definition", "offset": [3149, 3160]}, {"key": "national-provider-identifier", "type": "definition", "offset": [3345, 3373]}, {"key": "services-for", "type": "clause", "offset": [3444, 3456]}, {"key": "accounts-receivable-and-payable", "type": "clause", "offset": [3605, 3636]}, {"key": "payment-cycle", "type": "clause", "offset": [3704, 3717]}, {"key": "for-providers", "type": "clause", "offset": [3829, 3842]}, {"key": "changes-of-ownership", "type": "clause", "offset": [3848, 3868]}, {"key": "by-the-contractor", "type": "clause", "offset": [3905, 3922]}, {"key": "approved-format", "type": "definition", "offset": [4053, 4068]}, {"key": "periodic-basis", "type": "definition", "offset": [4131, 4145]}], "size": 5, "hash": "bee4c679abc926cf3c32a9f2c4a38e45", "id": 7}, {"samples": [{"hash": "hTBD0keFR1p", "uri": "/contracts/hTBD0keFR1p#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "dFsL10KgbAi", "uri": "/contracts/dFsL10KgbAi#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "bYUtCgouXEp", "uri": "/contracts/bYUtCgouXEp#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}], "snippet": "The primary processes of Claims Operations Management are to maintain sufficient on-line claims information, provide on-line access to this information, and produce claims processing reports. The claims operations management function of the MIS must:\n1. Maintain Claim history at the level of service line detail.\n2. Maintain all adjudicated (paid and denied) claims history. Claims history must include at a minimum: \uf0b7 All submitted diagnosis codes (including service line detail, if applicable); \uf0b7 Line item procedure codes, including modifiers; \uf0b7 Member ID and medical coverage group identifier; \uf0b7 Billing, performing, referring, and attending provider Ids and corresponding provider types; \uf0b7 All error codes associated with service line detail, if applicable; \uf0b7 Billed, allowed, and paid amounts; \uf0b7 TPL and Member liability amounts, if any; \uf0b7 Prior Authorization number; \uf0b7 Procedure, drug, or other service codes; \uf0b7 Place of service; \uf0b7 Date of service, date of entry, date of adjudication, date of payment, date of adjustment, if applicable.\n3. Maintain non-claim-specific financial transactions as a logical component of Claims history.\n4. Provide access to the adjudicated and Claims in process, showing service line detail and the edit/audits applied to the Claim.\n5. Maintain accurate inventory control status on all Claims.", "snippet_links": [{"key": "the-primary", "type": "clause", "offset": [0, 11]}, {"key": "claims-operations-management", "type": "clause", "offset": [25, 53]}, {"key": "to-maintain", "type": "clause", "offset": [58, 69]}, {"key": "claims-information", "type": "definition", "offset": [89, 107]}, {"key": "provide-on", "type": "clause", "offset": [109, 119]}, {"key": "claims-processing", "type": "clause", "offset": [165, 182]}, {"key": "the-claims", "type": "clause", "offset": [192, 202]}, {"key": "management-function", "type": "clause", "offset": [214, 233]}, {"key": "service-line", "type": "definition", "offset": [293, 305]}, {"key": "claims-history", "type": "clause", "offset": [360, 374]}, {"key": "diagnosis-codes", "type": "clause", "offset": [434, 449]}, {"key": "if-applicable", "type": "definition", "offset": [482, 495]}, {"key": "line-item", "type": "definition", "offset": [500, 509]}, {"key": "procedure-codes", "type": "definition", "offset": [510, 525]}, {"key": "coverage-group", "type": "definition", "offset": [572, 586]}, {"key": "attending-provider", "type": "definition", "offset": [637, 655]}, {"key": "provider-types", "type": "definition", "offset": [678, 692]}, {"key": "error-codes", "type": "clause", "offset": [700, 711]}, {"key": "associated-with", "type": "definition", "offset": [712, 727]}, {"key": "paid-amounts", "type": "definition", "offset": [787, 799]}, {"key": "member-liability", "type": "clause", "offset": [811, 827]}, {"key": "authorization-number", "type": "definition", "offset": [853, 873]}, {"key": "other-service", "type": "clause", "offset": [897, 910]}, {"key": "place-of-service", "type": "definition", "offset": [920, 936]}, {"key": "date-of-service", "type": "definition", "offset": [940, 955]}, {"key": "date-of-entry", "type": "definition", "offset": [957, 