Common use of Encounter Data Submission Penalties Clause in Contracts

Encounter Data Submission Penalties. Based on Blue Shield’s quarterly determinations and following no less than thirty (30) days prior notice to Group, Blue Shield may withhold a portion of Group’s Capitation, as set forth in Exhibit C., in the event that Blue Shield determines that a significant portion (as described in the Provider Manual) of the monthly Encounter Data which Group is obligated to provide (Paragraph 2.12) has not been delivered to Blue Shield within the prior quarter. If at the quarterly determination next following such withhold, Blue Shield determines that Group has satisfactorily delivered to Blue Shield the previously non-delivered Encounter Data, such withheld Capitation shall be paid to Group, without interest. In the event that Group does not deliver such Encounter Data to Blue Shield prior to such quarterly determination, Blue Shield shall be entitled to retain such withheld Capitation and will continue to deduct from the Group’s Capitation and retain such deductions as described in Exhibit C. from each quarter’s Capitation. If at a later date Group resumes the timely and complete submission of encounter data as required by this Agreement, then Blue Shield will cease deducting these penalties from Group’s Capitation beginning as of the month in which compliance is demonstrated by Group.

Encounter Data Submission Penalties. Based on Blue Shield’s quarterly determinations and following no less than thirty (30) days prior notice to Group, Blue Shield may withhold a portion of Group’s Capitation, as set forth in Exhibit C., in the event that Blue Shield determines that a significant portion (as described in the Provider Manual) of the monthly Encounter Data which Group is obligated to provide (Paragraph 2.12) has not been delivered to Blue Shield within the prior quarter. If at the quarterly determination next following such withhold, Blue Shield determines that Group has satisfactorily delivered to Blue Shield the previously non-delivered Encounter Data, such withheld Capitation shall be paid to Group, without interest. In the event that Group does not deliver such Encounter Data to Blue Shield prior to such quarterly determination, . Blue Shield shall be entitled to retain such withheld Capitation and will continue to deduct from the Group’s Capitation and retain such deductions as described in Exhibit C. from each quarter’s Capitation. If at a later date Group resumes the timely and complete submission of encounter data as required by this Agreement, then Blue Shield will cease deducting these penalties from Group’s Capitation beginning as of the month in which compliance is demonstrated by Group.

Encounter Data Submission Penalties. Based on Blue Shield’s quarterly determinations and following no less than thirty (30) days prior notice to Group, Blue Shield may withhold a portion of Group’s Capitation, as set forth in Exhibit C., in the event that Blue Shield determines that a significant portion (as described in the Provider Manual) of the monthly Encounter Data which Group is obligated to provide (Paragraph 2.12) has not been delivered to Blue Shield within the prior quarter. If at the quarterly determination next following such withhold, Blue Shield determines that Group has satisfactorily delivered to Blue Shield the previously non-delivered Encounter Data, such withheld Capitation shall be paid to Group, without interest. In the event that Group does not deliver such Encounter Data to Blue Shield prior to such quarterly determination, Blue Shield shall be entitled to retain such withheld Capitation and will continue to deduct from the Group’s Capitation and retain such deductions as described in Exhibit C. C, from each quarter’s Capitation. If at a later date Group resumes the timely and complete submission of encounter data as required by this Agreement, then Blue Shield will cease deducting these penalties from Group’s Capitation beginning as of the month in which compliance is demonstrated by Group.