Common use of PIHP Enrollment Rosters Clause in Contracts

PIHP Enrollment Rosters. The Department will promptly notify the PIHP of all members enrolled in the PIHP under this Contract. Notification will be effected through the PIHP Enrollment Rosters. These rosters shall be available through electronic file transfer capability and will include medical status codes. For each month of coverage throughout the term of the contract, the Department will provide “PIHP Enrollment Rosters” to the PIHP. These rosters will provide the PIHP with ongoing information about its enrollees and disenrollees and will be used as the basis for the monthly nonrisk payments to the PIHP. The PIHP Enrollment Rosters will be generated in the following sequence: a. The Initial and Final Enrollment Rosters in the X12 834 format that will be available via the ForwardHealth Trading Partner Portal. These rosters will provide the PIHP with ongoing information about its FCMH members and will be used as the basis for the monthly PIHP nonrisk payments as described in this contract. 1) The X12 834 Initial Enrollment Report will list all of the PIHP’s members and those disenrolled for the enrollment month that are known on the date of report generation. The Initial Enrollment Report will be available to the PIHP on or about the twenty-first of each month. A monthly nonrisk prepayment shall be generated for each member listed as an ADD or CONTINUE on this report. Members who appear as PENDING on the Initial Report and are reinstated into the PIHP prior to the end of the month will appear as a CONTINUE on the Final Report and a payment will be generated for those members. 2) The X12 834 Final Enrollment Report will list all of the PIHP’s members for the enrollment month, which were not included in the Initial or who have had a status change since the Initial Enrollment Report. The Final PIHP Enrollment Report will be available to the PIHP on or around the first business day of the enrollment month. A monthly nonrisk prepayment will be generated for every member listed as an ADD or CONTINUE on this report. 3) The Initial and Final Rosters will identify changes in member demographics and medical status codes, since the last enrollment roster. b. The X12 820 Capitation Payment Listing Report will identify all members for which a non-risk prepayment was made or recouped for the specified enrollment dates. The report will be available via the ForwardHealth Trading Partner Portal on the Tuesday after the first Friday of every month.

PIHP Enrollment Rosters. The Department will promptly notify the PIHP of all members enrolled in the PIHP under this Contract. Notification will be effected through the PIHP Enrollment Rosters. These rosters shall be available through electronic file transfer capability and will include medical status codes. For each month of coverage throughout the term of the contract, the Department will provide “PIHP Enrollment Rosters” to the PIHP. These rosters will provide the PIHP with ongoing information about its enrollees memberss and disenrollees and will be used as the basis for the monthly nonrisk payments to the PIHP. The PIHP Enrollment Rosters will be generated in the following sequence: a. The Initial and Final Enrollment Rosters in the X12 834 format that will be available via the ForwardHealth Trading Partner Portal. These rosters will provide the PIHP with ongoing information about its FCMH members and will be used as the basis for the monthly PIHP nonrisk payments as described in this contract. 1) The X12 834 Initial Enrollment Report will list all of the PIHP’s members and those disenrolled for the enrollment month that are known on the date of report generation. The Initial Enrollment Report will be available to the PIHP on or about the twenty-first of each month. A monthly nonrisk prepayment shall be generated for each member listed as an ADD or CONTINUE on this report. Members who appear as PENDING on the Initial Report and are reinstated into the PIHP prior to the end of the month will appear as a CONTINUE on the Final Report and a payment will be generated for those members. 2) The X12 834 Final Enrollment Report will list all of the PIHP’s members for the enrollment month, which were not included in the Initial or who have had a status change since the Initial Enrollment Report. The Final PIHP Enrollment Report will be available to the PIHP on or around the first business day of the enrollment month. A monthly nonrisk prepayment will be generated for every member listed as an ADD or CONTINUE on this report. 3) The Initial and Final Rosters will identify changes in member demographics and medical status codes, since the last enrollment roster. b. The X12 820 Capitation Payment Listing Report will identify all members for which a non-risk prepayment was made or recouped for the specified enrollment dates. The report will be available via the ForwardHealth Trading Partner Portal on the Tuesday after the first Friday of every month.