Common use of Encounter Data Quality Clause in Contracts

Encounter Data Quality. ‌ 3.14.2.1 The STATE shall monitor and evaluate encounter data lines and shall require correction of encounter data found deficient according to specifications published on the STATE’s managed care web site. Encounter data not corrected shall be assessed a penalty as specified in section 5.8 below. [42 CFR § 438.242(d)]‌‌‌ (1) Within twenty-one (21) days after the end of each calendar quarter, the STATE shall provide to the MCO an error reference report (ERR) of erroneous encounter lines and/or headers processed during the quarter, as described in the technical specifications posted on the STATE’s managed care web site. (2) The MCO shall, within the calendar quarter in which the ERR is provided, respond by appropriately voiding the erroneous encounter lines and/or headers and submitting corrected encounter data claims. (3) The MCO shall include on each corrected encounter data claim a “tracking ICN” as defined in the technical specifications posted on the STATE’s managed care web site. (4) The STATE will post on its managed care web site technical specifications including but not limited to definitions for encounter lines and headers; definitions for edits and errors; management of duplicate encounter lines or headers, submissions of multiple errors on one encounter claim, and voids that are within the same quarter; and a list of designated edits which may change at the discretion of the STATE. The STATE shall provide a minimum of ninety (90) days’ notice before implementing a new edit that will require correction.‌‌ (5) Encounter headers/lines identified by the STATE as errors subject to this section may not be voided as a method to avoid penalties. Encounter claims that should not have been submitted to the STATE and should not reside in STATE data as MCO accepted claims must be explicitly identified as such. Voided claims are subject to a validation process by the STATE. (6) The MCO may contest encounter lines or claims the STATE has identified as erroneous by sending the encounter ICN and a detailed description of the contested encounter lines or claims by e-mail to the STATE’s Encounter Data Quality contact. The STATE will remove the encounter line from the penalty assessment pending resolution of the issue. Contested errors will not be adjusted retroactively, but can be removed from the penalty going forward (as defined in the technical specifications posted on the STATE’s managed care web site). (7) The notice and opportunity to cure requirements in section 5.4 will not apply to encounter data quality errors and penalties assessed under section 5.8 below.‌‌‌‌ 3.14.2.2 The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider NPI or UMPI (the Provider that actually provided the service), when the Provider is part of a group practice that bills on the 837P format or 837D format. The treating Provider is not required when the billing provider is an individual and is the same as the individual that provided the service. Procedure codes on 837P and 837D format claim lines, for which registered individual treating Provider data submissions are required, are listed on the DHS web portal page as HCPCS codes. 3.14.2.3 The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. 3.14.2.4 The MCO must require any Subcontractor to include the MCO when contacting the STATE regarding any issue with encounter data. The MCO will work with the STATE and Subcontractor or agent to resolve any issue with encounter data.

