Encounter Data Submission Requirements. 4.16.3.1 The Georgia Families program utilizes encounter data to determine the adequacy of medical services and to evaluate the quality of care rendered to members. DCH will use the following requirements to establish the standards for the submission of data and to measure the compliance of the Contractor to provide timely and accurate information. Encounter data from the Contractor also allows DCH to budget available resources, set contractor capitation rates, monitor utilization, follow public health trends and detect potential fraud. Most importantly, it allows the Division of Managed Care and Quality to make recommendations that can lead to the improvement of healthcare outcomes.
Appears in 7 contracts
Samples: Business Associate Agreement, Business Associate Agreement (Wellcare Health Plans, Inc.), Business Associate Agreement (Wellcare Health Plans, Inc.)
