Enrollment and Monthly Capitation Reconciliation. The MCP shall maintain the integrity of its membership data through processing and loading of data contained for each individual in the daily HIPAA 834C (Daily Benefit Enrollment and Maintenance) files and reconciling the daily changes with the monthly HIPAA 834F (Monthly Benefit Enrollment and Maintenance) file. 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 of enrollment(s)/Disenrollment(s) contained on the HIPAA 834 files and HIPAA 820 file, for the associated 834 files, is due and shall be submitted, no later than 60 calendar days after the issuance of the HIPAA 820 payment file.
Appears in 16 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
