Payer-Initiated Eligibility Information Exchange Sample Clauses

Payer-Initiated Eligibility Information Exchange. (PIE) Transaction PIE is a requirement of the Deficit Reduction Act (DRA) of 2005. The DRA of 2005 specifies data electronic exchange requirements for health insurers to send Member information to State Medicaid Agencies. Contractor shall create an easily repeatable, automated process to receive, match and upload health insurance information provided by insurers into the ACCESS and MMIS systems. Contractor shall modify the MMIS to support the CMS standard for transmission of PIE transaction data to be received and processed from insurance carriers licensed to operate in the State of Vermont. Contractor shall improve and automate current manual processes to identify members with other health insurance from insurer files, and upload other insurer information into eligibility, pharmacy, and MMIS systems. Contractor’s MMIS technical work activities shall include analysis, design, construction, project management and testing including integration testing between MMIS and ACCESS systems, and support of testing with additional carriers.
Sample 1
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Payer-Initiated Eligibility Information Exchange. Transaction is hereby deleted and replaced as set forth below. Payer-Initiated Eligibility Information Exchange (PIE) Transaction Contractor shall create an easily repeatable, automated process to receive, match and upload health insurance information from commercial insurers into the ACCESS and MMIS systems. Contractor shall improve and automate current manual processes to identify members with other health insurance from insurer files and upload other insurer information into eligibility systems. Contractor’s MMIS technical work activities shall include analysis, design, construction, project management and testing, including integration testing between MMIS and ACCESS systems, and support of testing with sources of commercial insurance information. A Vermont-specific set of files and file layouts shall be jointly agreed upon and implemented for automation of members’ other insurance information loads from MMIS into the ACCESS system, and for manual review of other insurance information that cannot be automatically loaded into ACCESS based on rules established by the State. These file formats will be utilized for traditional PIE data exchanges from specific carriers, as well as for consolidated information about other insurance verified via Contractor’s COB On Demand service. Contractor shall monitor and maintain the software and services required to provide other insurance information to ACCESS. The MMIS process will supplement the other insurance file information as needed to meet ACCESS load data requirements and will modify data formats and codes as needed to be compatible with ACCESS. Contractor shall utilize its COB On Demand service, including the Contractor’s National Eligibility Database (NEDB), to verify other insurance for each identified change in member eligibility. Because Blue Cross Blue Shield of Vermont (BCBSVT) eligibility data currently is not incorporated within the Contractor’s NEDB, Contractor will work with BCBSVT to incorporate it. An optional process for periodically verifying all Vermont members for other insurance against the Contractor’s NEDB is available to be utilized at the State’s sole discretion at the fixed fee specified in Table B.5 for “PIE/COB Population Verification.” COB On Demand Implementation Deliverables The one-time fee for implementation of the COB On Demand service includes: • One instance of verifying the full, active Vermont member population; • Analysis, design, development, testing, project management, an...
Sample 1

Related to Payer-Initiated Eligibility Information Exchange

  • Eligibility Information Group shall provide timely and accurate eligibility information, including Medicare status, and identify all persons subject to the Medicare Secondary Payer statutes and regulations. Group acknowledges that BCN will rely upon the accuracy of all eligibility information Group provides, and Group shall indemnify and hold BCN harmless against any loss, claim or action, including costs, penalties and reasonable attorney fees, arising from the provision of inaccurate eligibility information.

  • Exclusions from Confidential Information Receiving Party's obligations under this Agreement do not extend to information that is: (a) publicly known at the time of disclosure or subsequently becomes publicly known through no fault of the Receiving Party; (b) discovered or created by the Receiving Party before disclosure by Disclosing Party; (c) learned by the Receiving Party through legitimate means other than from the Disclosing Party or Disclosing Party's representatives; or (d) is disclosed by Receiving Party with Disclosing Party's prior written approval.

