Health Information System i. As required by 42 CFR 438.242(a), the MCOP shall maintain a health information system that collects, analyzes, integrates, and reports data. The system shall provide information on areas including, but not limited to, utilization, grievances and appeals, and MCOP membership terminations for other than loss of Medicaid eligibility.
ii. As required by 42 CFR 438.242(b)(1), the MCOP shall collect data on member and provider characteristics and on services furnished to its members.
iii. As required by 42 CFR 438.242(b)(2), the MCOP shall ensure data received from providers is accurate and complete by verifying the accuracy and timeliness of reported data, screening the data for completeness, logic, and consistency, and collecting service information in standardized formats to the extent feasible and appropriate.
iv. As required by 42 CFR 438.242(b)(4), the MCOP shall make all collected data available upon request by ODM or CMS.
v. Acceptance testing of any data electronically submitted to ODM is required:
1. Before the MCOP may submit production files;
2. When the MCOP changes the method or preparer of the electronic media; and/or
3. When ODM determines the MCOP’s data submissions have an unacceptably high error rate.
vi. When the MCOP changes or modifies information systems involved in producing any type of electronically submitted files, either internally or by changing vendors, it is required to submit to ODM for review and approval a transition plan that includes the submission of test files in the ODM-specified formats. Once an acceptable test file is submitted to ODM, as determined solely by ODM, the MCOP can return to submitting production files. ODM will inform the MCOP in writing when a test file is acceptable. Once the MCOP’s new or modified information system is operational, the MCOP will have up to 90 calendar days to submit an acceptable test file and an acceptable production file.
vii. Submission of test files can start before the new or modified information system is in production. ODM reserves the right to verify the MCOP’s capability to report elements in the minimum data set prior to executing the Agreement for the next contract period. Sanctions for noncompliance with this requirement are specified in the Compliance Methodology document.
Health Information System. 12 Provider shall implement a documented health information system and a privacy security 13 program that includes administrative, technical and physical safe guards designed to 14 prevent the accidental or unauthorized use or disclosure of individual PHI and medical
Health Information System. 12 Provider shall implement a documented health information system and a privacy 13 security program that includes administrative, technical and physical safe guards 14 designed to prevent the accidental or unauthorized use or disclosure of individual 15 PHI and medical records. The information system and the privacy and security 16 program shall, at a minimum, comply with applicable HIPAA regulations regarding 17 the privacy and security of PHI, including but not limited to 42 CFR § 438.242; 45 CFR 18 § 164.306(a); as well as, HIPAA privacy provisions in Title 13 of the American 19 Recovery and Reinvestment Act of 2009 (ARRA).
Health Information System. Pursuant to 42 CFR 438.242, the Contractor shall maintain a health information system that collects, analyzes, integrates, and reports data. The system shall provide information on areas including, but not limited to, utilization, grievances, disenrollments, and appeals.
1) The Contractor’s health information system shall, at a minimum:
a) Collect data on beneficiary and provider characteristics as specified by DHCS, and on services furnished to beneficiaries as specified by DHCS in the Cal OMS Data Collection Guide (attached as Document 3J); xxxx://xxx.xxxx.xx.xxx/provgovpart/Documents/CalOMS_Tx_Data_Collection_ Guide_JAN%202014.pdf
b) Ensure that data received from providers is accurate and complete by:
i. Verifying the accuracy and timeliness of reported data;
ii. Screening the data for completeness, logic, and consistency; and
iii. Collecting service information in standardized formats to the extent feasible and appropriate.
c) Make all collected data available to DHCS and, upon request, to CMS.
Health Information System. The Contractor shall maintain a health information system that collects, analyzes, integrates, and reports data. The system must provide information on areas including, but not limited to, utilization, grievances and appeals, and disenrollment for other than loss of Medicaid eligibility. The Contractor must collect data on Enrollee and provider characteristics i.e. trimester of enrollment, tracking of appointments kept and not kept, place of service, provider type, and make all collected data available to the Division, to CMS, to the Mississippi Department of Insurance, and to any other oversight agency of the Division.