970]}, {"key": "date-of-payment", "type": "definition", "offset": [994, 1009]}, {"key": "financial-transactions", "type": "definition", "offset": [1077, 1099]}, {"key": "access-to-the", "type": "clause", "offset": [1153, 1166]}, {"key": "claims-in-process", "type": "clause", "offset": [1183, 1200]}, {"key": "control-status", "type": "clause", "offset": [1303, 1317]}, {"key": "all-claims", "type": "definition", "offset": [1321, 1331]}], "size": 5, "hash": "b68dac9ca8a9e5db6f418cbcef3479b6", "id": 8}, {"samples": [{"hash": "hTBD0keFR1p", "uri": "/contracts/hTBD0keFR1p#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "dFsL10KgbAi", "uri": "/contracts/dFsL10KgbAi#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}, {"hash": "bYUtCgouXEp", "uri": "/contracts/bYUtCgouXEp#processing-requirements", "label": "Medicaid Managed Care Contract", "score": 24.1704311371, "published": true}], "snippet": "The Utilization/Quality Improvement function must include the following capabilities:\n1. Maintain Provider credentialing and recredentialing activities.\n2. Maintain Contractor\u2019s processes to monitor and identify deviations in patterns of treatment from established standards or norms. Provide feedback information for monitoring progress toward goals, identifying optimal practices, and promoting continuous improvement.\n3. Maintain development of cost and utilization data by Provider and services.\n4. Provide aggregate performance and outcome measures using standardized quality indicators similar to Medicaid HEDIS as specified by the Department.\n5. Support focused quality of care studies.\n6. Support the management of referral/utilization control processes and procedures.\n7. Monitor PCP referral patterns.\n8. Support functions of reviewing access, use and coordination of services (i.e. actions of peer review and alert/flag for review and/or follow-up; laboratory, x-ray and other ancillary service utilization per visit).\n9. Store and report Member satisfaction data through use of Member surveys, Grievance/Appeals processes, etc.\n10. Provide Fraud, Waste and Abuse detection, monitoring and reporting.", "snippet_links": [{"key": "quality-improvement", "type": "clause", "offset": [16, 35]}, {"key": "provider-credentialing-and-recredentialing", "type": "clause", "offset": [98, 140]}, {"key": "monitoring-progress", "type": "clause", "offset": [318, 337]}, {"key": "continuous-improvement", "type": "clause", "offset": [397, 419]}, {"key": "development-of", "type": "clause", "offset": [433, 447]}, {"key": "utilization-data", "type": "definition", "offset": [457, 473]}, {"key": "by-provider", "type": "clause", "offset": [474, 485]}, {"key": "performance-and-outcome-measures", "type": "clause", "offset": [521, 553]}, {"key": "quality-indicators", "type": "definition", "offset": [573, 591]}, {"key": "similar-to", "type": "definition", "offset": [592, 602]}, {"key": "as-specified", "type": "clause", "offset": [618, 630]}, {"key": "by-the-department", "type": "clause", "offset": [631, 648]}, {"key": "quality-of-care", "type": "definition", "offset": [669, 684]}, {"key": "management-of", "type": "clause", "offset": [709, 722]}, {"key": "utilization-control", "type": "definition", "offset": [732, 751]}, {"key": "processes-and-procedures", "type": "clause", "offset": [752, 776]}, {"key": "functions-of", "type": "clause", "offset": [823, 835]}, {"key": "coordination-of-services", "type": "clause", "offset": [862, 886]}, {"key": "peer-review", "type": "clause", "offset": [904, 915]}, {"key": "for-review", "type": "clause", "offset": [931, 941]}, {"key": "service-utilization", "type": "clause", "offset": [998, 1017]}, {"key": "member-satisfaction", "type": "clause", "offset": [1050, 1069]}, {"key": "monitoring-and-reporting", "type": "definition", "offset": [1186, 1210]}], "size": 4, "hash": "0392f226be153623538a032e5c5b4b91", "id": 9}, {"samples": [{"hash": "rLlFqMrm0a", "uri": "/contracts/rLlFqMrm0a#processing-requirements", "label": "Life Insurance Policy (Northwestern Mutual Variable Life Account II)", "score": 28.6591377258, "published": true}, {"hash": "4DhK8N5hvSG", "uri": "/contracts/4DhK8N5hvSG#processing-requirements", "label": "Life Insurance Policy (Northwestern Mutual Variable Life Account II)", "score": 28.6591377258, "published": true}, {"hash": "gb5QZy8RuNK", "uri": "/contracts/gb5QZy8RuNK#processing-requirements", "label": "Life