Common use of Benefit and Reference Files Clause in Contracts

Benefit and Reference Files. The system shall provide file-driven processing for benefit determination, validation of code values, pricing (multiple methods and schedules), and other functions as appropriate. Files should include code descriptions, edit criteria, and effective dates. The system shall support the State’s procedure and diagnosis coding schemes and other codes that shall be submitted on the hardcopy and electronic reports and files. The system shall provide for an automated update to the National Drug Code file including all product, packaging, prescription, and pricing information. The system shall provide online access to reference file information. The system should maintain a history of the pricing schedules and other significant reference data.

Benefit and Reference Files. The system shall provide file-driven processing for benefit determination, validation of code values, pricing (multiple methods and schedules), and other functions as appropriate. Files should include code descriptions, edit criteria, and effective dates. The system shall support the State’s 's procedure and diagnosis coding schemes and other codes that shall be submitted on the hardcopy and electronic reports and files. The system shall provide for an automated update to the National Drug Code file including all product, packaging, prescription, and pricing information. The system shall provide online access to reference file information. The system should maintain a history of the pricing schedules and other significant reference data.