Data Exchange Requirements Sample Clauses
The Data Exchange Requirements clause defines the obligations and standards for sharing data between parties involved in an agreement. It typically outlines the types of data to be exchanged, the format and frequency of data transfers, and any security or confidentiality measures that must be observed. For example, it may require parties to use specific file formats or secure transmission protocols when exchanging sensitive information. The core function of this clause is to ensure that data is shared efficiently, securely, and in a manner that supports the operational needs of both parties, thereby reducing the risk of misunderstandings or data breaches.
Data Exchange Requirements. The Contractor shall be able to receive, maintain and utilize data extracts from the Division and/or its contractors, e.g., pharmacy data from the Division or its PBM. These data extract files will be used for obtaining necessary information to properly identify members, reimburse providers for services rendered, and/or to reconcile records accordingly. The Contractor shall systematically update its database within five (5) calendar days of receipt of the files, and shall ensure that their Subcontractors update within five (5) calendar days of receipt of the files. However, the NCPDP Formulary Drug file and the Actual Acquisition Cost (AAC) files must be systematically updated via PBM database within one
(1) business day. Additionally, the Smart Prior Authorization criteria and rule changes must be updated by the PBM within thirty (30) calendar days. The Contractor must notify the Division when unable to comply with this requirement with reason and proposed resolution. Any data file unable to systematically update must be manually updated within one (1) calendar day of receipt. Data extract files include but are not limited to the following:
1. Daily Active Provider Extract;
2. Weekly Provider Affiliation Details Extract;
3. 834 Enrollment Files;
4. 835 Claims Payment Remittance Advice Transaction; 5. 277 Claims Acknowledgement;
Data Exchange Requirements. The Contractor shall be able to receive, maintain and utilize data extracts from the Division and/or its contractors, e.g., pharmacy data from the Division or its PBM. These data extract files will be used for obtaining necessary information to properly identify members, reimburse providers for services rendered, and/or to reconcile records accordingly. The Contractor shall systematically update its database within five (5) calendar days of receipt of the files, and shall ensure that their Subcontractors update within five (5) calendar days of receipt of the files. The Contractor must notify the Division when unable to comply with this requirement with reason and proposed resolution. Any data file unable to systematically update must be manually updated within one (1) calendar day of receipt. Data extract files include but are not limited to the following:
1. Daily Active Provider Extract;
2. Weekly Provider Affiliation Details Extract;
3. 834 Enrollment Files;
4. 835 Claims Payment Remittance Advice Transaction; 5. 277 Claims Acknowledgement;
Data Exchange Requirements. The Contractor must be able to receive, maintain, and utilize data extracts from the Division and/or its Agents. These data extract files will be used for obtaining necessary information to properly identify members, reimburse providers for services rendered, and/or to reconcile records accordingly. The Contractor must systematically update its database within five (5) calendar days of receipt of the files and shall ensure that its Subcontractors update within five (5) calendar days of receipt of the files, unless otherwise directed by the Division to update more frequently. Data extract files include but are not limited to the following:
1. Daily Active Provider Extract;
2. Weekly Provider Affiliation Details Extract;
3. 834 Enrollment Files;
4. 835 Claims Payment Remittance Advice Transaction; 5. 277 Claims Acknowledgement;
Data Exchange Requirements. The Contractor must be able to receive, maintain, and utilize data extracts from the Division and/or its Agents. These data extract files will be used for obtaining necessary information to properly identify members, reimburse providers for services rendered, and/or to reconcile records accordingly. The Contractor must systematically update its database within five (5) calendar days of receipt of the files and shall ensure that its Subcontractors update within five (5) calendar days of receipt of the files, unless otherwise directed by the Division to update more frequently. Data extract files include but are not limited to the following:
1. Daily Active Provider Extract;
2. Weekly Provider Affiliation Details Extract;
3. 834 Enrollment Files;
4. 835 Claims Payment Remittance Advice Transaction; 5. 277 Claims Acknowledgement;
6. Third Party Liability (TPL) Resource/Policy Information File, etc.;
7. Claims History Extracts;
8. Prior Authorization Extracts;
9. Denials Report;
10. Any files related to pharmacy and/or drug benefits and/or services as directed by and in a timeframe determined by the Division; and
11. Beneficiary Health Management Program (BHMP) to include but not be limited to: beneficiary, prescriber, and pharmacy lock-in information as requested by the Division’s Office of Program Integrity. The Contractor shall utilize the most current version of the Division’s Universal Preferred Drug List (PDL). The Division or its designee will continue to send to Contractor a weekly Formulary Drug file. The Contractor will have access to the Division’s up-to-date PDL through the Division’s website. The Division may impose liquidated damages under Section 15, Non-Compliance and Termination, of the Base CHIP Contract for non-compliance with these requirements.