Common use of Business Rules for Processing Clause in Contracts

Business Rules for Processing. ‌ 1. The monthly Input File submitted by the PAP is a full-file-replacement file. The PAP’s entire file (participation record) of enrollees must be submitted each month on this file, and it must include any corrections to errors found in the previous month’s file. Each month’s Input File will fully replace the previous month’s Input File. 2. Data-sharing partners are required to continue to include coverage records for 3 years after the termination date of the coverage. 3. A Response File will be returned to each PAP, containing a response record for each input record received. This Response File will also contain a response record for each deleted record (i.e., records that were in the previous Input File that are not in the current Input File). The disposition of the input record will be provided on its corresponding response record, including whether the record was accepted. 4. The BCRC will attempt to create one record for each enrollee record received. 5. The BCRC will not send incomplete records to the MBD. 6. On all PAP input files, the fields required are Medicare ID (HICN or MBI) or SSN, Surname, First Initial, Date of Birth, Sex Code, Network Indicator, Effective Date, Termination Date, Coverage Type Indicator, Insurance Type Indicator, and PAP ID (in both the Header and Trailer). 7. If a new Input File is received by the BCRC, it is compared with the previously submitted Input File. If it is detected that processing the new Input File will delete at least 30% of the records that were accepted in the previous submission, a “threshold error” will be generated and the file will not be processed without additional confirmation from the data-sharing partner. The PAP will be asked to verify the high number of delete records in the current submission.