MCO Data Integrity and Systems Assessments Sample Clauses

MCO Data Integrity and Systems Assessments. Health and long-term care service information from each MCO is transmitted to the Department on a regular basis through the encounter reporting process. This information is used for research, capitation rate calculations, and various other ad hoc applications. The accuracy of encounter data may be impacted by various systems maintained by the MCO. The purpose of data integrity and system assessments is to assure the data that exist in the organizations’ originating system are accurately reflected in the data existing in the encounter data repository, and that the repository accurately reflects the service records present in the local MCO systems. The objectives of the data integrity and systems assessments are to verify that: • Claims and encounter data exist in local MCO systems; • Data from local MCO systems is presented to the State correctly; • Data submitted to the State accurately reflects encounters; and • Data that resides with the State is an accurate reflection of what exists in the local MCO system. MCO system and data integrity assessments will be scheduled and conducted on an as needed basis as determined by the Department. The MCO data integrity and system assessments are specific to the Family Care, Partnership, or PACE processes. These assessments include processes or activities regarding the operation of specific managed care programs, the operation of the encounter reporting application, or MCO financial systems and processes.
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