Common use of Provider Reporting Clause in Contracts

Provider Reporting. 1. The Health Plan shall submit its provider directory as described in Section IV, A.5., Provider Directory, of this Contract, to the Agency or its Choice Counselor/Enrollment Broker at least on a monthly basis via FTP. The required file will be due the first Thursday of each month. 2. The Health Plan shall ensure that the Provider Network Report as described in Table 3 of this Section is an electronic representation of the Health Plan’s complete network of Providers, not a listing of entities for whom the Health Plan has paid claims. 3. The Provider Network Report shall be in an ASCII flat file and must be a complete refresh of the Health Plan’s Provider information. The file name will be XXX_PROVYYYYMMDD.dat (replacing X’s with the Health Plan’s three character approved abbreviation and the date the file is submitted). This file name may change upon notice from the Agency. Plans will receive final instructions regarding file naming, Plan Code (see layout below), file transfers, file submission frequency and schedule and other issues prior to implementation. 4. The Health Plan may choose to submit the Provider Network Report each Thursday of the month, as needed. The files will be compiled during the following weekend and available for Agency and Choice Counselor/Enrollment Broker staff use on the following Monday (or workday if the Monday is a Holiday.) If a new file is not submitted, the last good file will be used. This reporting schedule is subject to change upon notice from the Agency.

Provider Reporting. 1. The Health Plan shall submit its provider directory as described in Section IV, A.5.IV.A.5, Provider Directory, of this Contract, to the Agency or its Choice Counselor/Enrollment Broker at least on a monthly basis via FTP. The required file will be due the first Thursday of each month. 2. The Health Plan shall ensure that the Provider Network Report as described in Table 3 of this Section is an electronic representation of the Health Plan’s complete network of Providers, not a listing of entities for whom the Health Plan has paid claims. 3. The Provider Network Report shall be in an ASCII flat file and must be a complete refresh of the Health Plan’s Provider information. The file name will be XXX_PROVYYYYMMDD.dat (replacing X’s with the Health Plan’s three character approved abbreviation and the date the file is submitted). This file name may change upon notice from the Agencyin implementation. Plans will receive final instructions regarding file naming, Plan Code (see layout below), file transfers, file submission frequency and schedule and other issues prior to implementation. 4. The Health Plan may choose to submit the Provider Network Report each Thursday of the month, month as needed. The files will be compiled during the following weekend and available for Agency and Choice Counselor/Enrollment Broker staff use on the following Monday (or workday if the Monday is a Holiday.) If a new file is not submitted, the last last, good file will be used. This reporting schedule is subject to change upon notice from the Agency.