Neonatal Intensive Care Unit (NICU) Risk-Sharing Report Format and Detail Data Requirements Sample Clauses

Neonatal Intensive Care Unit (NICU) Risk-Sharing Report Format and Detail Data Requirements. HMO reporting of NICU costs must include all of the data elements specified in this section. Risk-sharing for NICU is based on the criteria defined in Article VI, I of this Contract. As specified in Article VII, I of this Contract NICU reports must be submitted to the Department’s Contract Specialist on or before May 1 of the following year. The HMO does not have to file a report if the NICU criteria is not met. The NICU report form, detailed data format and worksheet follow this page. HMO Contract for February 1, 2006 - December 31, 2007 HMO NEONATAL INTENSIVE CARE UNIT (NICU) REPORT FORM HMO Name: HMO Medicaid (Payee) Number Report Period: January 1, 200 through December 31, 200 Questions regarding this report should be referred to: (please print) Phone Number:
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Neonatal Intensive Care Unit (NICU) Risk-Sharing Report Format and Detail Data Requirements. HMO reporting of NICU costs must include all of the data elements specified in this section. Risk-sharing for NICU is based on the criteria defined in Article VI, I of this Contract. As specified in Article VII, J of this Contract NICU reports must be submitted to the Department’s Contract Specialist on or before May 1 of the following year. The HMO does not have to file a report if the NICU criteria is not met. The NICU report form, detailed data format and worksheet follow this page (report form pg. 118, detailed data reporting format pg. 119, worksheet pg. 120) HMO NEONATAL INTENSIVE CARE UNIT (NICU) REPORT FORM HMO Name: HMO Medicaid (Payee) Number Report Period: January 1, 200 through December 31, 200 Questions regarding this report should be referred to: ____________________________ (please print) Phone Number:

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