Agency-Based Formatting Standards and Methods Sample Clauses

Agency-Based Formatting Standards and Methods. Health Plan systems shall exchange the following data with the Agency and/or its agent in a format to be jointly agreed upon by the Health Plan and the Agency: a. Provider network data; b. Case management fees, if applicable; and
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Agency-Based Formatting Standards and Methods a. Health Plan Systems shall exchange the following data with the Agency and/or its Agent in a format to be jointly agreed upon by the Health Plan and the Agency: (1) Provider network data; (2) Case Management fees; and (3) Administrative payments. A. Health Plan Reporting Requirements 1. The Health Plan shall comply with all Reporting Requirements set forth by the Agency in this Contract. a. The Health Plan is responsible for assuring the accuracy, completeness, and timely submission of each report. b. The Health Plan’s chief executive officer (CEO), chief financial officer (CFO), or an individual who reports to the CEO or CFO and who has delegated authority to certify the Health Plan’s reports, must attest, based on his/her best knowledge, information, and belief, that all data submitted in conjunction with the reports and all documents requested by the Agency are accurate, truthful, and complete (see 42 CFR 438.606(a) and (b)). c. The Health Plan must submit its certification at the same time it submits the certified data reports (see 42 CFR 438.606(c)). The certification page should be scanned and submitted it electronically. d. Before October 1 of each year, the Health Plan shall deliver to the Agency a certification by an Agency-approved independent auditor that the Performance Measure data reported for the previous calendar year are fairly and accurately presented. e. Deadlines for report submission referred to in this Contract specify the actual time of receipt at the Agency, not the date the file was postmarked or transmitted. f. If a reporting due date falls on a weekend, the report shall be due to the Agency on the following Business Day. g. All reports filed on a quarterly basis shall be filed on a calendar year quarter. 2. The Agency shall furnish the Health Plan with the appropriate reporting formats, templates, instructions, submission timetables, and technical assistance, as required. 3. The Agency reserves the right to modify the Reporting Requirements, with a ninety (90) Calendar Day notice to allow the Health Plan to complete implementation, unless otherwise required by law.
Sample 1

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