Insurance Policy (Northwestern Mutual Variable Life Account II)", "score": 28.1800136566, "published": true}], "snippet": "The Company will process requested transactions, payments, and changes under this Policy only after receipt in the Home Office of all requirements in good order according to the Company\u2019s then current procedures. These requirements, which the Company may change from time to time, may include proper completion of forms, valid instructions and authorizations, or other administrative or evidentiary requirements of the Company. The Company reserves the right to require the Owner or other persons providing a signature in connection with a disbursement of any amounts under this Policy, or a change in ownership or beneficial rights under this Policy, to provide a signature guarantee to protect against fraud.", "snippet_links": [{"key": "the-company-will", "type": "clause", "offset": [0, 16]}, {"key": "requested-transactions", "type": "clause", "offset": [25, 47]}, {"key": "this-policy", "type": "definition", "offset": [77, 88]}, {"key": "home-office", "type": "definition", "offset": [115, 126]}, {"key": "all-requirements", "type": "clause", "offset": [130, 146]}, {"key": "good-order", "type": "definition", "offset": [150, 160]}, {"key": "to-the-company", "type": "definition", "offset": [171, 185]}, {"key": "from-time-to-time", "type": "clause", "offset": [262, 279]}, {"key": "completion-of-forms", "type": "clause", "offset": [300, 319]}, {"key": "instructions-and-authorizations", "type": "clause", "offset": [327, 358]}, {"key": "other-administrative", "type": "clause", "offset": [363, 383]}, {"key": "of-the-company", "type": "clause", "offset": [412, 426]}, {"key": "right-to", "type": "definition", "offset": [453, 461]}, {"key": "the-owner", "type": "clause", "offset": [470, 479]}, {"key": "other-persons", "type": "clause", "offset": [483, 496]}, {"key": "in-connection-with", "type": "clause", "offset": [519, 537]}, {"key": "change-in-ownership", "type": "definition", "offset": [592, 611]}, {"key": "beneficial-rights", "type": "clause", "offset": [615, 632]}, {"key": "provide-a", "type": "definition", "offset": [655, 664]}, {"key": "signature-guarantee", "type": "clause", "offset": [665, 684]}], "size": 4, "hash": "c96df17b3bbba32cdced190b5d713aee", "id": 10}], "next_curs": "CmASWmoVc35sYXdpbnNpZGVyY29udHJhY3RzcjwLEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2IiBwcm9jZXNzaW5nLXJlcXVpcmVtZW50cyMwMDAwMDAwYQyiAQJlbhgAIAA=", "clause": {"children": [["", ""], ["timely-processing", "Timely Processing"], ["error-tracking-and-audit-trails", "Error Tracking and Audit Trails"], ["comprehensive-edits-and-audits", "Comprehensive Edits and Audits"], ["system-controls-and-balancing", "System Controls and Balancing"]], "title": "Processing Requirements", "size": 128, "parents": [["fees-and-payment-terms", "Fees and Payment Terms"], ["general", "General"], ["the-contract", "The Contract"], ["disclosure-of-certain-financial-information", "Disclosure of Certain Financial Information"], ["general-operational-requirements-for-the-mcmis", "GENERAL OPERATIONAL REQUIREMENTS FOR THE MCMIS"]], "id": "processing-requirements", "related": [["staffing-requirements", "Staffing Requirements", "Staffing Requirements"], ["monitoring-requirements", "Monitoring Requirements", "Monitoring Requirements"], ["bonding-requirements", "Bonding Requirements", "Bonding Requirements"], ["trunking-requirements", "Trunking Requirements", "Trunking Requirements"], ["operating-requirements", "Operating Requirements", "Operating Requirements"]], "related_snippets": [], "updated": "2026-03-21T04:22:45+00:00", "also_ask": [], "drafting_tip": "", "explanation": "The Processing Requirements clause defines the standards and procedures that must be followed when handling data or materials under the agreement. It typically outlines specific methods, security measures, or compliance obligations that parties must adhere to during processing activities, such as data encryption, access controls, or adherence to relevant laws. By establishing clear expectations for how processing should occur, this clause helps ensure consistency, legal compliance, and protection of sensitive information throughout the contractual relationship."}, "json": true, "cursor": ""}}