Common use of Encounter Data Clause in Contracts

Encounter Data. The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §1903(m)(2)(A)(xi) of the Social Security Act, 42 USC §1396b(m)(2)(A)(xi). The MCO agrees to furnish information from its records to the STATE, or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide the STATE upon the STATE’s request in the format determined by the STATE and for the time frame indicated by the STATE, the following information: Individual Enrollee-specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all Medicare and Medicaid medical and dental diagnostic and treatment encounters, all pharmaceuticals (including Medicare Part D items), supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, Nursing Facility services, and Home Care Services for which the MCO is financially responsible. The MCO shall submit encounter data that includes all paid lines and all MCO- denied lines associated with the claim. Claims and lines for which Medicare or another Third Party has paid in part or in full are considered paid and shall be submitted as such. (a) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. Claim-level data must be reported to the STATE using the following claim transaction formats: 1) the X12 837 standard format for physician, professional services, physician-dispensed pharmaceuticals (837P), specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), and dental services (837D) that are the responsibility of the MCO; and 2) the NCPDP Batch 1.2/D.0 pharmacy. The MCO may submit the NCPDP Batch 1.2/D.0 for non-durable medical supplies which have an NDC code. All encounter claims must be submitted electronically. (a) The MCO must comply with state and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amounts. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liability, Provider withhold and Provider incentives, and Medical Assistance cost-sharing. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-ons. In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a), the data reported herein is defined as non-public in Minnesota Statutes,

Encounter Data. (A) The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §1903(m)(2)(A)(xi) of the Social Security Act, 42 USC U.S.C. §1396b(m)(2)(A)(xi). . (B) The MCO agrees to furnish information from its records to the STATE, or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide the STATE upon the STATE’s request in the format determined by the STATE and for the time frame indicated by the STATE, the following information: : (1) Individual Enrollee-Enrollee specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all Medicare and Medicaid medical and dental diagnostic and treatment encounters, all pharmaceuticals (including Medicare Part D items), supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, Nursing Facility services, and Home Care Services for which the MCO is financially responsible. The MCO Encounter data shall submit encounter data that includes include all paid lines and all MCO- denied lines associated with the a claim. Claims , and lines include in its encounter submission those denied claims or lines, for which Medicare or another Third Party a third party has paid in part full or F-codes associated with CPT code 99387 or 99397 related to the CEHE incentive in full are considered paid and shall be submitted as suchsection 7.14.5. (a2) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. Claim-level data must be reported to the STATE using the following claim transaction formats: 1a) the X12 837 standard format for physician, physician and professional services, physician-dispensed pharmaceuticals (837P), services and specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), and dental services (837D) that are the responsibility of the MCOMCO (837D); and 2b) the 5.1 NCPDP Batch 1.2/D.0 for 1.1 batch pharmacy, and for physician-dispensed pharmaceuticals. The MCO may submit the 5.1 NCPDP Batch 1.2/D.0 for non-durable medical supplies which have an NDC code. . (3) All encounter claims must be submitted electronically. (a) . The MCO must comply with state STATE and federal requirements, including the federal Implementation GuidesGuide, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) . The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. Claims submitted must include, but are not limited to the paid units of service, valid procedure codes, bill type, place of service, dates of services and accurate applicable Provider numbers. (4) The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amountsamounts effective January 1, 2011 for the NCPDP 1.1 pharmacy claim format, and effective April 1, 2011 for the 837P, 837D and 837I professional, dental and institutional claim formats respectively. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liabilitythird party liability, Provider withhold and Provider incentives, and Medical Assistance costco-sharingpayments. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-add- ons. . (c) In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a9b(b), the data reported herein is defined as non-public and is defined in Minnesota Statutes,, §13.02. (d) For allocation of Medicare and Medicaid data for the purpose of reporting Medicaid data, see also section 3.4.2(V)(3). (5) The MCO will submit Medicaid drug information, effective for paid dates occurring on or after January 1, 2011 on pharmacy (NCPDP 1.1), and effective for paid dates occurring on or after April 1, on professional (837P) and institutional (837I) encounter claims in accordance with STATE data element specifications related to the collection of drug rebates. These specifications will be outlined in the Companion Guides for the NCPDP Batch 1.1 Pharmacy, 837 Professional and 837 Institutional encounter claims. The MCO and its subcontractor, if applicable, must comply with these specifications and submit encounter data no less than monthly and no later than 30 days after the MCO (or its subcontractor) adjudicates these outpatient pharmacy and physician-administered drug claims in order