Common use of POWER Account Reconciliation Clause in Contracts

POWER Account Reconciliation. In the event of member termination, the POWER Account reconciliation process occurs as below:  Member refund: Prepaid months where the member is no longer enrolled must be refunded 30 calendar days after the member termination.  State refund: One-hundred and twenty (120) calendar days from end of the calendar year One hundred and twenty (120) calendar days following the end of the calendar year , the Contractor shall notify the State fiscal agent of the amount of the member and EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK state refunds and other data set forth in the PRF File Layout. This information shall be provided on the Power Account Reconciliation File (PRF), which is an electronic transaction between the Contractor and the State fiscal agent. Member and state refunds shall be reported even if the amount is zero, in order to verify to the State that the reconciliation process is finalized. Any amounts reported as owed to the State will be transferred to the State via the 820 transaction. Once the final PRF is filed one hundred and twenty (120) calendar days following the end of the calendar year, the Contractor may only make adjustments via the void process at the approval of the State. The Contractor shall be responsible for any claims received after the POWER Account has been reconciled and/or member refund has been issued. All missing POWER Account payment and capitation must be reported to the Indiana Medicaid fiscal agent and OMPP and reconciled no later than two years following the end of the benefit period. The Contractor shall not pursue the member’s portion of an appealed claim after a member refund is made. The Contractor shall be required to comply with these requirements as of the effective date of the Contract. POWER Account Reconciliation for benefit periods ending prior to December 31, 2017 shall follow the policy and procedures documented in the MCE Policy and Procedures Manual. OMPP will provide a timeline prior to reconciliation start date so that adjustments to the required submission timeframes can be made as needed. Reconciliation must be demonstrated at readiness review.

POWER Account Reconciliation. In Effective January 1, 2018, POWER Accounts transition from alignment with the event member’s eligibility period to the calendar year. The member’s POWER Account covers the first $2,500 of eligible services in each calendar year. Members that continue enrollment in HIP for multiple calendar years have a POWER account assigned to them for every calendar year in which they are enrolled. Where a member terminationleaves HIP and then reenters the program within the same calendar year, the member’s POWER account is reactivated. To allow for claims runout, one hundred and twenty (120) days following the end of the calendar year, the POWER Account account is reconciled with the state. The Contractor shall submit an initial reconciliation process occurs as below:  Member refund: Prepaid months where for the member is no longer enrolled must be refunded 30 calendar rollover thirty (30) days after the member terminationend of their benefit period.  State refund: One-During the one hundred and twenty (120) calendar days from end of the calendar year One hundred and twenty (120) calendar days following the end of the calendar year day reconciliation period, the Contractor shall notify the State fiscal agent of whether the member obtained the recommended preventive services and the amount, if any, of either the member’s POWER Account that will be rolled over to reduce the next benefit period’s required contribution or the percent discount that will be applied to reduce the member’s participation in HIP Plus. This notice shall also indicate the amount, if any, of the amount of member’s POWER Account that will be credited back to the member and EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK state refunds State and other data set forth in as required by the PRF File LayoutState. This information shall be provided on the Power Account Reconciliation File (PRF), which is an electronic transaction between the Contractor and the State fiscal agent. For POWER accounts requiring reconciliation for benefit periods ending prior to December 31, 2017, the Contractor is required to submit the final reconciliations one hundred and twenty (120) days after the end of the benefit period. See POWER Account technical requirements and the HIP MCE Policies and Procedure Manual. The Contractor shall be required to comply with these requirements as of the effective date of the Contract. Member roll over amounts and state the State’s refunds shall be reported even if the amount is zero, in order to verify to the State that the reconciliation process is finalized. Any amounts reported as owed to the State will be transferred to the State via the 820 transaction. Once The Contractor may not make adjustments after the final PRF is filed one hundred and twenty (120) calendar days following the end of the calendar year, the Contractor may only make adjustments via the void process at the approval of the State. The Contractor shall be responsible for any claims received after the POWER Account has been reconciled and/or member refund has been issued. All missing POWER Account payment and capitation must be reported to the Indiana Medicaid fiscal agent and OMPP and reconciled no later than two years following the end of the member’s benefit period. The Contractor shall not pursue Any PRF transactions filed with errors must complete the member’s portion of an appealed claim after a member refund is madevoid and replace process. The Contractor shall be required to comply with these requirements as of the effective date of the Contract. POWER Account Reconciliation for benefit periods ending prior to December 31, 2017 shall follow the policy and procedures documented in the MCE Policy and Procedures Manual. OMPP will provide a timeline prior to reconciliation start date so that adjustments to the required submission timeframes can be made as needed. Reconciliation must be demonstrated at readiness review.

