Common use of Data Exchange Requirements Clause in Contracts

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;