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 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 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 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 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 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.