Common use of Health Information System Requirements Clause in Contracts

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) As required by 42 CFR 438.242(b)(l), each MCP must collect data on member and provider characteristics and on services furnished to its members. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) Acceptance testing of any data that is electronically submitted to ODJFS is required: (a) Before an MCP may submit production files (b) Whenever an MCP changes the method or prepare!" of the electronic media; and/or (c) When the ODJFS determines an MCP's data submissions have an unacceptably high error rate. MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's new or modified information system is operational, that MCP w'ill have up to 90 days to submit an acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is in production. ODJFS reserves the right to verify any MCP's capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS ODJFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) i. As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) . As required by 42 CFR 438.242(b)(l438.242(b)(1), each MCP must collect data on member and provider characteristics and on services furnished to its members. iii. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) v. Acceptance testing of any data that is electronically submitted to ODJFS is required: (a) a. Before an MCP may submit production filesfiles ODJFS-specified formats; and/or (b) b. Whenever an MCP changes the method or prepare!" preparer of the electronic media; and/or (c) c. When the ODJFS determines an MCP's ’s data submissions have an havean unacceptably high error rate. MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies files in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. , as determined solely by ODJFS, the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's ’s new or modified information system is operational, that MCP w'ill will have up to 90 ninety (90) days to submit an submitan acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is in production. ODJFS reserves the right to verify any MCP's ’s capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.Requirements

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS ODJFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) i. As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) . As required by 42 CFR 438.242(b)(l438.242(b)(1), each MCP must collect data on member and provider characteristics and on services furnished to its members. iii. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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.. Appendix C (iv) . As required by 42 CFR 438.242(b)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) v. Acceptance testing of any data that is electronically submitted to ODJFS is required: (a) a. Before an MCP may submit production files (b) b. Whenever an MCP changes the method or prepare!" preparer of the electronic media; and/or (c) c. When the ODJFS determines an MCP's ’s data submissions have an unacceptably high error rate. MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies files in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. , as determined solely by ODJFS, the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's ’s new or modified information system is operational, that MCP w'ill will have up to 90 ninety (90) days to submit an acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is in production. ODJFS reserves the right to verify any MCP's ’s capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS ODJFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) i. As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) . As required by 42 CFR 438.242(b)(l), each MCP must collect data on member and provider characteristics and on services furnished to its members. iii. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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.. Appendix C (iv) . As required by 42 CFR 438.242(b)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) v. Acceptance testing of any data that is electronically submitted to ODJFS is required: (a) a. Before an MCP may submit production files (b) b. Whenever an MCP changes the method or prepare!" preparer of the electronic media; and/or (c) c. When the ODJFS determines an MCP's data submissions have an unacceptably high error rate. MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies files in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. , as determined solely by ODJFS, the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's new or modified information system is operational, that MCP w'ill will have up to 90 ninety (90) days to submit an acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is in production. ODJFS reserves the right to verify any MCP's capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.Requirements

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS ODJFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) i. As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) . As required by 42 CFR 438.242(b)(l438.242(b)(1), each MCP must collect data on member and provider characteristics and on services furnished to its members. iii. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) v. Acceptance testing of any data that is electronically submitted to ODJFS is required:: Appendix C Covered Families and Children (CFC) population Page 16 (a) a. Before an MCP may submit production files (b) b. Whenever an MCP changes the method or prepare!" preparer of the electronic media; and/or (c) c. When the ODJFS determines an MCP's ’s data submissions have an unacceptably high error rate. MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies files in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. , as determined solely by ODJFS, the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's ’s new or modified information system is operational, that MCP w'ill will have up to 90 ninety (90) days to submit an acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is in production. ODJFS reserves the right to verify any MCP's ’s capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.Requirements

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS ODJFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) i. As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) . As required by 42 CFR 438.242(b)(l438.242(b)(1), each MCP must collect data on member and provider characteristics and on services furnished to its members. iii. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) v. Acceptance testing of any data that is electronically submitted to ODJFS is required: (a) a. Before an MCP may submit production filesfilesODJFS-specified formats; and/or (b) b. Whenever an MCP changes the method or prepare!" preparer of the electronic media; and/or (c) c. When the ODJFS determines an MCP's ’s data submissions have an unacceptably high error rate. MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies files in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. , as determined solely by ODJFS, the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's ’s new or modified information system is operational, that MCP w'ill will have up to 90 ninety (90) days to submit an acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is in production. ODJFS reserves the right to verify any MCP's ’s capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.Requirements