Encounter Data Quality. ‌ 3.14.2.1 The STATE shall monitor and evaluate encounter data lines and shall require correction of encounter data found deficient according to specifications published on the STATE’s managed care web site. Encounter data not corrected shall be assessed a penalty as specified in section 5.8 5.9 below. [42 CFR § 438.242(d)]‌‌‌§438.242(d)]‌‌ (1) Within twenty-one (21) days after the end of each calendar quarter, the STATE shall provide to the MCO an error reference report (ERR) of erroneous encounter lines and/or headers processed during the quarter, as described in the technical specifications posted on the STATE’s managed care web site.site.‌‌ (2) The MCO shall, within the calendar quarter in which the ERR is provided, respond by appropriately voiding the erroneous encounter lines and/or headers and submitting corrected encounter data claims. (3) The MCO shall include on each corrected encounter data claim a “tracking ICN” as defined in the technical specifications posted on the STATE’s managed care web site. (4) The STATE will post on its managed care web site technical specifications including but not limited to definitions for encounter lines and headers; definitions for edits and errors; management of duplicate encounter lines or headers, submissions of multiple errors on one encounter claim, and voids that are within the same quarter; and a list of designated edits which may change at the discretion of the STATE. The STATE shall provide a minimum of ninety (90) days’ notice before implementing a new edit that will require correction.‌‌correction. (5) Encounter headers/lines identified by the STATE as errors subject to this section may not be voided as a method to avoid penalties. Encounter claims that should not have been submitted to the STATE and should not reside in STATE data as MCO accepted claims must be explicitly identified as such. Voided claims are subject to a validation process by the STATE. (6) The MCO may contest encounter lines or claims the STATE has identified as erroneous by sending the encounter ICN and a detailed description of the contested encounter lines or claims by e-mail to the STATE’s Encounter Data Quality contact. The STATE will remove the encounter line from the penalty assessment pending resolution of the issue. Contested errors will not be adjusted retroactively, but can be removed from the penalty going forward (as defined in the technical specifications posted on the STATE’s managed care web site). (7) The notice and opportunity to cure requirements in section 5.4 5.5 will not apply to encounter data quality errors and penalties assessed under section 5.8 5.9 below.‌‌‌‌ 3.14.2.2 The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider NPI or UMPI (the Provider that actually provided the service), when the Provider is part of a group practice that bills on the 837P format or 837D format. The treating Provider is not required when the billing provider is an individual and is the same as the individual that provided the service. Procedure codes on 837P and 837D format claim lines, for which registered individual treating Provider data submissions are required, are listed on the DHS web portal page as HCPCS codes. 3.14.2.3 The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. 3.14.2.4 The MCO must require any Subcontractor to include the MCO when contacting the STATE regarding any issue with encounter data. The MCO will work with the STATE and Subcontractor or agent to resolve any issue with encounter data.

Encounter Data Quality. ‌ 3.14.2.1 3.16.2.1 The STATE shall monitor and evaluate encounter data lines and shall require correction of encounter data found deficient according to specifications published on the STATE’s managed care web site. Encounter data not corrected shall be assessed a penalty as specified in section 5.8 below. [42 CFR § 438.242(d)]‌‌‌ (1) Within twenty-one (21) days after the end of each calendar quarter, the STATE shall provide to the MCO an error reference report (ERR) of erroneous encounter lines and/or headers processed during the quarter, as described in the technical specifications posted on the STATE’s managed care web site. (2) The MCO shall, within the calendar quarter in which the ERR is provided, respond by appropriately voiding the erroneous encounter lines and/or headers and submitting corrected encounter data claims, as described in the technical specifications posted on the STATE’s managed care web site. (3) The MCO shall include on each corrected encounter data claim a “tracking ICN” as defined in the technical specifications posted on the STATE’s managed care web site.site.‌‌ (4) The STATE will post on its managed care web site technical specifications including but not limited to definitions for encounter lines and headers; definitions for edits and errors; management of duplicate encounter lines or headers, submissions of multiple errors on one encounter claim, and voids that are within the same quarter; and a list of designated edits which may change at the discretion of the STATE. The STATE shall provide a minimum of ninety (90) days’ notice before implementing a new edit that will require correction.‌‌correction. (5) Encounter headers/lines identified by the STATE as errors subject to this section may not be voided as a method to avoid penalties. Encounter claims that should not have been submitted to the STATE and should not reside in STATE data as MCO accepted claims must be explicitly identified as such. Voided claims are subject to a validation process by the STATE. (6) The MCO may contest encounter lines or claims the STATE has identified as erroneous by sending the encounter ICN and a detailed description of the contested encounter lines or claims by e-mail to the STATE’s Encounter Data Quality contact. The STATE will remove the encounter line from the penalty assessment pending resolution of the issue. Contested errors will not be adjusted retroactively, but can be removed from the penalty going forward (as defined in the technical specifications posted on the STATE’s managed care web site). (7) The notice and opportunity to cure requirements in section 5.4 will not apply to encounter data quality errors and penalties assessed under section 5.8 below.‌‌‌‌ 3.14.2.2 5.8.‌‌‌‌ The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider NPI or UMPI (the Provider that actually provided the service), when the Provider is part of a group practice that bills on the 837P format or 837D format. The treating Provider is not required when the billing provider is an individual and is the same as the individual that provided the service. Procedure codes on 837P and 837D format claim lines, for which registered individual treating Provider data submissions are required, are listed on the DHS web portal page as HCPCS codes. 3.14.2.3 3.16.2.2 The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. 3.14.2.4 3.16.2.3 The MCO must require any Subcontractor to include the MCO when contacting the STATE regarding any issue with encounter data. The MCO will work with the STATE and Subcontractor or agent to resolve any issue with encounter data.

