Common use of Encounter Data Reporting Clause in Contracts

Encounter Data Reporting. A. Contractor shall maintain a MIS that collects and reports Encounter Data to DHCS in compliance with 42 CFR 438.242, and pursuant to applicable DHCS All Plan Letters (APL). B. Contractor shall implement policies and procedures for ensuring the complete, accurate, reasonable, and timely submission of Encounter Data to DHCS for all items and services furnished to a Member under this Contract, whether directly or through Subcontracts or other arrangements, including capitated Providers. Encounter Data shall be submitted on at least a monthly basis in a form and manner specified by DHCS. C. Contractor shall require Subcontractors and non-contracting Providers to submit claims and Encounter Data to Contractor to meet its administrative functions and the requirements set forth in this Section. Contractor shall have in place mechanisms, including edit and reporting systems sufficient to assure Encounter Data is complete, accurate, reasonable, and timely prior to submission to DHCS. Contractor shall ensure the completeness, accuracy, reasonability, and timeliness of all Subcontractor Encounter Data regardless of whether Subcontractor is reimbursed on a Fee-For- Service (FFS) or capitated basis. D. Contractor shall submit complete, accurate, reasonable, and timely Encounter Data within six (6) business days of the end of each month following the month of payment, under this Contract or as otherwise agreed upon by DHCS, and in the format specified by DHCS. E. DHCS shall review and validate the Encounter Data for completeness, accuracy, reasonability, and timeliness. F. If DHCS finds deficiencies regarding the completeness, accuracy, reasonability, and timeliness of the Encounter Data, DHCS may notify Contractor in writing of the deficiency and request correction and resubmission of the relevant Encounter Data. Contractor shall ensure that corrected Encounter Data is resubmitted within 15 calendar days of the date of DHCS' notice. Upon Contractor's written request, DHCS may grant an extension for submission of corrected Encounter Data. G. Contractor shall ensure all Encounter Data is submitted to DHCS within two (2) months of adjudication of a FFS claim or receipt of a capitated Encounter. Subcontractors and Providers must comply with this Provision for submission of Encounter Data to Contractor. All Encounter Data shall be submitted to Contractor no later than 12 months from the date of service. H. DHCS or its agent will periodically, but not less frequently than once every three (3) years, conduct an independent audit of the Encounter Data submitted by, or on behalf of, Contractor, In accordance with 42 CFR 438.602(e).

Encounter Data Reporting. A. Contractor shall maintain a MIS that collects and reports Encounter Data to DHCS DHCS, including allowed amounts and paid amounts as required, in compliance with 42 CFR section 438.242, and pursuant to applicable DHCS All Plan Letters (APL). B. Contractor shall implement policies and procedures for ensuring the complete, accurate, reasonable, and timely submission of Encounter Data to DHCS for all items and services furnished to a Member under this Contract, whether directly or through Subcontracts Network Provider Agreements or other arrangements, including capitated ProvidersSubcontractor Agreements. Encounter Data shall be submitted on at least a monthly basis in a form and manner specified by DHCS. C. Contractor shall require Subcontractors Subcontractors, Network Providers, and nonOut-contracting of- Network Providers to submit claims and Encounter Data to Contractor to meet its administrative functions and the requirements set forth in this Section. Contractor shall have in place mechanisms, including edit and reporting systems sufficient to assure Encounter Data is complete, accurate, reasonable, and timely prior to submission to DHCS. Contractor shall ensure the completeness, accuracy, reasonability, and timeliness of all Subcontractor Network Provider, Subcontractor, and Out-of-Network Provider Encounter Data regardless of whether Subcontractor Subcontractor, Network Provider, or Out-of-Network Provider is reimbursed on a Fee-For- For-Service (FFS) or capitated basis. D. Contractor shall submit complete, accurate, reasonable, and timely Encounter Data within six (6) business days of the end of each month following the month of payment, under this Contract or as otherwise agreed upon by DHCS, and in the format specified by DHCS. E. DHCS shall review and validate the Encounter Data for completeness, accuracy, reasonability, and timeliness. F. If DHCS finds deficiencies regarding the completeness, accuracy, reasonability, and timeliness of the Encounter Data, DHCS may notify Contractor in writing of the deficiency and request correction and resubmission of the relevant Encounter Data. Contractor shall ensure that corrected Encounter Data is resubmitted within 15 calendar days of the date of DHCS' notice. Upon Contractor's written request, DHCS may grant an extension for submission of corrected Encounter Data. G. Contractor shall ensure all Encounter Data is submitted to DHCS within two (2) months of adjudication of a FFS claim or receipt of a capitated Encounter. Subcontractors Subcontractors, Network Providers, and Out-of-Network Providers must comply with this Provision for submission of Encounter Data to Contractor. All Encounter Data shall be submitted to Contractor no later than 12 months from the date of service. H. DHCS or its agent will periodically, but not less frequently than once every three (3) years, conduct an independent audit of the Encounter Data submitted by, or on behalf of, Contractor, In accordance with 42 CFR 438.602(e).