POWER Account Reconciliation. In Effective January 1, 2018 POWER Accounts transition from alignment with the event member’s eligibility period to the calendar year. The member’s POWER Account covers the first $2,500 of eligible services in each calendar year. Members that continue enrollment in HIP for multiple calendar years have a POWER account assigned to them for every calendar year in which they are enrolled. Where a member terminationleaves HIP and then reenters the program within the same calendar year, the member’s POWER account is reactivated. To allow for claims runout, one hundred and twenty (120) days following the end of the calendar year, the POWER Account account is reconciled with the state. The Contractor shall submit an initial reconciliation process occurs as below:  Member refund: Prepaid months where for the member is no longer enrolled must be refunded 30 calendar rollover thirty (30) days after the member terminationend of their benefit period.  State refund: One-During the one hundred and twenty (120) calendar days from end of the calendar year One hundred and twenty (120) calendar days following the end of the calendar year day reconciliation period, the Contractor shall notify the State fiscal agent of whether the member obtained the recommended preventive services and the amount, if any, of either the member’s POWER Account that will be rolled over to reduce the next benefit period’s required contribution or the percent discount that will be applied to reduce the member’s participation in HIP Plus. This notice shall also indicate the amount, if any, of the amount of member’s POWER Account that will be credited back to the member and EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK state refunds State and other data set forth in as required by the PRF File LayoutState. This information shall be provided on the Power Account Reconciliation File (PRF), which is an electronic transaction between the Contractor and the State fiscal agent. For POWER accounts requiring reconciliation for benefit periods ending prior to December 31, 2017, the Contractor is required to submit the final reconciliations one hundred and twenty (120) days after the end of the benefit period. See POWER Account technical requirements and the HIP MCE Policies and Procedure Manual. The Contractor shall be required to comply with these requirements as of the effective date of the Contract. Member roll over amounts and state the State’s refunds shall be reported even if the amount is zero, in order to verify to the State that the reconciliation process is finalized. Any amounts reported as owed to the State will be transferred to the State via the 820 transaction. Once The Contractor may not make adjustments after the final PRF is filed one hundred and twenty (120) calendar days following the end of the calendar year, the Contractor may only make adjustments via the void process at the approval of the State. The Contractor shall be responsible for any claims received after the POWER Account has been reconciled and/or member refund has been issued. All missing POWER Account payment and capitation must be reported to the Indiana Medicaid fiscal agent and OMPP and reconciled no later than two years following the end of the member’s benefit period. The Contractor shall not pursue Any PRF transactions filed with errors must complete the member’s portion of an appealed claim after a member refund is madevoid and replace process. The Contractor shall be required to comply with these requirements as of the effective date of the Contract. POWER Account Reconciliation for benefit periods ending prior to December 31, 2017 shall follow the policy and procedures documented in the MCE Policy and Procedures Manual. OMPP will provide a timeline prior to reconciliation start date so that adjustments to the required submission timeframes can be made as needed. Reconciliation must be demonstrated at readiness review.

POWER Account Reconciliation. In the event of member termination, the POWER Account reconciliation process occurs as below:  ▪ Member refund: Prepaid months where the member is no longer enrolled must be refunded 30 calendar days after the member termination.  ▪ State refund: One-hundred and twenty (120) calendar days from end of the calendar year One hundred and twenty (120) calendar days following the end of the calendar year , the Contractor shall notify the State fiscal agent of the amount of the member and EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK state refunds and other data set forth in the PRF File Layout. This information shall be provided on the Power Account Reconciliation File (PRF), which is an electronic transaction between the Contractor and the State fiscal agent. Member and state refunds shall be reported even if the amount is zero, in order to verify to the State that the reconciliation process is finalized. Any amounts reported as owed to the State will be transferred to the State via the 820 transaction. Once the final PRF is filed one hundred and twenty (120) calendar days following the end of the calendar year, the Contractor may only make adjustments via the void process at the approval of the State. The Contractor shall be responsible for any claims received after the POWER Account has been reconciled and/or member refund has been issued. All missing POWER Account payment and capitation must be reported to the Indiana Medicaid fiscal agent and OMPP and reconciled no later than two years following the end of the benefit period. The Contractor shall not pursue the member’s portion of an appealed claim after a member refund is made. The Contractor shall be required to comply with these requirements as of the effective date of the Contract. POWER Account Reconciliation for benefit periods ending prior to December 31, 2017 shall follow the policy and procedures documented in the MCE Policy and Procedures Manual. OMPP will provide a timeline prior to reconciliation start date so that adjustments to the required submission timeframes can be made as needed. Reconciliation must be demonstrated at readiness review.