Enrollment and Monthly Capitation Reconciliation. The MCOP shall maintain the integrity of its membership data through reconciliation of the daily HIPAA 834C files (Daily Benefit Enrollment and Maintenance) and the monthly HIPAA 834F file (Monthly Benefit Enrollment and Maintenance) transactions pursuant to ODM instructions. Discrepancies between the HIPAA 834C and 834F that have a negative impact on a member’s access to care shall be reported to ODM within one business day. Reconciliation for any discrepancies between the HIPAA 834 and HIPAA 820 is due and shall be submitted, as instructed by ODM, no later than 60 calendar days after the issuance of the HIPAA 820.
Appears in 16 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