Encounter Data Quality. ‌ 3.14.2.1 The STATE shall monitor and evaluate encounter data lines and shall require correction of encounter data found deficient according to specifications published on the STATE’s managed care web site. Encounter data not corrected shall may be assessed a penalty as specified in section 5.8 5.9 below. [42 CFR § 438.242(d)]‌‌‌§438.242(d); Minnesota Statutes, §256B.69, subd. 9d] (1) Within twenty-one (21) days after the end of each calendar quarter, the STATE shall provide to the MCO an error reference report (ERR) of erroneous encounter lines and/or headers processed during the quarter, as described in the technical specifications posted on the STATE’s managed care web site. The October, 2021 and January, 2022 ERR reports will be suspended. (2) The MCO shall, within the calendar quarter in which the ERR is provided, respond by appropriately voiding the erroneous encounter lines and/or headers and submitting corrected encounter data claims. (3) The MCO shall include on each corrected encounter data claim a “tracking ICN” as defined in the technical specifications posted on the STATE’s managed care web site. (4) The STATE will post on its managed care web site technical specifications including but not limited to definitions for encounter lines and headers; definitions for edits and errors; management of duplicate encounter lines or headers, submissions of multiple errors on one encounter claim, and voids that are within the same quarter; and a list of designated edits which may change at the discretion of the STATE. The STATE shall provide a minimum of ninety (90) days’ notice before implementing a new edit that will require correction.‌‌correction. (5) Encounter headers/lines identified by the STATE as errors subject to this section may not be voided as a method to avoid penalties. Encounter claims that should not have been submitted to the STATE and should not reside in STATE data as MCO accepted claims must be explicitly identified as such. Voided claims are subject to a validation process by the STATE. (6) The MCO may contest encounter lines or claims the STATE has identified as erroneous by sending the encounter ICN and a detailed description of the contested encounter lines or claims by e-mail to the STATE’s Encounter Data Quality contact. The STATE will remove the encounter line from the penalty assessment pending resolution of the issue. Contested errors will not be adjusted retroactively, but can be removed from the penalty going forward (as defined in the technical specifications posted on the STATE’s managed care web site). (7) The notice and opportunity to cure requirements in section 5.4 5.5 will not apply to encounter data quality errors and penalties assessed under section 5.8 below.‌‌‌‌5.9 below. 3.14.2.2 The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider NPI or UMPI (the Provider that actually provided the service), when the Provider is part of a group practice that bills on the 837P format or 837D format. The treating Provider is not required when the billing provider is an individual and is the same as the individual that provided the service. Procedure codes on 837P and 837D format claim lines, for which registered individual treating Provider data submissions are required, are listed on the DHS web portal page as HCPCS codes. 3.14.2.3 The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. 3.14.2.4 The MCO must require any Subcontractor to include the MCO when contacting the STATE regarding any issue with encounter data. The MCO will work with the STATE and Subcontractor or agent to resolve any issue with encounter data.

