Payment File Reconciliation. 7.3.1 Within thirty (30) days after the 820 Payment File is made available, Contractor shall notify the Department of any discrepancies, and Contractor and the Department will work together to resolve the discrepancies. Discrepancies include the following: 7.3.1.1 Enrollees who Contractor believes are in its plan but who are not included on the 820 Payment File; 7.3.1.2 Enrollees who are included on the 820 Payment File but who Contractor believes have not been enrolled with Contractor; and 7.3.1.3 Enrollees who are included on the 820 Payment File but who Contractor believes are in a different rate cell. 7.3.2 Contractor shall notify the Department within sixty (60) days of identifying Capitation or other payment amounts in excess of amounts specified in this Contract.
Appears in 3 contracts
Samples: Contract for Furnishing Health Services by a Managed Care Organization, Contract for Furnishing Health Services by a Managed Care Organization, Contract for Furnishing Health Services by a Managed Care Organization
Payment File Reconciliation. 7.3.1 β Within thirty (30) days after the 820 Payment File is made available, Contractor shall notify the Department of any discrepancies, and Contractor and the Department will work together to resolve the discrepancies. Discrepancies include the following:
7.3.1.1 Enrollees who Contractor believes are in its plan but who are not included on the 820 Payment File;
7.3.1.2 Enrollees who are included on the 820 Payment File but who Contractor believes have not been enrolled with Contractor; and
7.3.1.3 Enrollees who are included on the 820 Payment File but who Contractor believes are in a different rate cell.
7.3.2 Contractor shall notify the Department within sixty (60) days of identifying Capitation or other payment amounts in excess of amounts specified in this Contract.
Appears in 1 contract
Samples: Contract for Furnishing Health Services by a Managed Care Organization
