Claims Data Generally Clause Samples
Claims Data Generally. 1.2.1.1 Any claim adjudicated during the reporting period should be included in the submitted file. Actions include payment, adjustment or other modification. Claims that have been “soft” denied (denied for incompleteness, incorrect or other administrative reasons) which the data supplier expects to be resubmitted upon correction, do not have to be submitted until corrections have been completed and the claim paid.
1.2.1.2 Each submitted data file shall have control totals and transmission control data as defined in the Header and Trailer Record for each defined file. (see Exhibit A for specific formats).
Claims Data Generally. 1.2.1.1 Any claim adjudicated during the reporting period should be included in the submitted file. Actions include payment, adjustment or other modification. Claims that have been “soft” denied (denied for incompleteness, incorrect or other administrative reasons) which the data supplier expects to be resubmitted upon correction, do not have to be submitted until corrections have been completed and the claim paid.
1.2.1.2 Each submitted data file shall have control totals and transmission control data as defined in the Header and Trailer Record for each defined file. (see Exhibit A for specific formats).
1.2.1.3 Reporting Entities shall provide documentation prior to submitting data files that describes how an original claim may be linked to all subsequent actions associated with that claim (see Exhibit A-‐2 for specifics).