Prior Claims History. The Division will review claims data and encounters from CHIP, CHIP Program, and Medicaid Fee-for-Service Program during the last six (6) months. The Division will assign each Member to the Contractor with the highest number of claims for a participating Contractor. In cases where the number of highest claims is equal across more than one Contrator, the Division will perform a review for the most recent date of service.
Appears in 2 contracts
Samples: Contract for Administration of the Children’s Health Insurance Program, Contract for Administration of the Children’s Health Insurance Program
Prior Claims History. The Division will review claims data and encounters from CHIP, CHIP Program, and Medicaid Fee-for-Service Program during the last six (6) months. The Division will assign each Member to the Contractor with the highest number of claims for a participating Contractor. In cases where the number of highest claims is equal across more than one ContratorContractor, the Division will perform a review for the most recent date of service.
Appears in 2 contracts
Samples: Contract for Administration of the Children’s Health Insurance Program, Contract for Administration of the Children’s Health Insurance Program
