Management Information Systems. A. The CONTRACTOR shall maintain a process that collects, analyzes, integrates, and reports data. (42 C.F.R. § 438.242(a); Cal. Code Regs., tit. 9, § 1810.376.) This process shall provide information on areas including, but not limited to, utilization, claims, grievances, and appeals. (42 C.F.R. § 438.242(a).)
B. CONTRACTOR shall provide this information to the COUNTY within the specified timelines of the MHP Contract and Federal regulations.
Management Information Systems. 21.1. The CONTRACTOR shall maintain a process that collects, analyzes, integrates, and reports data. (42 C.F.R. § 438.242(a); Cal. Code Regs., tit. 9, § 1810.376) This process shall provide information on areas including, but not limited to, utilization, claims, grievances, and appeals. (42 C.F.R. § 438.242(a))
21.2. CONTRACTOR shall provide this information to the COUNTY within the specified timelines of the MHP Contract and Federal regulations.
21.3. The CONTRACTOR shall maintain a process that allows for electronic data sharing of health information in compliance with federal interoperability regulations (CMS-9115-F; ONC CURES Act Final Rule). CONTRACTOR shall make available all data elements listed on the United States Core Data for Interoperability (USCDI) data elements, to authorized requesting parties, including the COUNTY, within regulatory timeframes and formats.
21.4. CONTRACTOR shall not engage in any practices, that except as required by law or covered by an exception, is likely to interfere with access, exchange or use of electronic health information, when requested by Beneficiaries or appropriate third parties.
Management Information Systems. The CHC-MCO must have a comprehensive, automated and integrated health MIS, including a test environment, that is capable of meeting the requirements listed below and throughout this Agreement. See the information provided on the DHS Internet at the following link: xxxx://xxx.xxx.xx.xxx/provider/busandtechstandards/index.htm.
a. The CHC-MCO must have, at a minimum, the following MIS components or the capability to interface with other systems containing this information: Participants, Provider, Claims processing, Prior Authorization, and Reference.
b. The CHC-MCO must have an MIS sufficient to support data reporting requirements specified in this Agreement.
c. The Participant management system must have the capability to receive, update and maintain the CHC-MCO's Participant files consistent with information provided by the Department. The CHC- MCO must have the capability to provide daily updates of Participant information to subcontractors or Providers with responsibility for processing Claims or authorizing services based on Participant information.
d. The CHC-MCO must maintain its Provider file with detailed information on each Provider sufficient to support Provider payment and meet the Department's reporting and Encounter Data requirements. The CHC- MCO must be able to cross-reference its internal Provider identification number to the correct MMIS Provider ID and the Provider’s NPI number in the Commonwealth’s MMIS for each location in which the Provider renders services for the CHC-MCO. The CHC-MCO must verify that each Network Provider service location is enrolled and active with MA. In addition, the CHC-MCO must maintain all service locations in its own system. The CHC-MCO must verify that each Network Provider’s license information is valid in the Commonwealth’s MMIS, and must outreach to Network Providers to stress the importance of maintaining up to date information in the Commonwealth’s MMIS. The CHC-MCO must require its Network Providers with a specific Provider type/specialty to have the same Provider type/specialty in the Commonwealth’s MMIS for each service location.
e. The CHC-MCO’s Claims processing system must have the capability to process Claims consistent with timeliness and accuracy requirements identified in this Agreement.
f. The CHC-MCO’s Prior Authorization system must be linked with the Claims processing component.
g. The CHC-MCO’s MIS must be able to maintain Claims history with sufficient detail to meet all Department repor...
Management Information Systems. 17.1. CONTRACTOR shall maintain a health information 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).) The Contractor shall comply with Section 6504(a) of the Affordable Care Act which requires that State claims processing and retrieval systems are able to collect data elements necessary to enable the mechanized claims processing and information retrieval systems in operation by the State to meet the requirements of section 1903(r)(1)(F) of the Social Security Act. (42 C.F.R. § 438.242(b)(1).)
17.2. CONTRACTOR shall submit encounter data to the Department at a frequency and level specified by the Department and CMS. (42 C.F.R. § 438.242(c)(2).) CONTRACTOR shall ensure collection and maintenance of sufficient beneficiary encounter data to identify the provider who delivers service(s) to the beneficiary. (42 C.F.R. § 438.242(c)(1).) The Contractor shall submit all beneficiary encounter data that the Department is required to report to CMS under § 438.818. (42 C.F.R. § 438.242(c)(3).) The Contractor shall submit encounter data to the state in standardized Accredited Standards Committee (ASC) X12N 837 and National Council for Prescription Drug Programs (NCPDP) formats, and the ASC X12N 835 format as appropriate. (42 C.F.R. § 438.242(c)(4).)
