Common use of PROVIDER INFORMATION AND PROCESSING REQUIREMENTS Clause in Contracts

PROVIDER INFORMATION AND PROCESSING REQUIREMENTS. A. Provider Data. The Contractor shall maintain individual and group provider network information with basic demographics, EIN or tax identification number, professional credentials, license and/or certification numbers and dates, sites, risk arrangements (i.e., individual and group risk pools), services provided, payment methodology and/or reimbursement schedules, group/individual provider relationships, facility linkages, and number of grievances. For PCPs, the Contractor shall maintain identification as traditional or safety net provider, specialties, enrollees with beginning and ending effective dates, capacity, emergency arrangements or contact, other limitations or restrictions, languages spoken, address, office hours, disability access. See Articles 4.8 and 5. The Contractor shall maintain provider history files and provide for easy data retrieval. The system should maintain audit trails of key updates. Providers should be identified with a unique number. The Contractor shall be able to cross- reference its provider number with the provider’s EIN, tax number, the provider’s license number, Unique Personal Identification Number (UPIN), National Provider Identifier, Medicaid provider number, Medicare provider number, and Social Security Number where applicable. The Contractor shall comply with HIPAA requirements for provider identification.

PROVIDER INFORMATION AND PROCESSING REQUIREMENTS. A. Provider Data. The Contractor shall maintain individual and group provider network information with basic demographics, EIN or tax identification number, professional credentials, license and/or certification numbers and dates, sites, risk arrangements (i.e., individual and group risk pools), services provided, payment methodology and/or reimbursement schedules, group/individual provider relationships, facility linkages, and number of grievancesgrievances and/or complaints. For PCPs, the Contractor shall maintain identification as traditional or safety net provider, specialties, enrollees with beginning and ending effective dates, capacity, emergency arrangements or contact, other limitations or restrictions, languages spoken, address, office hours, disability access. See Articles 4.8 and 5. The Contractor shall maintain provider history files and provide for easy data retrieval. The system should maintain audit trails of key updates. Providers should be identified with a unique number. The Contractor shall be able to cross- reference its provider number with the provider’s EIN, tax number, the provider’s license number, Unique Personal Identification Number (UPIN), National Provider Identifier, Medicaid provider number, Medicare provider number, and Social Security Number where applicable. The Contractor shall comply with HIPAA requirements for provider identification.