Claims Processing and MIS. Contractor agrees to have claims processing system and Management Information System (MIS) sufficient to support the provider payment and data reporting requirements specified elsewhere in this chapter. Contractor also shall be prepared to document its ability to expand claims processing or MIS capacity should either or both be exceeded through the enrollment of members.
Claims Processing and MIS. The Contractor must have a Claims processing system and MIS sufficient to support the Provider payment and data reporting requirements specified in Section VIII of this Agreement, Reporting Requirements. See also Exhibit MM of this Agreement, Management Information System and System Performance Review Standards, for MIS and Systems Performance Review (SPR) standards. The Contractor shall be prepared to document its ability to expand Claims processing or MIS capacity should either or both be exceeded through the enrollment of program Members.
Claims Processing and MIS. Broker agrees to have claims processing system and Management Information System (MIS) sufficient to support the provider payment and data reporting requirements specified elsewhere in this contract. Broker also shall be prepared to document its ability to expand claims processing or MIS capacity should either or both be exceeded through the enrollment of recipients. EOHHS, or its designees, maintains the right to conduct with reasonable notice whatever audit functions are necessary to verify proper invoicing by Broker for provision of services and proper payments by EOHHS to Broker in accordance with this contract. In the event that audit liabilities arising from any discrepancies in payments are discovered during the course of such audits, the net effect of which resulted in an overpayment to Broker, EOHHS may either: • Make a demand for repayment of overpayment amount within thirty (30) calendar days • Offset the amount of overpayment from invoices submitted to provide for payment and/or by the next monthly payment cycle. • Refer the matter to the Department of Attorney General Medicaid Fraud Unit for investigation and/or seek interest in funds pursuant to RI General Laws Section 40-8.2-22. In the event that audits discover underpayment to Broker, EOHHS will process a corrective payment within thirty (30) calendar days. Any dispute or controversy encountered pursuant to this provision shall be resolved pursuant to the guidelines specified herein. Broker agrees to submit all financial report requests by the EOHHS. These reports may include, but are not limited to, the submission of the following reports: • Broker’s Annual Audited Financial Statements; • Broker’s Annual Report to Owners, Shareholders, recipients, and Others; • Monthly Financial Statements; • Company's General Liability and Directors' and Officer's Insurance Coverages; • Where applicable, evidence that the parent Company provides 100% of subsidiary's financial backing. • Any other additional reports required due to special circumstances, studies, analyses, audits, and significant changes in the Broker’s financial position or performance. In the case where the Agreement amount identified Section 2.13 (Payments) is at least twenty-five thousand dollars ($25,000) in any year, Broker must submit an acceptable audited financial statement prepared by an independent auditor within twelve (12) months of the end of the Broker’s fiscal year. The audit must provide full and xxxxx disclosure of all as...
