Coding Requirements. The Contractor shall utilize existing activity codes and apply new codes to all new activities added by the Contractor. The coding and organization of the Project Schedule must be in a format that is acceptable to Princeton University.
Coding Requirements.
3.15.1 The MCO must use the most current version of the following coding sources: • Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification with ICD-10-CM/PCS coding requirements on claim and encounter data submissions; • Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2); • American Dental Association current dental terminology codes as specified in Minnesota Statutes, §62Q.78; • National Drug Codes; • Current local home care and waiver codes, including units of service. The EW codes must be HIPAA compliant according to the most current published instructional Minnesota Department of Human Services (DHS) bulletin 09-69-02, or as required in subsequent bulletins.
3.15.1.1 Neither the MCO nor its Subcontractors may redefine or substitute these required codes.
3.15.1.2 National Provider Identifier (NPI) and Atypical Provider Types. The MCO shall use the NPI for all Providers for whom CMS issues NPIs. For certain Providers of Atypical Services, the MCO shall use the STATE-issued UMPI.
Coding Requirements. The MCO must use the most current version of the following coding sources:
(a) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification ICD-10-CM/PCS coding requirements on claim and encounter data submissions;
(b) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2);
(c) American Dental Association current dental terminology codes as specified in Minnesota Statutes, § 62Q.78; and
(d) National Drug Codes.
(e) Current local home care codes including units of service. The MCO and its subcontractors must utilize the coding sources as defined in this section and follow the instructions and guidelines set forth in the most current versions of ICD-10-CM/PCS, and HCPCS and CPT. The STATE may request additional information on the MCO’s ICD-10 CM/PCS implementation. Neither the MCO nor its subcontractors may redefine or substitute these required codes. HIPAA compliant codes must be submitted on encounter data.
Coding Requirements. 3.27.1 The MCO must use the most current version of the following coding sources:
(A) Diagnosis codes obtained from the International Classification of Diseases, Clinical Modification (ICD-9-CM);
(B) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Healthcare Common Procedure Coding System (HCPCS Level 2);
(C) American Dental Association (ADA) current dental terminology codes as specified in Minnesota Statutes, § 62Q.78; and
(D) National Drug Codes.
(E) Current local home care codes including units of service.
3.27.2 The MCO and its subcontractors must utilize the coding sources as defined in this section and follow the instructions and guidelines set forth in the most current versions of HCPCS and CPT.
3.27.3 Neither the MCO nor its subcontractors may redefine or substitute these required codes.
3.27.4 HIPAA compliant codes must be submitted on encounter data.
Coding Requirements.
3.16.3.1 The MCO must use the most current version of the following coding sources:
(1) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification ICD-10-CM/PCS coding requirements on claim and encounter data submissions;
(2) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2);
(3) American Dental Association current dental terminology codes as specified in Minnesota Statutes, §62Q.78;
(4) National Drug Codes; and
(5) Current local home care codes including units of service.
3.16.3.2 Neither the MCO nor its Subcontractors may redefine or substitute these required codes.
3.16.3.3 National Provider Identifier (NPI) and Atypical Provider Types. The MCO shall use the NPI for all Providers for whom CMS issues NPIs. For certain Providers of Atypical Services, the MCO shall use the STATE-issued UMPI.
Coding Requirements. 18.1 Unless otherwise confirmed and/or agreed by the Authority in writing and subject to Clause 18.2 of this Schedule 2, the Supplier shall ensure comprehensive product information relating to each category of the Goods shall be placed by the Supplier into a GS1 certified data pool within the following timescales:
18.1.1 prior to or on the Commencement Date, in relation to all categories of Goods to be provided as part of the Contract as at the Commencement Date; or
18.1.2 where further categories of Goods are to be supplied in accordance with Clause 21 of this Schedule 2, prior to or on the date of implementation of any such variation.