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS ODJFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) i. As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) . As required by 42 CFR 438.242(b)(l438.242(b)(1), each MCP must collect data on member and provider characteristics and on services furnished to its members. iii. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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.. Appendix C Covered Families and Children (CFC) population Page 16 (iv) . As required by 42 CFR 438.242(b)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) v. Acceptance testing of any data that is electronically submitted to ODJFS is required: (a) a. Before an MCP may submit production files (b) b. Whenever an MCP changes the method or prepare!" preparer of the electronic media; and/or (c) c. When the ODJFS determines an MCP's ’s data submissions have an unacceptably high error rate. MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies files in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. , as determined solely by ODJFS, the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's ’s new or modified information system is operational, that MCP w'ill will have up to 90 ninety (90) days to submit an acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is in production. ODJFS reserves the right to verify any MCP's ’s capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.Requirements

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS ODJFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) i. As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) . As required by 42 CFR 438.242(b)(l438.242(b)(1), each MCP must collect data on member and provider characteristics and on services furnished to its members. iii. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) v. Acceptance testing of any data that is electronically submitted to ODJFS is required: (a) a. Before an MCP may submit production files (b) b. Whenever an MCP changes the method or prepare!" preparer of the electronic media; and/or (c) c. When the ODJFS determines an MCP's ’s data submissions have an unacceptably high error rate. Appendix C Aged, Blind or Disabled (ABD) population Page 17 MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies files in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. , as determined solely by ODJFS, the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's ’s new or modified information system is operational, that MCP w'ill will have up to 90 ninety (90) days to submit an acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is in production. ODJFS reserves the right to verify any MCP's ’s capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.

Health Information System Requirements. The ability to develop and maintain information management systems capacity is crucial to successful plan performance. OD.IFS ODJFS therefore requires MCPs to demonstrate their ongoing capacity in this area by meeting several related specifications. a. Health Information System (i) i. As required by 42 CFR 438.242(a), each MCP must 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 MCP membership terminations for other than loss of Medicaid eligibility. (ii) . As required by 42 CFR 438.242(b)(l), each MCP must collect data on member and provider characteristics and on services furnished to its members. iii. Appendix C (iii) As required by 42 CFR 438.242(b)(2), each MCP must ensure that 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)(3), each MCP must make all collected data available upon request by ODJFS or the Center for Medicare and Medicaid Services (CMS). (v) v. Acceptance testing of any data that is electronically submitted to ODJFS is required: (a) a. Before an MCP may submit production files (b) b. Whenever an MCP changes the method or prepare!" preparer of the electronic media; and/or (c) c. When the ODJFS determines an MCP's data submissions have an unacceptably high error rate. MCPs that change or modify information systems that are involved in producing any type of electronically submitted files, either internally or by changing vendors, are required to submit to ODJFS for review and approval a transition plan including the submission of test flies files in the ODJFS-specified formats. Once an acceptable test file is submitted to ODJFS. , as determined solely by ODJFS, the MCP can return to submitting production files. ODJFS will inform MCPs in writing when a test file is acceptable. Once an MCP's new or modified information system is operational, that MCP w'ill will have up to 90 ninety (90) days to submit an acceptable test file and an acceptable production file. Submission of test files can start before the new or modified information system is \s in production. ODJFS reserves the right to verify any MCP's capability to report elements in the minimum data set prior to executing the provider agreement for the next contract period. Penalties for noncompliance with this requirement are specified in Appendix "N, Compliance Assessment System of the Provider Agreement. b. Electronic Data Interchange and Claims Adjudication Requirements Appendix C The MCP must have the capacity to electronically accept and adjudicate all claims to final status (payment or denial). Information on claims submission procedures must be provided to non-contracting providers within thirty days of a request. MCPs must inform providers of its ability to electronically process and adjudicate claims and the process for submission. Such information must be initiated by the MCP and not only in response to provider requests. The MCP must notify providers who have submitted claims of claims status [paid, denied, pended (suspended)] w ithin one month of receipt. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis.Requirements