Common use of BILLING AGENT & CLEARINGHOUSE SERVICE VENDORS Clause in Contracts

BILLING AGENT & CLEARINGHOUSE SERVICE VENDORS. The following provisions are applicable to all Billing Agent Service Vendors, Clearinghouse Service Vendors, and State Agency Contractors. 4.1.1 Contractor shall provide service to SoonerCare providers whereby the Contractor transmits Electronic Data Interchange (EDI) claims or related data to the MMIS on behalf of the SoonerCare provider or its agent. Contractor shall abide by the policies affecting EDI submissions and submitters as published in the Provider Billing and Procedures Manual. These transactions must be in accordance with the accredited standards of the American National Standards Institute (ANSI), and in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, CFR§ 45, Parts 160 and 162, Standards for Electronic Transactions, published in the Federal Register August 17, 2000, 42 C.F.R. Part 2 and all subsequent updates. 4.1.2 Contractor agrees to report all billing information as directed by the SoonerCare provider to Gainwell; and, will not modify the billing information in any way, except with the express written consent of the SoonerCare provider. If Contractor is functioning as a Clearinghouse Service Contractor, the Contractor attests that the transactions sent to Gainwell do not alter the data stated in the original claim.

BILLING AGENT & CLEARINGHOUSE SERVICE VENDORS. The following provisions are applicable to all Billing Agent Service Vendors, Vendors and Clearinghouse Service Vendors, and State Agency Contractors. 4.1.1 Contractor shall provide service to SoonerCare providers whereby the Contractor transmits Electronic Data Interchange (EDI) claims or related data to the MMIS on behalf of the SoonerCare provider or its agent. Contractor shall abide by the policies affecting EDI submissions and submitters as published in the Provider Billing and Procedures Manual. These transactions must be in accordance with the accredited standards of the American National Standards Institute (ANSI), and in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, CFR§ 45, Parts 160 and 162, Standards for Electronic Transactions, published in the Federal Register August 17, 2000, 42 C.F.R. Part 2 2000 and all subsequent updates. 4.1.2 Contractor agrees to report all billing information as directed by the SoonerCare provider to GainwellES; and, will not modify the billing information in any way, except with the express written consent of the SoonerCare provider. If Contractor is functioning as a Clearinghouse Service Contractor, the Contractor attests that the transactions sent to Gainwell ES do not alter the data stated in the original claim.

BILLING AGENT & CLEARINGHOUSE SERVICE VENDORS. The following provisions are applicable to all Billing Agent Service Vendors, Clearinghouse Service Vendors, and State Agency Contractors. 4.1.1 Contractor shall provide service to SoonerCare providers whereby the Contractor transmits Electronic Data Interchange (EDI) claims or related data to the MMIS on behalf of the SoonerCare provider or its agent. Contractor shall abide by the policies affecting EDI submissions and submitters as published in the Provider Billing and Procedures Manual. These transactions must be in accordance with the accredited standards of the American National Standards Institute (ANSI), and in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, CFR§ 45, Parts 160 and 162, Standards for Electronic Transactions, published in the Federal Register August 17, 2000, 42 C.F.R. Part 2 and all subsequent updates. 4.1.2 Contractor agrees to report all billing information as directed by the SoonerCare provider to GainwellES; and, will not modify the billing information in any way, except with the express written consent of the SoonerCare provider. If Contractor is functioning as a Clearinghouse Service Contractor, the Contractor attests that the transactions sent to Gainwell ES do not alter the data stated in the original claim.