Data Submission Requirements to the Exchange Sample Clauses

Data Submission Requirements to the Exchange. Contractor shall submit a complete data set, inclusive of all member and provider identified data, claims, and encounter data, on a quarterly basis to the Exchange or the Exchange’s designated recipient to be used by the Exchange as it determines to be necessary. Such submissions will conform to all applicable Federal and State personal health information and related privacy laws, rules and regulations, and shall comply with the terms and conditions set forth in the Agreement by and between Contractor and the Exchange. Contractor will bear the full cost of data collection, extraction and submission; provided, however, that except as expressly set forth in this Attachment or the Agreement, Contractor will not be required to pay for any expenses related to the analysis of that data in order to comply with the terms of this Agreement. When data is submitted to a vendor for the Exchange, that vendor will be a Business Associate as defined by HIPAA of the Contractor and shall protect the information provided to the extent required under applicable laws, rules and regulations. Working with Contractors, the Exchange will develop data file formats that will be required of Contractor to support oversight requirements, including actuarial review, clinical quality improvement, network management and fraud and waste reduction, delivery system reform goals, consumer information and research. Additional data and expanded file formats may be requested in the future in support of the Exchange contributing data to statewide collaborative efforts to advance development of an all payer claims database. Specific data submission areas may include: • Plan and Product • Member • Member History • Providers (all providers with paid claims, including non-contracted) • Professional Claims If Contractor is unable to produce such information in the file format requested by the Exchange, Contractor shall coordinate with the Exchange with a plan to address data gaps or format preferences prior to the Contractor’s submission of such information. For any non-paid claims for capitated services, the Contractor shall provide full and complete encounter data.
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Data Submission Requirements to the Exchange. Contractor shall submit a complete data set, inclusive of all member- and provider-identified data, claims, encounter and pharmacy data, on a quarterly basis to the Exchange or the Exchange’s designated recipient to be used by the Exchange as it determines to be necessary. Such submissions will conform to all applicable State and Federal personal health information and related privacy laws, rules and regulations, and shall comply with the terms and conditions set forth in the Agreement by and between Contractor and the Exchange. Contractor will bear the full cost of data collection, extraction and submission; provided, however, that except as expressly set forth in this Attachment or the Agreement, Contractor will not be required to pay for any expenses related to the analysis of that data in order to comply with the terms of this Agreement. Data shall be submitted to a vendor for the Exchange that is a Business Associate of the Contractor that shall protect the information provided to the extent required under applicable laws, rules and regulations. Contractor shall submit such information at such times and in accordance with the data file formats attached as identified in Appendix 1 to this Attachment 7 , including, the technical specifications set forth in this Attachment 7. .  Plan  Member  Member History  Contracted PMGs  Providers (all providers with paid claims, including non-contracted)  Hospitals (all providers with paid claims, including non-contracted)  Professional Claims  Hospital Claims Header  Hospital Claims DetailDrug Claims  Total Medical Expense( non-claims payment)  Biometrics and Health Assessment ( provisional) In the event Contractor does not pay claims, it shall provide full and complete encounter data. The Exchange has provided the data file formats contained in Appendix 1 to this Attachment 7 as its initial expectation of Contractors’ provision of data to support oversight requirements( actuarial review ,clinical quality improvement, network management and fraud and waste reduction), delivery system reform goals, consumer information and research. Additional data and expanded file formats may be requested in the future in support of statewide collaborateive efforts to advance development of an all payer claims database. Additional Data Elements Expected Covered California and the Contractor recognize the importance of having appropriate data about Enrollees to address health disparities and health equity as well as p...
