Data and Systems a. Contractor will not modify any operational process during the Term of the Contract without the prior notification of the County, as well as approval by County for any County specific processes.
b. Upon termination of the Contract Term, Contractor shall provide data to succeeding contractor or the County, as directed, including all necessary data and information, except direct deposit information, including but not limited to claims data and patient profiles to ensure an orderly transition, at no additional charge to County. Contractor shall provide up to two files for historical paid claims and open claims, respectively, within 30 days of the termination of the Contract and deliver all records, accounts of operation and claim files to County.
c. Contractor shall accept electronic data transfer and administer membership information in compliance with HIPAA standards for privacy, security and electronic data interchange.
d. Contractor shall provide on-line, unlimited eligibility updating and entry capabilities for authorized County staff. Subject to applicable laws, rules and regulations relating to privacy and confidentiality, Contractor shall provide County’s Benefits Administrator with on-line access to read County’s eligibility information.
e. Contractor shall receive from County, on a twice-monthly basis, an eligibility file of eligible County Participants through a File Transfer Protocol (FTP) feed.
f. Contractor shall notify County or its designee, prior to the eligibility update application, of any material errors or coding problems on the eligibility file that exceeds agreed upon thresholds.
g. Contractor shall notify the County immediately, or as soon as administratively possible, upon identification of system-related problems, programming or data transfer problems. The Contractor shall make every effort necessary to correct such problems within 48 hours, regardless of the time or date, in order to minimize any disruption to Participants.
h. Contractor shall maintain complete records of all claims and payments for a minimum of six years or greater as required by law. At the end of the six-year period, records shall either be transferred to the County or destroyed under the County’s direction, unless further retention is otherwise required by law.
i. Contractor shall provide necessary data files to respond to government requests or respond to class action lawsuits without additional fees for the length of the contract. Such services shall be prov...
Data and Systems. 1. Contractor will not modify any operational or clinical program or process that substantially impacts the services Contractor provides to County during the Term of this Contract without the prior notification and approval of the County.
2. Contractor shall accept electronic data transfer and administer membership information in compliance with HIPAA standards for privacy, security and electronic data interchange.
3. Contractor shall agree to make internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by organization available to the Secretary of the Department of Health and Human Services for purposes of the Secretary of the Department of Health and Human Services determining organization's compliance with the privacy rules.
4. Contractor will adopt and implement written confidentiality policies and procedures in accordance with applicable law to ensure the confidentiality of member information used for any purpose.
5. Contractor will agree not use or further disclose protected health information (PHI) other than as permitted or required by the Business Associate Agreement or as required by law.
6. Contractor agrees to use appropriate safeguards to prevent the unauthorized use or disclosure of the PHI. Contractor agrees to report to the plan sponsor any unauthorized use or disclosure of the PHI.
7. Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to Contractor of a use or disclosure of PHI by Contractor in violation of the requirements of the federal privacy rule.
8. Contractor agrees to provide access to PHI in a "designated record set" in order to meet the requirements under 45 CFR 164.524.
9. Contractor agrees to make any amendment(s) to PHI in a "designated record set" pursuant to 45 CFR 164.526.
10. Contractor agrees to document such disclosures of PHI and information related to such disclosures as would be required to respond to a request by an individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.
11. The Contractor agrees to:
a. implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic PHI that it creates, receives, maintains, or transmits,
b. report to the plan sponsor any security incident (within the meaning of 45 CFR 164.304) of which Contractor becomes aware, and
c. ensure that any Contractor empl...
Data and Systems. 1. Contractor will not modify any operational or clinical program or process that substantially impacts the services Contractor provides to County during the Term of this Contract without the prior notification and approval of the County.
2. Contractor shall accept electronic data transfer and administer membership information in compliance with HIPAA standards for privacy, security and electronic data interchange.
3. Contractor will adopt and implement written confidentiality policies and procedures in accordance with applicable law to ensure the confidentiality of member information used for any purpose.
4. Contractor will agree to not use or further disclose protected health information (PHI) other than as permitted or required by the Business Associate Agreement, Attachment G, or as required by law.
5. The Contractor agrees to:
a. Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic PHI that it creates, receives, maintains, or transmits;
b. Report to the plan sponsor any security incident (within the meaning of 45 CFR 164.304) of which Contractor becomes aware; and,
c. Ensure that any Contractor employee or agent, including any subcontractor to whom it provides PHI received from, or created or received by the Contractor agrees to implement reasonable and appropriate safeguards to protect such PHI.
