Beneficiary Alignment Data Sample Clauses
The Beneficiary Alignment Data clause defines the requirements and procedures for identifying and maintaining accurate records of individuals or entities designated as beneficiaries under an agreement. In practice, this clause outlines how beneficiary information must be collected, updated, and verified, often specifying the format, frequency, and responsible parties for data submission. Its core function is to ensure that all parties have a clear and consistent understanding of who the beneficiaries are, thereby reducing the risk of disputes or errors related to benefit distribution.
Beneficiary Alignment Data. This data will include, for the relevant Performance Year:
(i) A Beneficiary alignment report, shared monthly, that includes a list of REACH Beneficiaries and Beneficiaries who have been removed from alignment to the ACO, including Originally Aligned Beneficiaries, as well as the following information for each such Beneficiary: the Alignment Year the Beneficiary became an Alignment-Eligible Beneficiary (as such terms are defined in Appendix A of the Agreement); the effective date of the Beneficiary’s alignment to the ACO; the effective date of the Beneficiary’s removal from alignment to the ACO and the reason for such removal (if applicable); the demographic characteristics specified in the Reporting and Data Sharing Overview; if the ACO is a High Needs Population ACO, which of the High Needs eligibility criteria the Beneficiary has met; whether the Beneficiary has Medicare Part D prescription coverage; and the REACH Beneficiary’s data sharing preferences made pursuant to Section 6.04 and Section 6.05.B, including whether the REACH Beneficiary is administratively opted out of all claims data-sharing pursuant to Section 6.04.E.
(ii) A provider alignment report, shared annually if the ACO elects Prospective Alignment or quarterly if the ACO elects Prospective Plus Alignment, that connects each REACH Beneficiary to the Participant Provider(s) that contributed to that Beneficiary’s alignment to the ACO through either Claims-Based Alignment or Voluntary Alignment.
(iii) A SVA response file, shared quarterly, that includes the results of a REACH Beneficiary’s selection of a Participant Provider as his or her main source of care via SVA, if applicable.