Reporting Format and Batch Submission Schedule Sample Clauses

Reporting Format and Batch Submission Schedule. The Contractor shall submit institutional, pharmacy, dental, vision, transportation and other professional encounter claims in an electronic format that adheres to the data specifications in the Companion Guides and any other state or federally mandated electronic claims submission standards, or be subject to liquidated damages. A diagnosis code and DRG, as applicable, is a required data field and must be included on all encounter claims. The Contractor’s encounter claims must include the National Drug Codes (NDCs) when an encounter involves products or services with NDCs, including medical and institutional claims where medications with NDCs are included and billed separately. An indication of claim payment status and an identification of claim type (i.e., original, void or replacement) is also required, in the form designated by FSSA. The Contractor shall submit via secure FTP at least one batch of encounter data for paid and denied institutional, pharmacy and professional claims before 5 p.m. Eastern on Wednesday each week, or other date and time as specified by the State. OMPP will use an overall average of calendar month submissions to assess compliance with this encounter claim submission requirement. The State shall require the Contractor to submit a corrective action plan and shall assess liquidated damages for failure to comply with the encounter claims submission requirements. See Exhibit 3 for a schedule of liquidated damages OMPP shall assess for non-compliance with this requirement. Only data and information accepted by the data warehouse by June 30 shall be considered for the next year’s capitation rate adjustments.
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