Provider Subsystem. The provider subsystem accepts and maintains comprehensive, current and historical information about Providers eligible to participate in the Contractor’s Network. The maintenance of provider data is required to support Claims and encounter processing, utilization/quality processing, financial processing and report functions. The Contractor shall electronically transmit provider enrollment information to the Department on a monthly basis, by the first Friday of the month following the month reported. The Contractor’s provider subsystem shall contain such items as demographic data, identification of provider type, specialty codes, maintenance of payment information, identification of licensing, credentialing/re-credentialing information, and monitoring of Primary Care Provider capacity for enrollment purposes. The Contractor shall demonstrate compliance with standards of provider network capacity and member access to services by producing reports illustrating that services, service locations, and service sites are available and accessible in terms of timeliness, amount, duration and personnel sufficient to provide all Covered Services on an emergency or urgent care basis, 24 hours a day, seven days a week. The Department shall monitor the Contractor’s Network capacity and member access by use of a Decision Support System. The Encounter Record submitted will be used to display Primary Care Provider location, Service Location, Member distribution, patterns of referral, quality measures, and other analytical data.
Provider Subsystem. The provider subsystem must accept, process, store and retrieve current and historical data on providers, including services, payment methodology, license information, service capacity, and facility linkages.
Provider Subsystem. 92 10.5 ENCOUNTER/CLAIMS PROCESSING SUBSYSTEM ................................93 10.6
Provider Subsystem. Subparts 7 and 8 of Section 10.4 are replaced with the following language:
Provider Subsystem. (A) The System implemented by CONTRACTOR must include a Provider Subsystem that accepts, processes, stores and retrieves current and historical data on health care providers in CONTRACTOR's network, including, but not limited to, the following data:
Provider Subsystem. The provider subsystem must accept, process, store and retrieve current and historical data on providers, including services, payment methodology, license information, service capacity, and facility linkages. Functions and Features: 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 95
Provider Subsystem. 23 (3) Claims/Services Data Subsystem.................................................................24 (4)
Provider Subsystem. The provider function accepts and maintains comprehensive, current and historical information about Providers eligible to participate in the Contractor’s
Provider Subsystem. The provider subsystem must accept, process, store and retrieve current and historical data on providers, including services, payment methodology, license information, service capacity, and facility linkages. 1999 Renewal Contract Harrxx Xxxvice Area 104 August 9, 1999 105 Functions and Features:
Provider Subsystem. 84 10.5 ENCOUNTER/CLAIMS PROCESSING SUBSYSTEM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 10.6