Encounter Data Quality. ‌ 3.14.2.1 The STATE shall monitor and evaluate encounter data lines and shall require correction of encounter data found deficient according to specifications published on the STATE’s managed care web site. Encounter data not corrected shall may be assessed a penalty as specified in section 5.8 5.9 below. [42 CFR § 438.242(d)]‌‌‌§438.242(d)] (1) Within twenty-one (21) days after the end of each calendar quarter, the STATE shall provide to the MCO an error reference report (ERR) of erroneous encounter lines and/or headers processed during the quarter, as described in the technical specifications posted on the STATE’s managed care web site. The October, 2021 and January, 2022 ERR reports will be suspended. (2) The MCO shall, within the calendar quarter in which the ERR is provided, respond by appropriately voiding the erroneous encounter lines and/or headers and submitting corrected encounter data claims. (3) The MCO shall include on each corrected encounter data claim a “tracking ICN” as defined in the technical specifications posted on the STATE’s managed care web site. (4) The STATE will post on its managed care web site technical specifications including but not limited to definitions for encounter lines and headers; definitions for edits and errors; management of duplicate encounter lines or headers, submissions of multiple errors on one encounter claim, and voids that are within the same quarter; and a list of designated edits which may change at the discretion of the STATE. The STATE shall provide a minimum of ninety (90) days’ notice before implementing a new edit that will require correction.‌‌correction. (5) Encounter headers/lines identified by the STATE as errors subject to this section may not be voided as a method to avoid penalties. Encounter claims that should not have been submitted to the STATE and should not reside in STATE data as MCO accepted claims must be explicitly identified as such. Voided claims are subject to a validation process by the STATE. (6) The MCO may contest encounter lines or claims the STATE has identified as erroneous by sending the encounter ICN and a detailed description of the contested encounter lines or claims by e-mail to the STATE’s Encounter Data Quality contact. The STATE will remove the encounter line from the penalty assessment pending resolution of the issue. Contested errors will not be adjusted retroactively, but can be removed from the penalty going forward (as defined in the technical specifications posted on the STATE’s managed care web site). (7) The notice and opportunity to cure requirements in section 5.4 5.5 will not apply to encounter data quality errors and penalties assessed under section 5.8 below.‌‌‌‌5.9 below. 3.14.2.2 The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider NPI or UMPI (the Provider that actually provided the service), when the Provider is part of a group practice that bills on the 837P format or 837D format. The treating Provider is not required when the billing provider is an individual and is the same as the individual that provided the service. Procedure codes on 837P and 837D format claim lines, for which registered individual treating Provider data submissions are required, are listed on the DHS web portal page as HCPCS codes. 3.14.2.3 The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. 3.14.2.4 The MCO must require any Subcontractor to include the MCO when contacting the STATE regarding any issue with encounter data. The MCO will work with the STATE and Subcontractor or agent to resolve any issue with encounter data.

Encounter Data Quality. ‌ 3.14.2.1 3.16.2.1 The STATE shall monitor and evaluate encounter data lines and shall require correction of encounter data found deficient according to specifications published on the STATE’s managed care web site. Encounter data not corrected shall may be assessed a penalty as specified in section 5.8 5.9 below. [42 CFR § 438.242(d)]‌‌‌§438.242(d)] (1) Within twenty-one (21) days after the end of each calendar quarter, the STATE shall provide to the MCO an error reference report (ERR) of erroneous encounter lines and/or headers processed during the quarter, as described in the technical specifications posted on the STATE’s managed care web site. (2) The MCO shall, within the calendar quarter in which the ERR is provided, respond by appropriately voiding the erroneous encounter lines and/or headers and submitting corrected encounter data claims, as described in the technical specifications posted on the STATE’s managed care web site. The October, 2021 and January, 2022 ERR reports will be suspended. (3) The MCO shall include on each corrected encounter data claim a “tracking ICN” as defined in the technical specifications posted on the STATE’s managed care web site. (4) The STATE will post on its managed care web site technical specifications including but not limited to definitions for encounter lines and headers; definitions for edits and errors; management of duplicate encounter lines or headers, submissions of multiple errors on one encounter claim, and voids that are within the same quarter; and a list of designated edits which may change at the discretion of the STATE. The STATE shall provide a minimum of ninety (90) days’ notice before implementing a new edit that will require correction.