6. Contractor shall notify the County immediately upon identification of system-related problems, programming problems or data transfer problems. The Contractor shall make every effort necessary to correct such problems within 48 hours in order to minimize any disruption to participants.
7. Contractor shall maintain a disaster recovery plan that contemplates a natural or unnatural disaster, cybersecurity incidence response, or national emergency, enabling Contractor to continue to provide core dental services using alternative sites and locations as reasonably necessary and appropriate.
8. Contractor will maintain and update sufficient documentation (such as Excel spreadsheets) to support the correct set-up of Contractor’s claims processing systems in conformance with the County’s Plan Design and subsequent Plan changes. System changes resulting from Plan Design changes shall be based upon receipt of signed documentation from the client.
9. Contractor will adhere to all best practices related to Cybersecurity as required by the National Institu...
Data and Systems a. Contractor will not modify any operational or clinical program or process during the term of this contract without the prior notification and approval of the County.
b. Upon termination of the contract term, Contractor shall provide data to succeeding Contractor or the County, including all necessary data and information including but not limited to claims data and patient profiles to ensure high quality patient care during the transition, as directed at no additional charge. Contractor shall provide up to three files for historical paid claims, open mail order refills, and open prior authorization, respectively, within 30 days of the termination of the Contract and deliver all records, accounts of operation and claim files to County.
c. Contractor shall accept electronic data transfer and administer membership information in compliance with HIPAA standards for privacy, security and electronic data interchange.
d. Contractor shall provide on-line, unlimited eligibility updating and entry capabilities for authorized the County staff. Subject to applicable laws, rules and regulations relating to privacy and confidentiality, Contractor shall provide County’s Benefits Administrator with on-line access to read County’s eligibility information.
e. Contractor shall conduct manual eligibility updates at no charge to the County. In the case of emergency eligibility Contractor shall provide either access for The County’s TPA staff to make on-line eligibility updates on a same-day basis.
f. Contractor shall contact County’s Benefits Administrator for verification of eligibility of a participant that is shown as ineligible online in the event of participant escalation.
g. Contractor shall receive on a twice-monthly basis, an eligibility file of eligible County participants from County’s PPO TPA in an existing format defined in a separate file layout. Contractor shall treat the eligibility file sent by County’s TPA as a Full File eligibility file. County has discretion to request that the Contractor receive such an eligibility file on a weekly basis. Upon receipt of file, Contractor shall load and determine if any discrepancy thresholds are triggered. If so, County or its designee will be notified of eligibility discrepancies. Contractor shall update the eligibility file within two working days of receipt of the clean eligibility file. Currently, the eligibility file is provided in HIPAA-compliant American National Standards Institute (ANSI) 834 format; however, Cou...
Data and Systems a. Contractor agrees to discuss with the County any material changes in operational processes that may have a material impact on the administration of the Plan in advance of these changes will not modify any operational process during the term of this Contract without the prior notification and approval of the County.
b. Upon termination of the Contract term, Contractor, or its third party Claims Administration subcontractor, shall provide data to succeeding Contractor or the County, as directed, including all necessary data and information including but not limited to claims data and patient profiles to ensure an orderly transition, at no additional charge. Contractor shall provide up to two files for historical paid claims and open claims, respectively, within 30 days of the termination of the Contract and deliver all records, accounts of operation and claim files to County.
c. Contractor shall accept electronic data transfer and administer membership information in compliance with HIPAA standards for privacy, security and electronic data interchange.
d. Contractor shall provide on-line, unlimited eligibility updating and entry capabilities for authorized the County staff. Subject to applicable laws, rules and regulations relating to privacy and confidentiality, Contractor shall provide County’s Benefits Administrator with on-line access to read County’s eligibility information.
e. Contractor shall receive on a twice-monthly basis, an eligibility file of eligible County Participants from County by FTP.
f. Contractor shall notify County or its designee prior to the eligibility update application, of any material errors or coding problems on the eligibility file that exceeds agreed upon thresholds.
g. Contractor shall notify the County immediately within a reasonable period or as soon as administratively feasible, upon identification of system-related problems, programming problems or data transfer problems. The Contractor shall make every effort necessary to correct such problems within 48 hours regardless of the time or date in order to minimize any disruption to Participants.
h. Contractor or its agents, including its third party Claims Administration services subcontractor, shall maintain complete records of all claims and payments for a minimum of six years or greater as required by law. At the end of the six-year period, records shall either be transferred to the County or destroyed under the County’s direction, except to the extent necessary for Con...
Data and Systems