for the STATE to comply with 1927(b), 1903m(2)(A) and 1927(j)(1) of the Social Security Act as amended by Section 2501 (c) of the Patient Protection and Affordable Care Act. (6) Third party liability payments, including Medicare reimbursement, shall be reported on the encounter claim. The MCO may choose to report personal injury settlements on a separate monthly report. The monthly report shall include all data elements required on the encounter claim and is due on the 10th of the month for all settlements paid to the MCO for the previous month. The MCO shall indicate to the STATE which method it chooses for reporting personal injury settlements. (7) The STATE shall provide the MCO with an electronic listing of all Medical Assistance Providers and their Provider numbers. The MCO must update the Provider identification numbers by submitting, for Providers who are new to the MCO and do not already have a STATE Provider number (UMPI) or NPI, demographic information about the Provider that is current and complete, on a form approved by the STATE. The MCO shall not require Providers to enroll as an MHCP fee-for-service Provider. If a Provider will only be serving MCO Enrollees, the MCO shall follow the process established by the STATE for MCO-only Providers. (8) The MCO shall comply with the applicable provisions of Subtitle F (Administrative Simplification) of the Health Insurance Portability and Accountability Act of 1996 and any regulations promulgated pursuant to its authority, including the new 5010 transaction standards that are required to be operational no later than January 1, 2012. The MCO also shall cooperate with the STATE as necessary to ensure compliance. (9) All encounter data for Nursing Facility and Skilled Nursing Facility services must be submitted according to procedures as prescribed by the STATE in the current EDI specifications document available on the STATE website at xxxx://xxx.xxx.xxxxx.xx.xx/provider/mco . (10) The MCO shall be responsible for submitting claim-level encounter data that distinguishes between the Skilled Nursing Facility (SNF) and the Nursing Facility (NF) days used by the Enrollee. (11) The MCO shall submit Home and Community-Based Services encounter data pursuant to the 837 national standard. This includes type of service, units of service, and dates of service, sufficient to provide CMS with the required audit trail. (12) The MCO agrees to participate in a workgroup with the STATE to ensure that all units of service, HCPCS codes and modifiers are being submitted correctly for encounter data for home care and Home and Community-Based Services. (13) The MCO shall submit encounter data on all Personal Care Assistance (PCA) services using the X12 837 standard transaction format, and report PCAs as treating Providers. The MCO shall submit complete encounter data on PCA services, including the date of service, the amount of service by date, and the treating PCA provider. The STATE will monitor PCAs as treating Providers. (14) The MCO shall notify the STATE sixty (60) days prior to any change in the submitter process, including but not limited to the use of a new submitter. (C) The MCO shall submit encounter claims at least monthly with all of the required data elements to the STATE no later than ninety (90) days after the date the MCO adjudicated the claim, except for outpatient pharmacy and physician-administered drug encounter claims, which must be submitted no later than thirty (30) days after adjudication. The MCO shall make submissions for each transaction at least monthly. If the MCO is unable to make a submission during a certain month, the MCO shall contact the STATE to notify it of the reason for the delay and the estimated date when the STATE can expect the submission.

Encounter Data. The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §§ 1903(m)(2)(A)(xi) of the Social Security Act, 42 USC §§ 1396b(m)(2)(A)(xi). The MCO agrees to furnish information from its records to the STATE, STATE or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide to the STATE STATE, upon the STATE’s request request, in the format determined by the STATE and for the time frame indicated by the STATE, the following information: : (1) Individual Enrollee-specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all of the following: Medicare and Medicaid medical and dental diagnostic and treatment encounters, ; all pharmaceuticals (including Medicare Part D covered items), ; supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, ; Nursing Facility services, ; and Home Care Services for which the MCO is financially responsible. . (2) The MCO shall submit encounter data that includes all paid lines and all MCO- MCO-denied lines associated with the claim. Claims and lines for which Medicare or another Third Party has paid in part or in full are considered paid and shall be submitted as such. Third Party paid claims include immunizations which are paid for by the Minnesota Vaccines for Children Program (MNVFC). (a) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. . (3) Claim-level data must be reported to the STATE using the following claim transaction formats: 1) the X12 837 standard format for physician, professional services, and for physician-dispensed pharmaceuticals (837P), specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), Nursing Facility services, and dental services (837D) that are the responsibility of the MCO; and 2) the NCPDP Batch 1.2/1.2/ D.0 pharmacy. The MCO may submit the NCPDP Batch 1.2/1.2/ D.0 for non-durable medical supplies which have an NDC code. . (4) All encounter claims must be submitted electronically. (a) The MCO must comply with state and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. . (5) The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amounts. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) . For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liability, Provider withhold and Provider incentives, and Medical Assistance cost-sharing. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-add- ons. In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a), the data reported herein is defined as non-public in Minnesota Statutes,, §13.02. (6) The MCO will submit Medicaid drug information on pharmacy (NCPDP Batch 1.2/D.0), professional (837P) and institutional (837I) encounter claims in accordance with STATE data element specifications related to the collection of drug rebates. These specifications will be outlined in the Encounter Companion Guides for the NCPDP Batch 1.2/D.0 Pharmacy, 837 Professional and 837 Institutional encounter claims. The MCO and its subcontractor, if applicable, must comply with these specifications and submit encounter data bi-weekly, every two weeks and no later than thirty (30) days for original claims and forty- five (45) days for adjusted claims, after the MCO (or its subcontractor) adjudicates these outpatient pharmacy and physician-administered drug claims in order for the STATE to comply with 1927(b) 1903m(2)(A) and 1927(j)(1) of the Social Security Act as amended by Section 2501 (c) of the Patient Protection and Affordable Care Act. (7) The MCO shall comply with the applicable provisions of Subtitle F (Administrative Simplification) of the Health Insurance Portability and Accountability Act of 1996 and any regulations promulgated pursuant to its authority, including the 5010 transaction standards. The MCO shall cooperate with the STATE as necessary to ensure compliance. (8) All encounter data for Nursing Facility and Skilled Nursing Facility services must be submitted according to procedures as prescribed by the STATE in the current EDI specifications on the STATE website at xxxx://xxx.xxx.xxxxx.xx.xx/provider/mco. (9) The MCO shall be responsible for submitting claim-level encounter data that distinguishes between the Skilled Nursing Facility (SNF) and the Nursing Facility (NF) days used by the Enrollee. (10) The MCO shall notify the STATE sixty (60) days prior to any change in the submitter process, including but not limited to the use of a new submitter. The MCO shall submit original submission encounter claims no later than thirty

Encounter Data. ‌ The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §1903(m)(2)(A)(xi) of the Social Security Act, 42 USC §1396b(m)(2)(A)(xi). The MCO agrees to furnish information from its records to the STATE, or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide the STATE upon the STATE’s request in the format determined by the STATE and for the time frame indicated by the STATE, the following information: Individual Enrollee-specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all Medicare and Medicaid medical and dental diagnostic and treatment encounters, all pharmaceuticals (including Medicare Part D items), supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, Nursing Facility services, and Home Care Services for which the MCO is financially responsible. The MCO shall submit encounter data that includes all paid lines and all MCO- denied lines associated with the claim. Claims and lines for which Medicare or another Third Party has paid in part or in full are considered paid and shall be submitted as such. (a) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. Claim-level data must be reported to the STATE using the following claim transaction formats: 1) the X12 837 standard format for physician, professional services, physician-dispensed pharmaceuticals (837P), specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), and dental services (837D) that are the responsibility of the MCO; and 2) the NCPDP Batch 1.2/D.0 pharmacy. The MCO may submit the NCPDP Batch 1.2/D.0 for non-durable medical supplies which have an NDC code. All encounter claims must be submitted electronically. (a) The MCO must comply with state and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amounts. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liability, Provider withhold and Provider incentives, and Medical Assistance cost-sharing. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-ons. In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a), the data reported herein is defined as non-public in Minnesota Statutes,

Encounter Data. (A) The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §§ 1903(m)(2)(A)(xi) of the Social Security Act, 42 USC §§ 1396b(m)(2)(A)(xi). . (B) The MCO agrees to furnish information from its records to the STATE, STATE or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide to the STATE STATE, upon the STATE’s request request, in the format determined by the STATE and for the time frame indicated by the STATE, the following information: : (1) Individual Enrollee-specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all of the following: Medicare and Medicaid medical and dental diagnostic and treatment encounters, ; all pharmaceuticals (including Medicare Part D covered items), ; supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, ; Nursing Facility services, ; and Home Care Services for which the MCO is financially responsible. . (2) The MCO shall submit encounter data that includes all paid lines and all MCO- MCO-denied lines associated with the claim. Claims and lines for which Medicare or another Third Party has paid in part or in full are considered paid and shall be submitted as such. Third Party paid claims include immunizations which are paid for by the Minnesota Vaccines for Children Program (MNVFC). (a) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. . (3) Claim-level data must be reported to the STATE using the following claim transaction formats: 1) the X12 837 standard format for physician, professional services, and for physician-dispensed pharmaceuticals (837P), specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), Nursing Facility services, and dental services (837D) that are the responsibility of the MCO; and 2) the NCPDP Batch 1.2/1.2/ D.0 pharmacy. The MCO may submit the NCPDP Batch 1.2/1.2/ D.0 for non-durable medical supplies which have an NDC code. . (4) All encounter claims must be submitted electronically. (a) The MCO must comply with state and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. . (5) The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amounts. