HIPAA 820 definition

HIPAA 820 means a transaction file prepared by the Department that indicates Enrollee’s capitated payment. HIPAA 834 means a transaction file prepared by the Department that indicates all Enrollees enrolled. Individual Education Plan (IEP) means Medically Necessary services for an eligible child coordinated between the schools and the Contractor that complement school services and promote the highest level of function for the child. Individuals with Disabilities Education Act (IDEA) is a law ensuring services to children with disabilities. IDEA governs how states and public agencies provide early intervention, special education and related services to eligible infants, toddlers, children and youth with disabilities. Individuals with Special Healthcare Needs (ISHCN) are Enrollees who have or are at high risk for chronic physical, developmental, behavioral, neurological, or emotional condition and who may require a broad range of primary, specialized medical, behavioral health, and/or related services. ISHCN may have an increased need for healthcare or related services due to their respective conditions. The primary purpose of the definition is to identify these Enrollees so the MCO can facilitate access to appropriate services. Insolvency means the inability of the Contractor to pay its obligations when they are due, or when its admitted assets do not exceed its liabilities. “Liabilities,” for purposes of the definition of Insolvency, shall include, but not be limited to, Claims payable required by the Kentucky Department of Insurance pursuant to Kentucky statutes, laws or regulations. Institution for Mental Disease (IMD) is defined by 42 C.F.R. 435.1010. Insurer is an Insurer under Subtitle 3 of the Kentucky Insurance Code with a health line of authority. I/T/U means (“I”) Indian Health Service, (“T”) Tribally operated facility/program, and (“U”) Urban Indian clinic. Kentucky HEALTH refers to the Section 1115 Demonstration Waiver known as Kentucky Helping to Engage and Achieve Long Term Health (HEALTH). Kentucky HEALTH Business Requirements refer to the technical and operational guidelines and documents, provided to the contractor by the Department, which outline how the various Kentucky Kentucky Health Information Exchange (KHIE) means the secure electronic information infrastructure created by the Commonwealth for sharing health information among health care providers and organizations and offers health care providers the functionality to support meaningful use an...
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HIPAA 820 means a monthly transaction file prepared by the Department that indicates Member’s cap payment. HIPAA 834 means a monthly transaction file prepared by the Department that indicates all Members enrolled. Individuals with Disabilities Education Act (IDEA) is a law ensuring services to children with disabilities. IDEA governs how states and public agencies provide early intervention, special education and related services to eligible infants, toddlers, children and youth with disabilities. Individual Education Plan (IEP) means medically necessary services for an eligible child coordinated between the schools and the Contractor that complement school services and promote the highest level of function for the child and is coordinated between the schools and the Contractor. Individuals with Special Healthcare Needs (ISHCN) are Members who have or are at high risk for chronic physical, developmental, behavioral, neurological, or emotional condition and who may require a broad range of primary, specialized medical, behavioral health, and/or related services. ISHCN may have an increased need for healthcare or related services due to their respective conditions. The primary purpose of the definition is to identify these Members so the MCO can facilitate access to appropriate services.
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Examples of HIPAA 820 in a sentence

  • The HIPAA 820 will contain the following: a capitation payment for each member listed on the HIPAA 834F, a capitation payment/recoupment for changes listed in the daily HIPAA 834C, and any other capitation payment/ recoupment.

  • Reconciliation for any discrepancies between the HIPAA 834 and HIPAA 820 is due and shall be submitted, as instructed by ODM, no later than 60 calendar days after the issuance of the HIPAA 820.

  • Reconciliation for any discrepancies of enrollment(s)/Disenrollment(s) contained on the HIPAA 834 files and HIPAA 820 file, for the associated 834 files, is due and shall be submitted, no later than 60 calendar days after the issuance of the HIPAA 820 payment file.

  • The HIPAA 820 (Monthly Remittance Advice) will contain the following: a capitation payment for each member listed on the HIPAA 834F monthly file, a capitation payment/recoupment for changes listed in the daily HIPAA 834C daily files, any other capitation payment/recoupment, and delivery payment/recoupment from the previous calendar month.

  • ODJFS or its designated entity provides a record of each payment via HIPAA 820 compliant transactions.

  • ODM or its designated entity will provide a record of each recipient detail level payment via HIPAA 820 compliant transactions.

  • The HIPAA 820 (Monthly Remittance Advice) will contain the following: a capitation payment for each member listed on the HIPAA 834F, a capitation payment/recoupment for changes listed in the daily HIPAA 834C, any other capitation payment/recoupment, and delivery payment/recoupment from the previous calendar month.

  • The HIPAA 820 monthly remittance advice contains the following: a capitation payment for each member listed on the HIPAA 834F monthly enrollment file, a capitation payment/recoupment for changes listed in the HIPAA 834C daily enrollment file, any other capitation payment/recoupment, and delivery payment/recoupment from the previous calendar month.

  • The MCO must submit reconciliation for any discrepancies of enrollments/disenrollments contained on the HIPAA 834 files, and HIPAA 820 monthly remittance advice for the associated HIPAA 834 files, to ODM no later than 60 calendar days after the issuance of the HIPAA 820 monthly remittance advice.

  • Reconciliation for any discrepancies between the HIPAA 834 and HIPAA 820 is due and must be submitted, as instructed by ODM, no later than sixty (60) days after the issuance of the HIPAA 834F.