Health Information System. The Contractor shall maintain a health information system or systems consistent with the requirements established in the Contract, the objectives of 42 C.F.R. Part 438, Subpart D, including 42 C.F.R. § 438.242, and that supports all aspects of the QI Program. General Marketing, Outreach, and Enrollee Communications Requirements The Contractor is subject to rules governing marketing and Enrollee Communications as specified under section 1851(h) of the Social Security Act, 42 C.F.R. §422.111, §422.2260 et. seq., §423.120(b) and (c), §423.128, §423.2260 et. seq., and § 438.10, and §438.104; the Medicare Communications and Marketing Guidelines as updated from time to time, and the Medicare‑Medicaid marketing guidance, with the following exceptions or modifications: The Contractor must refer Enrollees and Eligible Beneficiaries who inquire about Capitated Financial Alignment Model eligibility or enrollment to the enrollment broker, although the Contractor may provide Enrollees and Eligible Beneficiaries with information about the Contractor’s plan and its benefits prior to referring a request regarding eligibility or enrollment to the enrollment broker; The Contractor must make available to CMS and EOHHS, upon request, current schedules of all educational events conducted by the Contractor to provide information to Enrollees or Eligible Beneficiaries; The Contractor must convene all educational and marketing/sales events at sites within the Contractor’s Service Area that are physically accessible to all Enrollees or Eligible Beneficiaries, including persons with disabilities and persons using public transportation. The Contractor must distribute all materials to its entire Service Area. The Contractor may not offer financial or other incentives, including private insurance, to induce Enrollees or Eligible Beneficiaries to enroll with the Contractor or to refer a friend, neighbor, or other person to enroll with the Contractor; The Contractor may not directly or indirectly conduct door‑to‑door, telephone, email, texting, or other unsolicited contacts (with the exception of direct mail, which is permissible); Calls made by the Contractor to Medicare‑Medicaid eligible individuals enrolled in the Contractor’s other product lines, are not considered unsolicited direct contact and are permissible. Therefore, as provided in the Medicare Communications and Marketing Guidelines and the Medicare‑Medicaid marketing guidance, the Contractor may call such individuals, includ...
Health Information System. A. Should Contractor have a health information system, it shall maintain a system that collects, analyzes, integrates, and reports data (42 C.F.R. § 438.242(a); Cal. Code Regs., tit. 9, § 1810.376.) The system shall provide information on areas including, but not limited to, utilization, claims, grievances, and appeals [42 C.F.R. § 438.242(a)]. Contractor shall comply with Section 6504(a) of the Affordable Care Act [42 C.F.R. § 438.242(b)(1)].
B. Contractor’s health information system shall, at a minimum:
1. Collect data on beneficiary and Contractor characteristics as specified by the County, and on services furnished to beneficiaries as specified by the County; [42 C.F.R. § 438.242(b)(2)].
2. Ensure that data received is accurate and complete by:
a. Verifying the accuracy and timeliness of reported data.
b. Screening the data for completeness, logic, and consistency.
c. Collecting service information in standardized formats to the extent feasible and appropriate.
C. Contractor shall make all collected data available to DBH and, upon request, to DHCS and/or CMS [42 C.F.R. § 438.242(b)(4)].
D. Contractor’s health information system is not required to collect and analyze all elements in electronic formats [Cal. Code Regs., tit. 9, § 1810.376(c)].
Health Information System. Insurer shall maintain a health information system that collects, analyzes, integrates and reports data, including utilization, claims, and Grievances and Appeals. At a minimum, Insurer’s health information system must:
a. Comply with Section 6504(a) of the Affordable Care Act;
b. Collect data on Enrollee and Provider characteristics;
c. Collect data on all services provided to Enrollees through an encounter data system, including data sufficient to identify the Provider who delivers any item or service to Enrollees;
d. Ensure that data received from Providers is accurate and complete by:
i. Verifying the accuracy and timeliness of reported data, including data reported by Providers with a capitated payment arrangement;
ii. Screening the data for completeness, logic and consistency; and
iii. Collecting data from Providers in standardized formats to the extent feasible and appropriate.
e. Make all collected data available to FHKC, AHCA and CMS, upon request.
Health Information System. A. Should Contractor have a health information system, it shall maintain a system that collects, analyzes, integrates, and reports data (42 C.F.R. § 438.242(a); Cal. Code Regs., tit. 9, § 1810.376.) The system shall provide information on areas including, but not limited to, utilization, claims, grievances, and appeals [42 C.F.R. § 438.242(a)]. Contractor shall comply with Section 6504(a) of the Affordable Care Act [42 C.F.R. § 438.242(b)(1)].
B. Contractor’s health information system shall, at a minimum:
1. Collect data on beneficiary and Contractor characteristics as specified by the County, and on services furnished to beneficiaries as specified by the County; [42 C.F.R. § 438.242(b)(2)].
2. Ensure that data received is accurate and complete by:
a. Verifying the accuracy and timeliness of reported data.
b. Screening the data for completeness, logic, and consistency.
c. Collecting service information in standardized formats to the extent feasible and appropriate.
C. Collect and maintain sufficient beneficiary encounter data to identify the rendering provider, the service and beneficiary.
D. Contractor shall make all collected data, such as beneficiary encounter data available to DBH and, upon request, to DHCS and/or CMS [42 C.F.R. § 438.242(b)(4)] in a HIPAA compliant and standardized format as instructed by DBH.
Health Information System. Provider shall implement a documented health information system and a privacy security program that includes administrative, technical and physical safe guards designed to prevent the accidental or unauthorized use or disclosure of client PHI and medical records. The information system and the privacy and security program shall, at a minimum, comply with applicable HIPAA regulations regarding the privacy and security of PHI, including but not limited to 42 CFR § 438.242; 45 CFR § 164.306(a); and 45 CFR § 162.200 as well as the HIPAA privacy provisions in Title 13 of the American Recovery and Reinvestment Act of 2009 (“ARRA”). Provider shall adhere to requirements specified in Exhibit A, Data Security.