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) . For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liability, Provider withhold and Provider incentives, and Medical Assistance cost-sharing. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-add- ons. In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a), the data reported herein is defined as non-public in Minnesota Statutes,, §13.02. (6) The MCO will submit Medicaid drug information on pharmacy (NCPDP Batch 1.2/D.0), professional (837P) and institutional (837I) encounter claims in accordance with STATE data element specifications related to the collection of drug rebates. These specifications will be outlined in the Encounter Companion Guides for the NCPDP Batch 1.2/D.0 Pharmacy, 837 Professional and 837 Institutional encounter claims. The MCO and its subcontractor, if applicable, must comply with these specifications and submit encounter data bi-weekly, every two weeks and no later than thirty (30) days for original claims and forty- five (45) days for adjusted claims, after the MCO (or its subcontractor) adjudicates these outpatient pharmacy and physician-administered drug claims in order for the STATE to comply with 1927(b) 1903m(2)(A) and 1927(j)(1) of the Social Security Act as amended by Section 2501 (c) of the Patient Protection and Affordable Care Act. (7) The MCO shall comply with the applicable provisions of Subtitle F (Administrative Simplification) of the Health Insurance Portability and Accountability Act of 1996 and any regulations promulgated pursuant to its authority, including the 5010 transaction standards. The MCO shall cooperate with the STATE as necessary to ensure compliance. (8) All encounter data for Nursing Facility and Skilled Nursing Facility services must be submitted according to procedures as prescribed by the STATE in the current EDI specifications on the STATE website at xxxx://xxx.xxx.xxxxx.xx.xx/provider/mco. (9) The MCO shall be responsible for submitting claim-level encounter data that distinguishes between the Skilled Nursing Facility (SNF) and the Nursing Facility (NF) days used by the Enrollee. (10) The MCO shall notify the STATE sixty (60) days prior to any change in the submitter process, including but not limited to the use of a new submitter. (C) The MCO shall submit original submission encounter claims no later than thirty

Encounter Data. ‌ (A) The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §1903(m)(2)(A)(xi) of the Social Security Act, 42 USC U.S.C. §1396b(m)(2)(A)(xi). . (B) The MCO agrees to furnish information from its records to the STATE, or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide the STATE upon the STATE’s request in the format determined by the STATE and for the time frame indicated by the STATE, the following information: : (1) Individual Enrollee-Enrollee specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all Medicare and Medicaid medical and dental diagnostic and treatment encounters, all pharmaceuticals (including Medicare Part D items), supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, Nursing Facility services, and Home Care Services for which the MCO is financially responsible. The MCO Encounter data shall submit encounter data that includes include all paid lines and all MCO- denied lines associated with the a claim. Claims , and lines include in its encounter submission those denied claims or lines, for which Medicare or another Third Party a third party has paid in part full or F-codes associated with CPT code 99387 or 99397 related to the CEHE incentive in full are considered paid and shall be submitted as suchsection 7.13.3. (a2) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. Claim-level data must be reported to the STATE using the following claim transaction formats: 1) the X12 837 P standard format for physician, physician and professional services, physician-dispensed pharmaceuticals (837P), services and specified Elderly Waiver Services (837P)Services, inpatient and outpatient hospital services, Nursing Facility services (837I)services, and dental services (837D) that are the responsibility of the MCO; and 2) the 5.1 NCPDP Batch 1.2/D.0 for 1.1 batch pharmacy, and for physician-dispensed pharmaceuticals. The MCO may submit the 5.1 NCPDP Batch 1.2/D.0 for non-durable medical supplies which have an NDC code. . (3) All encounter claims must be submitted electronically. (a) The MCO electronically and must comply with state STATE and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) The MCO must requirements to submit charge data and to use the standard formats and procedures, using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. Claims submitted must include, as applicable, the units of service and/or valid procedure codes, bill type, place of service, dates of services and accurate Provider numbers (See the “837 Encounter Data Companion Guides” which are incorporated by reference and made a part of this Contract as applicable, on the STATE’s public website for encounter data requirements). (4) Third party liability payments, including Medicare reimbursement, shall be reported on the encounter claim. The MCO may choose to report personal injury settlements on a separate monthly report. The monthly report shall include all data elements required on the encounter claim and is due on the 10th of the month for all settlements paid to the MCO for the previous month. The MCO shall indicate to the STATE which method it chooses for reporting personal injury settlements. (5) The STATE shall provide the MCO with an electronic listing of all Medical Assistance Providers and their Provider numbers. The MCO must update the Provider identification numbers by submitting, for Providers who are new to the MCO and do not already have a STATE Provider number (UMPI) or NPI, demographic information about the Provider that is current and complete, on a form approved by the STATE. The MCO shall not require