‌‌correction. (5) Encounter headers/lines identified by the STATE as errors subject to this section may not be voided as a method to avoid penalties. Encounter claims that should not have been submitted to the STATE and should not reside in STATE data as MCO accepted claims must be explicitly identified as such. Voided claims are subject to a validation process by the STATE. (6) The MCO may contest encounter lines or claims the STATE has identified as erroneous by sending the encounter ICN and a detailed description of the contested encounter lines or claims by e-mail to the STATE’s Encounter Data Quality contact. The STATE will remove the encounter line from the penalty assessment pending resolution of the issue. Contested errors will not be adjusted retroactively, but can be removed from the penalty going forward (as defined in the technical specifications posted on the STATE’s managed care web site). (7) The notice and opportunity to cure requirements in section 5.4 5.5 will not apply to encounter data quality errors and penalties assessed under section 5.8 below.‌‌‌‌5.9. 3.14.2.2 3.16.2.2 The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider NPI or UMPI (the Provider that actually provided the service), when the Provider is part of a group practice that bills on the 837P format or 837D format. The treating Provider is not required when the billing provider is an individual and is the same as the individual that provided the service. Procedure codes on 837P and 837D format claim lines, for which registered individual treating Provider data submissions are required, are listed on the DHS web portal page as HCPCS codes. 3.14.2.3 3.16.2.3 The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. 3.14.2.4 3.16.2.4 The MCO must require any Subcontractor to include the MCO when contacting the STATE regarding any issue with encounter data. The MCO will work with the STATE and Subcontractor or agent to resolve any issue with encounter data.

Encounter Data Quality. ‌ 3.14.2.1 3.16.2.1 The STATE shall monitor and evaluate encounter data lines and shall require correction of encounter data found deficient according to specifications published on the STATE’s managed care web site. Encounter data not corrected shall may be assessed a penalty as specified in section 5.8 5.9 below. [42 CFR § 438.242(d)]‌‌‌§438.242(d)] (1) Within twenty-one (21) days after the end of each calendar quarter, the STATE shall provide to the MCO an error reference report (ERR) of erroneous encounter lines and/or headers processed during the quarter, as described in the technical specifications posted on the STATE’s managed care web site. (2) The MCO shall, within the calendar quarter in which the ERR is provided, respond by appropriately voiding the erroneous encounter lines and/or headers and submitting corrected encounter data claims, as described in the technical specifications posted on the STATE’s managed care web site. The October, 2021 and January, 2022 ERR reports will be suspended. (3) The MCO shall include on each corrected encounter data claim a “tracking ICN” as defined in the technical specifications posted on the STATE’s managed care web site. (4) The STATE will post on its managed care web site technical specifications including but not limited to definitions for encounter lines and headers; definitions for edits and errors; management of duplicate encounter lines or headers, submissions of multiple errors on one encounter claim, and voids that are within the same quarter; and a list of designated edits which may change at the discretion of the STATE. The STATE shall provide a minimum of ninety (90) days’ notice before implementing a new edit that will require correction.‌‌correction. (5) Encounter headers/lines identified by the STATE as errors subject to this section may not be voided as a method to avoid penalties. Encounter claims that should not have been submitted to the STATE and should not reside in STATE data as MCO accepted claims must be explicitly identified as such. Voided claims are subject to a validation process by the STATE. (6) The MCO may contest encounter lines or claims the STATE has identified as erroneous by sending the encounter ICN and a detailed description of the contested encounter lines or claims by e-mail to the STATE’s Encounter Data Quality contact. The STATE will remove the encounter line from the penalty assessment pending resolution of the issue. Contested errors will not be adjusted retroactively, but can be removed from the penalty going forward (as defined in the technical specifications posted on the STATE’s managed care web site). (7) The notice and opportunity to cure requirements in section 5.4 5.5 will not apply to encounter data quality errors and penalties assessed under section 5.8 below.‌‌‌‌5.9. 3.14.2.2 3.16.2.2 The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider NPI or UMPI (the Provider that actually provided the service), when the Provider is part of a group practice that bills on the 837P format or 837D format. The treating Provider is not required when the billing provider is an individual and is the same as the individual that provided the service. Procedure codes on 837P and 837D format claim lines, for which registered individual treating Provider data submissions are required, are listed on the DHS web portal page as HCPCS codes. 3.14.2.3 3.16.2.3 The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. 3.14.2.4 3.16.2.4 The MCO must require any Subcontractor to include the MCO when contacting the STATE regarding any issue with encounter data. The MCO will work with the STATE and Subcontractor or agent to resolve any issue with encounter data.