18.2 Where it is not practical for whatever reason for the Supplier to comply with its obligations under Clause 18.1 of this Schedule 2 within the timescales stated and the Authority requires compliance with such coding requirements, the Supplier shall provide an implementation plan and timetable that sets out how the Supplier shall achieve such compliance by an alternative timescale. This implementation plan and timetable must be submitted by the Supplier for agreement by the Authority prior to the first delivery of the relevant Goods under the Contract (such agreement not to be unreasonably withheld or delayed). Any failure by the Parties to agree such a timetable and plan shall be referred to and resolved in accordance with the Dispute Resolution Procedure. Once a timetable and plan have been agreed by the Authority, the Supplier shall comply with such timetable and plan as a condition of this Contract.
18.3 Once product information relating to Goods is placed by the Supplier into a GS1 certified data pool, the Supplier shall, during the Term, keep such information updated with any changes to the product data relating to the Goods.
Coding Requirements. Provider shall follow Company’s requirements and guidelines for Claims coding and processing that are specific to each provider type. Company shall notify Provider ninety (90) days before implementing changes to Claims coding and processing guidelines applicable to Provider. The State and HHS may inspect and audit any financial records of Company, Provider or its subcontractors. There shall be no restrictions on the right of the state or federal government to conduct whatever inspections and audits are necessary to assure quality, appropriateness or timeliness of services and reasonableness of their costs.
Coding Requirements. (1) The MCO must use the most current version of the following coding sources, unless otherwise precluded from doing so by state or federal law:
(a) Diagnosis codes obtained from the International Classification of Diseases, Clinical Modification (ICD-9-CM).
(b) Procedure codes obtained from the International Classification of Diseases, Clinical Modification (ICD-9-CM) for inpatient claims.
(c) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2).
(d) American Dental Association current dental terminology codes as specified in Minnesota Statutes, § 62Q.78.
(e) National Drug Codes.
(2) The MCO and its subcontractors must utilize the coding sources as defined in this section and follow the instructions and guidelines set forth in the most current versions of ICD-9-CM, HCPCS and CPT.
(3) Neither the MCO nor its subcontractors may redefine or substitute these required codes.
(4) HIPAA compliant codes must be submitted on encounter data.
Coding Requirements. The MCO must use the most current version of the following coding sources:
(a) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification with ICD-10- CM/PCS coding requirements on claim and encounter data submissions;
(b) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2);
(c) American Dental Association current dental terminology codes as specified in Minnesota Statutes, §62Q.78;
(d) National Drug Codes;
(e) Current local home care and waiver codes, including units of service. The EW codes must be HIPAA compliant according to the most current published instructional Minnesota Department of Human Services (DHS) bulletin 09-69- 02, or as required in subsequent bulletins. The MCO and its subcontractors must utilize the coding sources as defined in this section and follow the instructions and guidelines set forth in the most current versions of ICD-10-CM/PCS, and HCPCS and CPT. The STATE may request additional information on the MCO’s ICD-10 CM/PCS implementation. Neither the MCO nor its subcontractors may redefine or substitute these required codes. HIPAA compliant codes must be submitted on encounter data.
Coding Requirements. (1) The MCO must use the most current version of the following coding sources:
(a) Diagnosis codes obtained from the International Classification of Diseases, Clinical Modification (ICD-9-CM);
(b) Procedure codes obtained from the International Classification of Diseases, Clinical Modification (ICD-9-CM) for inpatient claims;
(c) Procedure codes obtained from Physician's Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2);
(d) American Dental Association current dental terminology codes as specified in Minnesota Statutes, §62Q.78;
(e) National Drug Codes;
(f) Current local home care and waiver codes, including units of service. The EW codes must be HIPAA compliant according to the most current published instructional Minnesota Department of Human Services (DHS) bulletin 09-69-02, or as required in subsequent bulletins.
(2) The MCO and its subcontractors must utilize the coding sources as defined in this section and follow the instructions and guidelines set forth in the most current versions of ICD-9-CM, HCPCS and CPT. The MCO will cooperate with the STATE as necessary to ensure the MCO will be in compliance with ICD-10 coding requirements when ICD-10 implementation takes effect.
(3) Neither the MCO nor its subcontractors may redefine or substitute these required codes.
(4) HIPAA compliant codes must be submitted on encounter data.