Providers to enroll as an MHCP fee-for-service Provider. If a Provider will only be serving MCO Enrollees, the MCO shall follow the process established by the STATE for MCO-only Providers. (6) The MCO shall comply with the applicable provisions of Subtitle F (Administrative Simplification) of the Health Insurance Portability and Accountability Act of 1996 and any regulations promulgated pursuant to its authority. The MCO also shall cooperate with the STATE as necessary to ensure compliance. (7) All encounter data for Nursing Facility and Skilled Nursing Facility services must be submitted according to procedures as prescribed by the STATE in the current EDI specifications document available on the STATE website at xxxx://xxx.xxx.xxxxx.xx.xx/provider/mco . (8) The MCO shall be responsible for submitting claim-level encounter data that distinguishes between the Skilled Nursing Facility (SNF) and the Nursing Facility (NF) days used by the Enrollee. (9) The MCO shall submit on Home and Community-Based Services encounter data pursuant to the encounter claim for NCPDP Batch 1.2/D.0837 national standard. This includes type of service, 837P, 837Dunits of service, and 837I dates of service, sufficient to provide CMS with the Provider allowed and paid amountsrequired audit trail. (a10) For MSHOThe MCO agrees to participate in a workgroup with the STATE to ensure that all units of service, this requirement applies to both Medicaid HCPCS codes and Medicare services, excluding Part D. For MSC+ this includes MCO payment modifiers are being submitted correctly for Medicare crossover claimsencounter data for home care and Home and Community-Based Services. (b11) For The MCO shall submit encounter data on all Personal Care Assistance (PCA) services using the purposes X12 837 standard transaction format, and report PCAs as treating Providers. The MCO shall submit complete encounter data on PCA services, including the date of this section “paid amount” is defined as service, the amount paid to the Provider excluding Third Party Liability, Provider withhold and Provider incentivesof service by date, and Medical Assistance cost-sharingthe treating PCA provider. For The STATE will monitor PCAs as treating Providers. (12) The MCO shall notify the purposes of this section “allowed amount” is defined as the Provider contracted rate STATE sixty (60) days prior to any exclusions change in the submitter process, including but not limited to the use of a new submitter. (C) The MCO shall submit encounter claims at least monthly with all of the required data elements to the STATE no later than ninety (90) days after the date the MCO adjudicated the claim. The MCO shall make submissions at least monthly. If the MCO is unable to make a submission during a certain month, the MCO shall contact the STATE to notify it of the reason for the delay and the estimated date when the STATE can expect the submission. (D) For all encounter claims, when the STATE returns or add-onsrejects a file of claims, the MCO shall have thirty (30) days from the date the MCO receives the file to resubmit the file with all of the required data elements in the correct file format. (E) Unless otherwise specified in the contract, the MCO may submit replacement claims for encounter claims previously submitted at any time. (F) If the MCO chooses to resubmit a claim previously denied on the MCO’s remittance advice, the MCO must resubmit the claim as a replacement claim. (G) The STATE will provide a remittance advice on a schedule specified by the STATE, for all submitted encounter claims, including void and replacement claims. In accordance with Minnesota StatutesThe Remittance Advice will be provided in X12 835 standard transaction format. (See the Encounter Data Companion Guides, §256B.69which are referenced on the DHS managed care website, subd. 9cincorporated by reference and made a part of this Contract as applicable for remittance advice requirements.) (H) The MCO shall collect and report to the STATE individual Enrollee specific, claim level encounter data that identifies the Enrollee’s treating Provider (athe Provider that actually provided the service within the groups below), when the data reported herein Provider is defined as nonpart of a group practice that bills on the CMS 837P format, or 837D format. The treating Provider is not required when there is an individual practice office, i.e., a sole treating Provider, because in those cases it will be identical to the pay-public in Minnesota Statutes,to Provider. Group practice Provider categories that bill on the 837P format or 837D format and will require a treating Provider are: (1) Community Mental Health Clinics; (2) Physician Clinics; (3) Dental Clinics; (4) County Contracted Mental Health Providers; (5) Indian Health Service; (6) Federally Qualified Health Centers; (7) Rural Health Clinics; (8) Chiropractic Clinics; (9) Personal Care Provider Agencies (PCPAs) and other organizations that employ PCAs, for PCA services. (I) No treating provider is required for any other claim type. (J) The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. (K) 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. (A) The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §1903(m)(2)(A)(xi) of the Social Security Act, 42 USC §1396b(m)(2)(A)(xi). . (B) The MCO agrees to furnish information from its records to the STATE, or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide the STATE upon the STATE’s request in the format determined by the STATE and for the time frame indicated by the STATE, the following information: : (1) Individual Enrollee-specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all Medicare and Medicaid medical and dental diagnostic and treatment encounters, all pharmaceuticals (including Medicare Part D items), supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, Nursing Facility services, and Home Care Services for which the MCO is financially responsible. . (2) The MCO shall submit encounter data that includes all paid lines and all MCO- denied lines associated with the claim. Claims and lines for which Medicare or another Third Party has paid in part or in full are considered paid and shall be submitted as such. (a) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. . (3) Claim-level data must be reported to the STATE using the following claim transaction formats: 1) the X12 837 standard format for physician, professional services, physician-dispensed pharmaceuticals (837P), specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), and dental services (837D) that are the responsibility of the MCO; and 2) the NCPDP Batch 1.2/D.0 pharmacy. The MCO may submit the NCPDP Batch 1.2/D.0 for non-durable medical supplies which have an NDC code. . (4) All encounter claims must be submitted electronically. (a) The MCO must comply with state and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. . (5) The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amounts. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liability, Provider withhold and Provider incentives, and Medical Assistance cost-sharing. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-ons. In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a), the data reported herein is defined as non-public in Minnesota Statutes, (6) The MCO will submit Medicaid drug information on pharmacy (NCPDP Batch 1.2/D.0), professional (837P) and institutional (837I) encounter claims in accordance with STATE data element specifications related to the collection of drug rebates. These specifications will be outlined in the Encounter Companion Guides for the NCPDP Batch 1.2/D.0 Pharmacy, 837 Professional and 837 Institutional encounter claims. The MCO and its subcontractor, if applicable, must comply with these specifications and submit encounter data every two weeks and no later than thirty

Encounter Data. ‌ The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §§ 1903(m)(2)(A)(xi) of the Social Security Act, 42 USC §§ 1396b(m)(2)(A)(xi). The MCO agrees to furnish information from its records to the STATE, STATE or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide to the STATE STATE, upon the STATE’s request request, in the format determined by the STATE and for the time frame indicated by the STATE, the following information: : (1) Individual Enrollee-specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all of the following: Medicare and Medicaid medical and dental diagnostic and treatment encounters, ; all pharmaceuticals (including Medicare Part D covered items), ; supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, ; Nursing Facility services, ; and Home Care Services for which the MCO is financially responsible. . (2) The MCO shall submit encounter data that includes all paid lines and all MCO- MCO-denied lines associated with the claim. Claims and lines for which Medicare or another Third Party has paid in part or in full are considered paid and shall be submitted as such. Third Party paid claims include immunizations which are paid for by the Minnesota Vaccines for Children Program (MNVFC). (a) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. . (3) Claim-level data must be reported to the STATE using the following claim transaction formats: 1) the X12 837 standard format for physician, professional services, and for physician-dispensed pharmaceuticals (837P), specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), Nursing Facility services, and dental services (837D) that are the responsibility of the MCO; and 2) the NCPDP Batch 1.2/1.2/ D.0 pharmacy. The MCO may submit the NCPDP Batch 1.2/1.2/ D.0 for non-durable medical supplies which have an NDC code. . (4) All encounter claims must be submitted electronically. (a) The MCO must comply with state and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. . (5) The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amounts. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) . For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liability, Provider withhold and Provider incentives, and Medical Assistance cost-sharing. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-add- ons. In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a), the data reported herein is defined as non-public in Minnesota Statutes,, §13.02. (6) The MCO will submit Medicaid drug information on pharmacy (NCPDP Batch 1.2/D.0), professional (837P) and institutional (837I) encounter claims in accordance with STATE data element specifications related to the collection of drug rebates. These specifications will be outlined in the Encounter Companion Guides for the NCPDP Batch 1.2/D.0 Pharmacy, 837 Professional and 837 Institutional encounter claims. The MCO and its subcontractor, if applicable, must comply with these specifications and submit encounter data bi-weekly, every two weeks and no later than thirty (30) days for original claims and forty- five (45) days for adjusted claims, after the MCO (or its subcontractor) adjudicates these outpatient pharmacy and physician-administered drug claims in order for the STATE to comply with 1927(b) 1903m(2)(A) and 1927(j)(1) of the Social Security Act as amended by Section 2501 (c) of the Patient Protection and Affordable Care Act. (7) The MCO shall comply with the applicable provisions of Subtitle F (Administrative Simplification) of the Health Insurance Portability and Accountability Act of 1996 and any regulations promulgated pursuant to its authority, including the 5010 transaction standards. The MCO shall cooperate with the STATE as necessary to ensure compliance. (8) All encounter data for Nursing Facility and Skilled Nursing Facility services must be submitted according to procedures as prescribed by the STATE in the current EDI specifications on the STATE website at xxxx://xxx.xxx.xxxxx.xx.xx/provider/mco. (9) The MCO shall be responsible for submitting claim-level encounter data that distinguishes between the Skilled Nursing Facility (SNF) and the Nursing Facility (NF) days used by the Enrollee. (10) The MCO shall notify the STATE sixty (60) days prior to any change in the submitter process, including but not limited to the use of a new submitter. The MCO shall submit original submission encounter claims no later than thirty