Encounter Data Quality. ‌ 3.14.2.1 3.16.2.1 The STATE shall monitor and evaluate encounter data lines and shall require correction of encounter data found deficient according to specifications published on the STATE’s managed care web site. Encounter data not corrected shall be assessed a penalty as specified in section 5.8 below. [42 CFR § §438.242(d)]‌‌‌ (1) Within twenty-one (21) days after the end of each calendar quarter, the STATE shall provide to the MCO an error reference report (ERR) of erroneous encounter lines and/or headers processed during the quarter, as described in the technical specifications posted on the STATE’s managed care web site. (2) The MCO shall, within the calendar quarter in which the ERR is provided, respond by appropriately voiding the erroneous encounter lines and/or headers and submitting corrected encounter data claims., as described in the technical specifications posted on the STATE’s managed care web site.‌‌ (3) The MCO shall include on each corrected encounter data claim a “tracking ICN” as defined in the technical specifications posted on the STATE’s managed care web site. (4) The STATE will post on its managed care web site technical specifications including but not limited to definitions for encounter lines and headers; definitions for edits and errors; management of duplicate encounter lines or headers, submissions of multiple errors on one encounter claim, and voids that are within the same quarter; and a list of designated edits which may change at the discretion of the STATE. The STATE shall provide a minimum of ninety (90) days’ notice before implementing a new edit that will require correction.‌‌correction. (5) Encounter headers/lines identified by the STATE as errors subject to this section may not be voided as a method to avoid penalties. Encounter claims that should not have been submitted to the STATE and should not reside in STATE data as MCO accepted claims must be explicitly identified as such. Voided claims are subject to a validation process by the STATE. (6) The MCO may contest encounter lines or claims the STATE has identified as erroneous by sending the encounter ICN and a detailed description of the contested encounter lines or claims by e-mail to the STATE’s Encounter Data Quality contact. The STATE will remove the encounter line from the penalty assessment pending resolution of the issue. Contested errors will not be adjusted retroactively, but can be removed from the penalty going forward (as defined in the technical specifications posted on the STATE’s managed care web site). (7) The notice and opportunity to cure requirements in section 5.4 will not apply to encounter data quality errors and penalties assessed under section 5.8 below.‌‌‌‌5.8.‌‌‌‌ 3.14.2.2 3.16.2.2 The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider NPI or UMPI (the Provider that actually provided the service), when the Provider is part of a group practice that bills on the 837P format or 837D format. The treating Provider is not required when the billing provider is an individual and is the same as the individual that provided the service. Procedure codes on 837P and 837D format claim lines, for which registered individual treating Provider data submissions are required, are listed on the DHS web portal page as HCPCS codes. 3.14.2.3 3.16.2.3 The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. 3.14.2.4 3.16.2.4 The MCO must require any Subcontractor to include the MCO when contacting the STATE regarding any issue with encounter data. The MCO will work with the STATE and Subcontractor or agent to resolve any issue with encounter data.