Common use of Reporting Provider Payment Rates Clause in Contracts

Reporting Provider Payment Rates. (1) According to guidelines developed by the State, in consultation with health care providers and MCOs, each MCO must annually provide to the State information on reimbursement rates paid by the MCO to provider and vendors for administrative services under contract with the plan, pursuant to Minnesota Statutes, § 256B.69, subd. 9b (b). In addition, each MCO must provide to the State in the form and manner specified by the State: (2) The amount of the payment received from the STATE under this contract that is paid to health care providers for patient care; (3) Aggregate provider payment data, categorized by inpatient payments and outpatient payments, with the outpatient payments categorized by payments to primary care providers and nonprimary care providers; (4) The process by which increases or decreases in payments made to the plan under this section, that are based on actuarial analysis related to provider cost increases or decreases, or that are required by legislative action, are passed through to health care providers, categorized by payments to primary care providers and nonprimary care providers; and (5) Specific information on the methodology used to establish provider reimbursement rates paid by the MCO. (6) The MCO will submit the provider payment data report on August 15 of the Contract Year. This report will include aggregate provider payment data, information on legislatively mandated provider rate changes, and information and data on provider reimbursement rates and rate methodologies. (U) Dental CHIPRA Data Files Submission. In accordance with section 501(e) of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) to promote and improve access to dental services for children, the MCO shall submit quarterly data files to the STATE that include information about dental providers in the MCO’s network. The MCO must provide certification of the quarterly data at the same time that it submits the data or by the 5th day of the month following the month of submission. If for any reason the data needs to be corrected, a new data certification will be required. The data files shall comply with the specifications and submission guide outlined in the document entitled, “Insure Kids Now (IKN) Provider Data Submission Technical Information” modified by the STATE and posted on the DHS managed care website.