Encounter Data. (A) The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §1903(m)(2)(A)(xi) of the Social Security Act, 42 USC §1396b(m)(2)(A)(xi). . (B) The MCO agrees to furnish information from its records to the STATE, or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide the STATE upon the STATE’s request in the format determined by the STATE and for the time frame indicated by the STATE, the following information: : (1) Individual Enrollee-specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all Medicare and Medicaid medical and dental diagnostic and treatment encounters, all pharmaceuticals (including Medicare Part D items), supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, Nursing Facility services, and Home Care Services for which the MCO is financially responsible. The MCO Encounter data shall submit encounter data that includes include all paid lines and all MCO- denied lines associated with the a claim. Claims , and denied claims or lines for which Medicare or another Third Party a third party has paid in part or in full are considered paid and shall be submitted as suchfull. (a2) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO must be submitted to the STATE. Claim-level data must be reported to the STATE using the following claim transaction formats: 1a) the X12 837 standard format for physician, professional services, physician-dispensed pharmaceuticals (837P), specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), and dental services (837D) that are the responsibility of the MCOMCO (837D); and 2b) the NCPDP Batch 1.2/D.0 pharmacy,. The MCO may submit the NCPDP Batch 1.2/D.0 for non-durable medical supplies which have an NDC code. . (3) All encounter claims must be submitted electronically. (a) . The MCO must comply with state and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) . The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. Claims submitted must include, but are not limited to paid units of service, valid procedure codes, bill type, place of service, dates of services and accurate applicable Provider numbers. (4) The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amounts. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liabilitythird party liability, Provider withhold and Provider incentives, and Medical Assistance cost-sharing. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-add- ons. In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a), the data reported herein is defined as non-public and is defined in Minnesota Statutes,, §13.02. (5) The MCO will submit Medicaid drug information on pharmacy (NCPDP Batch 1.2/D.0), professional (837P) and institutional (837I) encounter claims in accordance with STATE data element specifications related to the collection of drug rebates. These specifications will be outlined in the Companion Guides for the NCPDP Batch 1.2/D.0 Pharmacy, 837 Professional and 837 Institutional encounter claims. The MCO and its subcontractor, if applicable, must comply with these specifications and submit encounter data bi-weekly, every two weeks and no later than 30 days after the MCO (or its subcontractor) adjudicates these outpatient pharmacy and physician- administered drug claims in order for the STATE to comply with 1927(b), 1903m(2)(A) and 1927(j)(1) of the Social Security Act as amended by Section 2501

Encounter Data. (A) The MCO must maintain patient encounter data to identify the physician who delivers services or supervises services delivered to Enrollees, as required by §§ 1903(m)(2)(A)(xi) of the Social Security Act, 42 USC §§ 1396b(m)(2)(A)(xi). . (B) The MCO agrees to furnish information from its records to the STATE, STATE or the STATE’s agents that are required in State or federal law or which the STATE may reasonably require to administer this Contract. The MCO shall provide to the STATE STATE, upon the STATE’s request in the format determined by the STATE and for the time frame indicated by the STATE, the following information: : (1) Individual Enrollee-specific, claim-level encounter data for services provided by the MCO to Enrollees detailing all Medicare and Medicaid medical and dental diagnostic and treatment encounters, all pharmaceuticals (including Medicare Part D items)pharmaceuticals, supplies and medical equipment dispensed to Enrollees, Home and Community-Based Services, Nursing Facility services, and Home Care Services for all nursing facility services which the MCO is financially responsible. provides instead of inpatient services that are covered under this Contract. (2) The MCO shall submit encounter data that includes all paid lines and all MCO- denied lines associated with the claim. Claims and lines for which Medicare or another Third Party has paid in part or in full are considered paid and shall be submitted as such. Third Party paid claims include immunizations which are paid for by the Minnesota Vaccines for Children Program (MNVFC). (a) All denied claims, except those claims that are denied because the enrollee was not enrolled in the MCO MCO, must be submitted to the STATE. . (3) Claim-level data must be reported to the STATE using the following claim transaction formats: 1) the X12 837 standard format for physician, professional services, services and physician-dispensed pharmaceuticals (837P), specified Elderly Waiver Services (837P), inpatient and outpatient hospital services, Nursing Facility services (837I), ) and dental services (837D) that are the responsibility of the MCO; and 2) the NCPDP Batch 1.2/D.0 pharmacy. The MCO may submit the NCPDP Batch 1.2/D.0 for non-durable medical supplies which have an NDC code. . (4) All encounter claims must be submitted electronically. (a) The MCO must comply with state and federal requirements, including the federal Implementation Guides, and the STATE’s 837 Encounter Companion Guide for Professional, Institutional and Dental Claims, and the Pharmacy Encounter Claims Guide posted on the STATE’s managed care