  • Exceptional Access to Thick Registration Data In case of a registrar failure, deaccreditation, court order, etc. that prompts the temporary or definitive transfer of its domain names to another registrar, at the request of ICANN, Registry Operator will provide ICANN with up-­‐to-­‐date data for the domain names of the losing registrar. The data will be provided in the format specified in Specification 2 for Data Escrow. The file will only contain data related to the domain names of the losing registrar. Registry Operator will provide the data as soon as commercially practicable, but in no event later than five (5) calendar days following ICANN’s request. Unless otherwise agreed by Registry Operator and ICANN, the file will be made available for download by ICANN in the same manner as the data specified in Section 3.1 of this Specification.

  • Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions (a) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

  • Facility Information The Product is: Renewable Energy Facility or Unit Specific; if so, complete the following: Name of Facility Location of Facility EIA number Online Date Renewable Energy Source specific; if so, state: Aggregator area specific. Use the following table for generator aggregation programs: REC Delivery Unit Specific Generating Renewable Energy Unit / Renewable Energy Source Generating Renewable Energy Aggregation Program / Renewable Energy Sources Location of Generator or Area of Aggregation Delivery 3

  • Certification of Funds; Budget and Fiscal Provisions; Termination in the Event of Non-Appropriation This Agreement is subject to the budget and fiscal provisions of the City’s Charter. Charges will accrue only after prior written authorization certified by the Controller, and the amount of City’s obligation hereunder shall not at any time exceed the amount certified for the purpose and period stated in such advance authorization. This Agreement will terminate without penalty, liability or expense of any kind to City at the end of any fiscal year if funds are not appropriated for the next succeeding fiscal year. If funds are appropriated for a portion of the fiscal year, this Agreement will terminate, without penalty, liability or expense of any kind at the end of the term for which funds are appropriated. City has no obligation to make appropriations for this Agreement in lieu of appropriations for new or other agreements. City budget decisions are subject to the discretion of the Mayor and the Board of Supervisors. Contractor’s assumption of risk of possible non-appropriation is part of the consideration for this Agreement. THIS SECTION CONTROLS AGAINST ANY AND ALL OTHER PROVISIONS OF THIS AGREEMENT.

  • Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion First Tier Participants:

  • Client Eligibility Client eligibility and service referral are the responsibility of DDA under chapter 388- 823 WAC (Eligibility) and chapter 388-825 WAC (Service Rules). Only persons referred by DDA shall be eligible for direct Client services under this Program Agreement. It is DDA’s responsibility to determine and authorize the appropriate direct service(s) type. Direct Client services provided without authorization are not reimbursable under this Program Agreement.

  • Exclusions to Confidential Information For purposes of this Confidentiality Agreement, Confidential Information does not include information that:

  • Exceptions to Confidential Information The obligations set forth in Section 13.1 (Confidential Information) shall not apply to the extent that Confidential Information includes information which is: (a) now or hereafter, through no unauthorized act or failure to act on the Receiving Party’s part, in the public domain; (b) was in the Receiving Party’s possession before receipt from the Disclosing Party and obtained from a source other than the Disclosing Party and other than through the prior relationship of the Disclosing Party and the Receiving Party before the Separation Date; (c) hereafter furnished to the Receiving Party by a third party as a matter of right and without restriction on disclosure; (d) furnished to others by the Disclosing Party without restriction on disclosure; or (e) independently developed by the Receiving Party without use of the Disclosing Party’s Confidential Information. Nothing in this Agreement shall prevent the Receiving Party from disclosing Confidential Information to the extent the Receiving Party is legally compelled to do so by any governmental, investigative or judicial agency pursuant to proceedings over which such agency has jurisdiction; provided, however, that prior to any such disclosure, the Receiving Party shall: (i) assert the confidential nature of the Confidential Information to the agency; (ii) immediately notify the Disclosing Party in writing of the agency’s order or request to disclose; and (iii) cooperate fully with the Disclosing Party in protecting against any such disclosure and/or obtaining a protective order narrowing the scope of the compelled disclosure and protecting its confidentiality.

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