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Data Submission Requirements to the Exchange. Contractor shall submit a complete data set, inclusive of all member and provider identified data, claims, encounter and pharmacy data, on a quarterly basis to the Exchange or the Exchange’s designated recipient to be used by the Exchange as it determines to be necessary. Such submissions will conform to all applicable State and Federal personal health information and related privacy laws, rules and regulations, and shall comply with the terms and conditions set forth in the Agreement by and between Contractor and the Exchange. Contractor will bear the full cost of data collection, extraction and submission; provided, however, that except as expressly set forth in this Attachment or the Agreement, Contractor will not be required to pay for any expenses related to the analysis of that data in order to comply with the terms of this Agreement. Data shall be submittedWhen data is submitted to a vendor for the Exchange, that vendor will be is a Business Associate of the Contractor andthat shall protect the information provided to the extent required under applicable laws, rules and regulations. The Exchange has provided the data file formats contained in Appendix 1 to this Attachment 7 as its initial expectation of Contractors’ provision of data to support oversight requirements, including actuarial review, clinical quality improvement, network management and fraud and waste reduction, delivery system reform goals, consumer information and research. Additional data and expanded file formats may be requested in the future in support of the Exchange contributing data to statewide collaborative efforts to advance development of an all payer claims database. Specific data submission areas in Appendix 1 include: • Plan and Product • Member • Member History • Contracted PMGs • Providers (all providers with paid claims, including non-contracted) • Hospitals (all providers with paid claims, including non-contracted) • Professional Claims • Hospital Claims Header
Sample 1
Data Submission Requirements to the Exchange. Contractor shall provide to the Exchange information regarding Contractor’s membership through the Exchange in a consistent manner to that which Contractor currently provides to its major purchasers. Contractor and the Exchange shall work together in good faith to further define mutually agreeable information and formats for Contractor to provide to the Exchange, in all cases to remain generally consistent with the information shared by Contractor with its major purchasers. Covered California’s Enterprise Analytics Solution (EAS) Vendor shall provide Issuer with a written list of data elements [“EAS Dataset”] and a data submission template that defines the data elements and format for transmitting the data. A preliminary list of data elements, to be finalized when Vendor prepares the proposed EAS Dataset, is attached as Appendix 1 to Attachment 7. These data elements are subject to change based on mutual agreement. Health Plan may propose, in writing, revisions to the EAS Dataset or the data submission template. Unless there is inadequate data documentation, Vendor will recommend to Covered California the adoption of the Issuer proposed revisions. Upon the mutual agreement of Issuer, Vendor and Covered California, the EAS Dataset shall be finalized. The Issuer and Vendor shall execute a Data Use Agreement whose terms shall govern the EAS Dataset. Issuer shall disclose Personally Identifiable Health Information only in accordance with the terms and conditions contained in the Issuer-Covered California Agreement and this Amendment hereof, and in compliance with all applicable federal and state laws, rules and regulations, including the Privacy Rules. In complying with the EAS Dataset terms, Issuer shall submit Personally Identifiable Health Information to the Vendor. The Issuer and Vendor shall execute a Business Associate Agreement. Vendor shall protect the EAS Dataset information as required under applicable laws, rules and regulations. Personally Identifiable Health Information that Issuer discloses to the Vendor shall be de-identified in any data or analyses provided to the Covered California.
Sample 1
Data Submission Requirements to the Exchange. Contractor shall provide to the Exchange information regarding Contractor’s membership through the Exchange in a consistent manner to that which Contractor currently provides to its major purchasers. Contractor and the Exchange shall work together in good faith to further define mutually agreeable information and formats for Contractor to provide to the Exchange, in all cases to remain generally consistent with the information shared by Contractor with its major purchasers.
Sample 1
Data Submission Requirements to the Exchange. Contractor shall submit a complete data set, inclusive of all claims, encounter and pharmacy data, on a quarterly basis to the Exchange or the Exchange’s designated recipient. Such submissions will conform to all applicable State and Federal personal health information and related privacy laws, rules and regulations, and shall comply with the terms and conditions set forth in the Agreement by and between Contractor and the Exchange. Contractor will bear the full cost of data collection, extraction and submission; provided, however, that except as expressly set forth in this Attachment or the Agreement, Contractor will not be required to pay for any expenses related to the analysis of that data in order to comply with the terms of this Agreement. Contractor shall submit such information at such times and in accordance with the data set standards established by the Exchange, including, the technical specifications set forth in separate attachments to the Administrative Manual • Plan • Member • Member History • Contracted PMGs • Providers (all providers with paid claims, including non-contracted) • Hospitals (all providers with paid claims, including non-contracted) • Professional Claims • Hospital Claims Header • Hospital Claims Detail • Drug Claims Additional Data Elements Expected Contractor agrees to work with the Exchange to add additional data elements critical to the Exchange’s Enrollees and in order to refine existing quality related assessments. By 2015, Contractor shall be capable of stratifying claims and quality data to the following categories:
Sample 1

Related to Data Submission Requirements to the Exchange

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