Data Processing and Management System Requirements Sample Clauses

Data Processing and Management System Requirements. PBM agrees that its data management processes and data systems will be capable of accomplishing the following: 4.1.5.1 Collection of data in either an NCPDP or X12 format in accordance with the Health Insurance Portability and Accountability Act of 1996, and regulations issued there under (“HIPAA”). The data to be collected will encompass quantity, type, and costs of pharmaceutical prescriptions filled for Covered Individual and will be linked to Medicare beneficiary identification numbers (HIC#); 4.1.5.2 Submission of prescription drug Claims information for Covered Individuals for Part D Covered Services in the format required by CMS, using batch submission processes. Data to be submitted will encompass quantity, type, and costs of Covered Prescriptions filled for Covered Individuals and will be linked to Medicare beneficiary identification numbers (HIC#);\ 4.1.5.3 Submission of data to CMS via the Medicare Data Communications Network (MDCN) in compliance with CMS requirements; 4.1.5.4 Performance of data edit and quality control procedures to help ensure accurate and complete prescription drug data; 4.1.5.5 Correction of all data errors identified by CMS; 4.1.5.6 Collection of data for dates of service within the coverage period with a 3-month close-out window for the submission of remaining unreported Claims data; 4.1.5.7 Provision of additional information for the purposes of reconciliation of risk factors, low income subsidy payments, reinsurance payments, and risk corridor as required by CMS, and 4.1.5.8 Sending and receiving Claims data for third party payers from the CMS contractor that will serve as the clearinghouse for all Part D beneficiary outpatient drug Claims.