Common use of Provider Subsystem Clause in Contracts

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 Harr▇▇ ▇▇▇vice Area 104 August 9, 1999 105 Functions and Features: (1) Identify specialty(s), admission privileges, enrollee linkage, capacity, facility linkages, emergency arrangements or contact, and other limitations, affiliations, or restrictions. (2) Maintain provider history files to include audit trails and effective dates of information. (3) Maintain provider fee schedules/remuneration agreements to permit accurate payment for services based on the financial agreement in effect on the date of service. (4) Support HMO credentialing, recredentialing, and credential tracking processes; incorporates or links information to provider record. (5) Support monitoring activity for physician to enrollee ratios (actual to maximum) and total provider enrollment to physician and HMO capacity. (6) Flag and identify providers with restrictive conditions (e.g., limits to capacity, type of patient, age restrictions, and other services if approved out- of-network). (7) Support national provider number format (UPIN, NPIN, CLIA, etc., as required by TDH). (8) Provide provider network files 90 days prior to implementation and updates monthly. Format will be provided by TDH to contracted entities. (9) Support the national CLIA certification numbers for clinical laboratories. (10) Exclude providers from participation that have been identified by TDH as ineligible or excluded. Files must be updated to reflect period and reason for exclusion.

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 Harr▇▇ ▇▇▇vice Bexar Service Area 104 August 9, 1999 105 Functions and Features:1999 (1) Identify specialty(s), admission privileges, enrollee linkage, capacity, facility linkages, emergency arrangements or contact, and other limitations, affiliations, or restrictions. (2) Maintain provider history files to include audit trails and effective dates of information. (3) Maintain provider fee schedules/remuneration agreements to permit accurate payment for services based on the financial agreement in effect on the date of service. (4) Support HMO credentialing, recredentialing, and credential tracking processes; incorporates or links information to provider record. (5) Support monitoring activity for physician to enrollee ratios (actual to maximum) and total provider enrollment to physician and HMO capacity. (6) Flag and identify providers with restrictive conditions (e.g., limits to capacity, type of patient, age restrictions, and other services if approved out- out-of-network). (7) Support national provider number format (UPIN, NPIN, CLIA, etc., as required by TDH). (8) Provide provider network files 90 days prior to implementation and updates monthly. Format will be provided by TDH to contracted entities. (9) Support the national CLIA certification numbers for clinical laboratories. (10) Exclude providers from participation that have been identified by TDH as ineligible or excluded. Files must be updated to reflect period and reason for exclusion.

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 Harr▇▇ ▇▇▇vice ▇▇▇ Service Area 104 August 9, 1999 105 Functions and Features:95 (1) Identify specialty(s), admission privileges, enrollee linkage, capacity, facility linkages, emergency arrangements or contact, and other limitations, affiliations, or restrictions. (2) Maintain provider history files to include audit trails and effective dates of information. (3) Maintain provider fee schedules/remuneration agreements to permit accurate payment for services based on the financial agreement in effect on the date of service. (4) Support HMO credentialing, recredentialing, and credential tracking processes; incorporates or links information to provider record. (5) Support monitoring activity for physician to enrollee ratios (actual to maximum) and total provider enrollment to physician and HMO capacity. (6) Flag and identify providers with restrictive conditions (e.g.e g., limits to capacity, type of patient, age restrictions, and other services if approved out- out-of-network). (7) Support national provider number format (UPIN, NPIN, CLIA, etc., as required by TDH). (8) Provide provider network files 90 days prior to implementation and updates monthly. Format will be provided by TDH to contracted entities. (9) Support the national CLIA certification numbers for clinical laboratories. (10) Exclude providers from participation that have been identified by TDH as ineligible or excluded. Files must be updated to reflect period and reason for exclusion.