Common use of Beneficiary Alignment Data Clause in Contracts

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.

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 alignment or quarterly if the ACO elects Prospective Plus Alignmentalignment, 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.

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 DC Beneficiaries and Beneficiaries who have been removed from alignment to the ACODCE, including Originally Aligned Beneficiaries, as well as the following information for each such DC 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 ACODCE; the effective date of the Beneficiary’s removal from alignment to the ACO DCE and the reason for such removal (if applicable); the demographic characteristics specified in the Reporting and Data Sharing Overview; if the ACO DCE is a High Needs Population ACODCE, which of the High Needs eligibility criteria the Beneficiary has met; whether the Beneficiary has Medicare Part D prescription coverage; and the REACH DC Beneficiary’s data sharing preferences made pursuant to Section 6.04 and Section 6.05.B, including whether the REACH DC 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 DCE elects Prospective Alignment alignment or quarterly if the ACO DCE elects Prospective Plus Alignmentalignment, that connects each REACH DC Beneficiary to the DC Participant Provider(s) that contributed to that Beneficiary’s alignment to the ACO DCE through either Claims-Based Alignment or Voluntary Alignment. (iii) A SVA paper-based Voluntary Alignment response file, shared quarterly, that includes the results of a REACH Beneficiary’s selection of a DC Participant Provider as his or her main source of care via SVAPaper-Based Voluntary Alignment, if applicable.