website. (b) The MCO must submit charge data using HIPAA standard transaction formats. Charge data shall be the lesser of the usual and customary charge (or appropriate amount from a Relative Value Scale for missing or unavailable charges) or submitted charge. . (5) The MCO shall submit on the encounter claim for NCPDP Batch 1.2/D.0, 837P, 837D, and 837I the Provider allowed and paid amounts. (a) For MSHO, this requirement applies to both Medicaid and Medicare services, excluding Part D. For MSC+ this includes MCO payment for Medicare crossover claims. (b) . For the purposes of this section “paid amount” is defined as the amount paid to the Provider excluding Third Party Liability, Provider withhold and Provider incentives, and Medical Assistance cost-sharing. For the purposes of this section “allowed amount” is defined as the Provider contracted rate prior to any exclusions or add-ons. In accordance with Minnesota Statutes, §256B.69, subd. 9c, (a), the data reported herein is defined as non-public in Minnesota Statutes,, §13.02. (6) The MCO will submit Medicaid drug information on pharmacy (NCPDP Batch 1.2/D.0), professional (837P) and institutional (837I) encounter claims in accordance with STATE data element specifications related to the collection of drug rebates. These specifications will be outlined in the Encounter Companion Guides for the NCPDP Batch 1.2/D.0 Pharmacy, 837 Professional and 837 Institutional encounter claims. The MCO and its subcontractor, if applicable, must comply with these specifications and submit encounter data bi-weekly, every two weeks, and no later than thirty (30) days for original claims and forty-five (45) days for adjusted claims, after the MCO (or its subcontractor) adjudicates these outpatient pharmacy and physician-administered drug claims, in order for the STATE to comply with 1927(b) 1903m(2)(A) and 1927(j)(1) of the Social Security Act as amended by Section 2501 (c) of the Patient Protection and Affordable Care Act. (7) The MCO shall comply with the applicable provisions of Subtitle F (Administrative Simplification) of the Health Insurance Portability and Accountability Act of 1996 and any regulations promulgated pursuant to its authority, including the 5010 transaction standards. The MCO shall cooperate with the STATE as necessary to ensure compliance. (8) The MCO shall submit encounter data on all Personal Care Assistance (PCA) services using the X12 837P standard transaction format and report PCAs as treating Providers. The MCO shall submit complete encounter data on PCA services, including the date of service, the paid units of service by date, and the treating PCA Provider. The STATE will monitor PCAs as treating Providers. (9) The MCO shall notify the STATE sixty (60) days prior to any change in the submitter process, including but not limited to the use of a new submitter. (C) The MCO shall submit original submission encounter claims no later than thirty (30) days after the date the MCO adjudicates the claim. Initial submissions of the first claim for newborns are exempt from the thirty (30) days submission requirement if a claim has been adjudicated before the MCO has received the newborn’s PMI. The MCO shall make submissions for each transaction format at least bi-weekly. If the MCO is unable to make a submission during a certain month, the MCO shall contact the STATE to notify it of the reason for the delay and the estimated date when the STATE can expect the submission. The MCO’s submission of claim adjustments must be done by voiding the original claim and submitting a corrected claim, within forty-five (45) days of the date adjusted at the MCO. See also section 9.9.2(E) below regarding claims voided or reversed because of program integrity concerns. (D) When the STATE returns or rejects a file of encounter claims, the MCO shall have twenty (20) calendar days from the date the MCO receives the rejected file to resubmit the file with all of the required data elements in the correct file format. (E) The STATE will provide a remittance advice, on a schedule specified by the STATE, for all submitted encounter claims, including successful void claims. The remittance advice will be provided in the X12 835 standard transaction format. (F) 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 website. Encounter data not corrected shall be assessed a penalty as specified in section 5.10 below. (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. (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 website. (4) The STATE shall provide the ERR of uncorrected encounter data lines within twenty-one (21) days after the end of each calendar quarter as described in the technical specifications posted on the STATE’s managed care website. (5) The STATE will post on its managed care website 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. (6) 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. (7) 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 website). (8) The notice and opportunity to cure requirements in section 5.5 will not apply to encounter data quality errors and penalties assessed under section 5.10. (G) 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 there is an individual practice office (i.e., a sole treating Provider), because in those cases it will be identical to the pay-to Provider. Group practice Provider categories that bill on the 837P format or 837D format and will require a treating Provider are: (1) Community Mental Health Clinics; (2) Physician Clinics; (3) Dental Clinics; (4) County Contracted Mental Health Providers; (5) Indian Health Care Providers, where applicable; (6) Federally Qualified Health Centers; (7) Rural Health Clinics; (8) Chiropractic Clinics; (9) Personal Care Assistance Provider Agencies (PCPAs), and other organizations that employ PCAs for PCA services. No treating Provider is required for any other claim type. (H) The MCO shall submit interpreter services on encounter claims, if the interpreter service was a separate, billable service. (I) 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.