Encounter Data Reporting. A. Contractor shall maintain a MIS that collects and reports Encounter Data to DHCS in compliance with 42 CFR 438.242, and pursuant to applicable DHCS All Plan Letters (APL). B. Contractor shall implement policies and procedures for ensuring the submission of complete, accurate, reasonable, and timely submission of Encounter Data to DHCS for all items and services furnished to a Member under this Contract, whether directly or through Subcontracts or other arrangements, including capitated Providers. Encounter Data shall be submitted on at least a monthly basis in a form and manner specified by DHCS.at C. Contractor shall require Subcontractors and non-contracting Providers to submit claims and Encounter Data to Contractor to meet its administrative functions and the requirements set forth in this Section. Contractor shall have in place mechanisms, including edit and reporting systems sufficient to assure Encounter Data is complete, accuratetimely, reasonable, and timely accurate prior to submission to DHCS. Contractor shall ensure the completeness, accuracy, reasonability, and timeliness of all Subcontractor Encounter Data regardless of whether Subcontractor is reimbursed on a Fee-For- Service (FFS) or capitated basis. D. Contractor shall submit complete, accurate, reasonable, and timely Encounter Data to DHCS within six (6) business days of the end of each month following the month of payment, under this Contract or as otherwise agreed upon by DHCS, and in the format form and manner specified by in DHCS. E. DHCS shall review and validate the Encounter Data for completeness, accuracy, reasonability, and timeliness. F. If DHCS finds any deficiencies regarding the completeness, accuracy, reasonability, and timeliness of the Encounter Data, DHCS may notify Contractor in writing of the deficiency and request correction and resubmission of the relevant Encounter Data. Contractor shall ensure that corrected Encounter Data is resubmitted within 15 calendar days of the date of DHCS' notice. Upon Contractor's written request, DHCS may grant an extension for submission of corrected Encounter Data. G. Contractor shall ensure all Encounter Data is submitted to DHCS within two (2) months of adjudication of a FFS claim or receipt of a capitated Encounter. Subcontractors and Providers must comply with this Provision for submission of Encounter Data to Contractor. All Encounter Data shall be submitted to Contractor no later than 12 months from the date of service. H. DHCS or its agent will periodically, but not less frequently than once every three (3) years, conduct an independent audit of the Encounter Data submitted by, or on behalf of, Contractor, In accordance with 42 CFR 438.602(e).

Encounter Data Reporting. A. Contractor shall maintain a MIS that collects and reports Encounter Data to DHCS in compliance with 42 CFR 438.242, and pursuant to applicable DHCS All Plan Letters (APL). B. Contractor shall implement policies and procedures for ensuring the complete, accurate, reasonable, and timely submission of Encounter Data to DHCS for all items and services furnished to a Member under this Contract, whether directly or through Subcontracts or other arrangements, including capitated Providers. Encounter Data shall be submitted on at least a monthly basis in a form and manner specified by DHCS. C. Contractor shall require Subcontractors and non-contracting Providers to submit claims and Encounter Data to Contractor Contractor, to meet its administrative functions and the requirements set forth in this Section. Contractor shall have in place mechanisms, including edit and reporting systems sufficient to assure Encounter Data is complete, accurate, reasonable, and timely prior to submission to DHCS. Contractor shall ensure the completeness, accuracy, reasonability, and timeliness of all Subcontractor Encounter Data regardless of whether Subcontractor is reimbursed on a Fee-For- Service (FFS) or capitated basis. D. Contractor shall submit complete, accurate, reasonable, and timely Encounter Data within six (6) business days of the end of each month following the month of payment, under this Contract or as otherwise agreed upon by DHCS, DHCS and in the format specified by DHCS. E. DHCS shall review and validate the Encounter Data for completeness, accuracy, reasonability, and timeliness. F. If DHCS finds deficiencies regarding the completeness, accuracy, reasonability, and timeliness of the Encounter Data or the quality of Encounter Data, DHCS may notify Contractor in writing of the deficiency and request correction and resubmission of the relevant Encounter Data. Contractor shall ensure that corrected Encounter Data is resubmitted within 15 calendar days of the date of DHCS' notice. Upon Contractor's written request, DHCS may grant an extension for submission of corrected Encounter Data. G. Contractor shall ensure all Encounter Data is submitted to DHCS within two (2) months of adjudication of a FFS claim or receipt of a capitated Encounter. Subcontractors and Providers must comply with this Provision for submission of Encounter Data to Contractor. All Encounter Data shall be submitted to Contractor no later than 12 months from the date of service. H. DHCS or its agent will periodically, but not less frequently than once every three (3) years, conduct an independent audit of the Encounter Data submitted by, or on behalf of, Contractor, In accordance with 42 CFR 438.602(e).. Exhibit A, Attachment 3 MANAGEMENT INFORMATION SYSTEM‌‌