17.3. CONTRACTOR shall enter into a Medi-Cal Privacy and Security Agreement (PSA) with the Department prior to obtaining access to MEDS and the MEDS monthly extract file (MMEF). The Contractor agrees to comply with the provisions as specified in the PSA. The County Mental Health Director or his or her authorized designee shall certify annually that Contractor is in compliance with the PSA agreement. Failure to comply with the terms of the agreement will result in the termination of access to MEDS and MMEF. (42 U.S.C. § 1396a(a)(7); 42 CFR § 431.300(a); 42 C.F.R. § 431.306(b); Welf. & Inst. Code §14100.2(a).).
Management Information Systems. The CMHSP shall ensure a Management Information System and related practices that reflect sufficient capacity to fulfill the obligations of this contract. Management information systems capabilities are necessary for at least the following areas: • Recipient registration and demographic information • Provider enrollment • Third party liability activity • Claims payment system and tracking • Grievance and complaint tracking • Tracking and analyzing services and costs by population group, and special needs categories as specified by MDHHS • Encounter and demographic data reporting • Quality indicator reporting • HIPAA compliance • UBP compliance • Recipient access and satisfaction
Management Information Systems. (1) Within sixty (60) days, the Board shall develop, implement, and thereafter ensure Bank adherence to a written program establishing an effective management information system (MIS) which facilitates risk identification, establishes controls, and delivers accurate information for timely review. In so doing, the Board shall identify the Bank’s specific information requirements and establish effective reporting mechanisms to guide decisions. The program shall include procedures for:
(a) expediting the timely delivery of current information;
(b) establishing controls to ensure the accuracy and confidentiality of information;
(c) ensuring that data are processed and compiled uniformly to facilitate meaningful trend analysis, and provide for future systems changes;
(d) producing complete and relevant information in a summarized form, for Board and management reports, to permit effective decision making;
(e) identifying, recording, and tracking missing, incomplete, or imperfect loan and collateral documentation, including lacking or outdated appraisals and operating statements on real estate projects;
(f) generating periodic reports, on at least a monthly basis which identify emerging problem loans, identified problem loans, Other Real Estate Owned (OREO), and foreclosed assets;
(g) maintaining a system by which the Board, or a delegated committee of the Board, can identify at the time of extension of credit, the aggregate customer liability relationship of that customer with the Bank;
(h) maintaining a system to calculate each concentration as a percentage of total capital;
(i) producing the information, which is listed in the XXX, that is necessary to effectively supervise the credit portfolio.
(2) The Board shall ensure that the Bank has processes, personnel, and control systems to ensure implementation of and adherence to the program developed pursuant to this Article. As a part of the Board’s ongoing responsibility to ensure that the Bank has an effective MIS, the Board shall designate a senior officer to coordinate the execution of this program.
Management Information Systems. The departments shall work toward integration of management information systems to administer the program and to perform the functions provided in this subsection.
A. The management information systems must track all types of nonresidential and residential care provided for children and supportive services provided for their families; the extent of met and unmet need for care; the extent of any waiting lists used in the program; behavioral, functional and clinical information; the development of resources; and the costs of the program. [PL 1997, c. 790, Pt. A, §1 (NEW); PL 1997, c. 790, Pt. A, §3 (AFF).]
B. Information on the care of children served through the program must be kept by treatment need, region, care provided, a child's progress and department involvement. Information on children who transfer from care out of the State to care in the State must be kept as part of the total system and must be kept separately. [PL 1997, c. 790, Pt. A, §1 (NEW); PL 1997, c. 790, Pt. A, §3 (AFF).]
C. The departments shall work toward data collection systems that use compatible data collection tools and procedures and toward care monitoring and evaluation systems. [PL 1997, c. 790, Pt. A, §1 (NEW); PL 1997, c. 790, Pt. A, §3 (AFF).] [PL 1997, c. 790, Pt. A, §1 (NEW); PL 1997, c. 790, Pt. A, §3 (AFF).]
Management Information Systems. The Holdings Group shall provide the Central Group with information processing, data retrieval and other management information systems services. If the Central Group elects to discontinue receiving such services from the Holdings Group, the Holdings Group shall return all information pertaining to the business and operations of the Central Group and shall use its best efforts in the transition of all data processing functions in a manner that does not unduly disrupt the business or operation of the Central Group.
Management Information Systems. The PIHP shall ensure a Management Information System and related practices that reflect sufficient capacity to fulfill the obligations of this contract. Management information systems capabilities are necessary for at least the following areas: • Monthly downloads of Medicaid eligible information • Individual registration and demographic information • Provider enrollment • Third party liability activity • Claims payment system and tracking • Grievance and complaint tracking • Tracking and analyzing services and costs by population group, and special needs categories as specified by MDCH • Encounter and demographic data reporting • Quality indicator reporting • HIPAA compliance • UBP compliance • Individual access and satisfaction
Management Information Systems. The implementation of the Company's planned management information systems is proceeding on schedule and, to the Company's knowledge, there are no circumstances currently existing or reasonably anticipated to delay such implementation or increase the cost thereof, except to the extent the failure of any of the foregoing would not, individually or in the aggregate, have a Material Adverse Effect.
