Common use of POWER Account Reconciliation Clause in Contracts

POWER Account Reconciliation. Effective January 1, 2018, POWER Accounts transition from alignment with the 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 leaves 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 is reconciled with the state. The Contractor shall submit an initial reconciliation for the member rollover thirty (30) days after the end of their benefit period. During the one hundred and twenty (120) calendar day reconciliation period, the Contractor shall notify the State 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 member’s POWER Account that will be credited back to the State and other data as required by the State. This information shall be provided on the 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 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. The Contractor may not make adjustments after the PRF is filed one hundred and twenty (120) calendar days following the end of the member’s benefit period. Any PRF transactions filed with errors must complete the void and replace process. The Contractor shall be required to comply with these requirements as of the effective date of the Contract. Reconciliation must be demonstrated at readiness review.

POWER Account Reconciliation. Effective January 1, 2018, 2018 POWER Accounts transition from alignment with the 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 leaves 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 is reconciled with the state. The Contractor shall submit an initial reconciliation for the member rollover thirty (30) days after the end of their benefit period. During the one hundred and twenty (120) calendar day reconciliation period, the Contractor shall notify the State 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 member’s POWER Account that will be credited back to the State and other data as required by the State. This information shall be provided on the 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 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. The Contractor may not make adjustments after the PRF is filed one hundred and twenty (120) calendar days following the end of the member’s benefit period. Any PRF transactions filed with errors must complete the void and replace process. The Contractor shall be required to comply with these requirements as of the effective date of the Contract. Reconciliation must be demonstrated at readiness review.