Statistical Reports. 12.2.1 HMO must electronically file the following monthly reports: (1) encounter; (2) encounter detail; (3) institutional; (4) institutional detail; and (5) claims detail for cost-reimbursed services filed, if any, with HMO. Encounter data must include the data elements, follow the format, and use the transmission method specified by TDH in the Encounter Data Submission Manual. Encounters must be submitted by HMO to TDH no later than 45 days after the date of adjudication (finalization) of the claims. 12.2.2 Monthly reports must include current month encounter data and encounter data adjustments to the previous month's data. 12.2.3 Data quality standards will be developed jointly by HMO and TDH. Encounter data must meet or exceed data quality standards. Data that does not meet quality standards must be corrected and returned within the period specified by TDH. Original records must be made available to validate all encounter data. 12.2.4 HMO must require providers to submit claims and encounter data to HMO no later than 95 days after the date services are provided. 12.2.5 HMO must use the procedure codes, diagnosis codes and other codes contained in the most recent edition of the Texas Medicaid Provider Procedures Manual and as otherwise provided by TDH. Exceptions or additional codes must be submitted for approval before HMO uses the codes. 12.2.6 HMO must use its TDH-specified identification numbers on all encounter data submissions. Please refer to the TDH Encounter Data Submission Manual for further specifications. 12.2.7 HMO must validate all encounter data using the encounter data validation methodology prescribed by TDH prior to submission of encounter data to TDH. 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 107
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Samples: Contract for Services (Centene Corp)
Statistical Reports. 12.2.1 HMO must electronically file the following monthly reports: (1) encounter; (2) encounter detail; (3) institutional; (4) institutional detail; and (5) claims detail for cost-reimbursed services filed, if any, with HMO. Encounter data must include the data elements, follow the format, and use the transmission method specified by TDH in the Encounter Data Submission Manual. Encounters must be submitted by HMO to TDH no later than 45 days after the date of adjudication (finalization) of the claims.
12.2.2 Monthly reports must include current month encounter data and encounter data adjustments to the previous month's data.
12.2.3 Data quality standards will be developed jointly by HMO and TDH. Encounter data must meet or exceed data quality standards. Data that does not meet quality standards must be corrected and returned within the period specified by TDH. Original records must be made available to validate all encounter data.
12.2.4 HMO must require providers to submit claims and encounter data to HMO no later than 95 days after the date services are provided.
12.2.5 HMO must use the procedure codes, diagnosis codes and other codes contained in the most recent edition of the Texas Medicaid Provider Procedures Manual and as otherwise provided by TDH. Exceptions or additional codes must be submitted for approval before HMO uses the codes.
12.2.6 HMO must use its TDH-specified identification numbers on all encounter 1999 Renewal Contract Harrxx Xxxvice Area August 9, 1999 117 data submissions. Please refer to the TDH Encounter Data Submission Manual for further specifications.
12.2.7 HMO must validate all encounter data using the encounter data validation methodology prescribed by TDH prior to submission of encounter data to TDH. 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 107.
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Statistical Reports. 12.2.1 HMO must electronically file the following monthly reports: (1) encounter; (2) encounter detail; (3) institutional; (4) institutional detail; and (5) claims detail for cost-reimbursed services filed, if any, with HMO. Encounter data must include the data elements, follow the format, and use the transmission method specified by TDH in the Encounter Data Submission Manual. Encounters must be submitted by HMO to TDH no later than 45 days after the date of adjudication (finalization) of the claims.
12.2.2 Monthly reports must include current month encounter data and encounter data adjustments to the previous month's data.
12.2.3 Data quality standards will be developed jointly by HMO and TDH. Encounter data must meet or exceed data quality standards. Data that does not meet quality standards must be corrected and returned within the period specified by TDH. Original records must be made available to validate all encounter data.
12.2.4 HMO must require providers to submit claims and encounter data to HMO no later than 95 days after the date services are provided.
12.2.5 HMO must use the procedure codes, diagnosis codes and other codes contained in the most recent edition of the Texas Medicaid Provider Procedures Manual and as otherwise provided by TDH. Exceptions or additional codes must be submitted for approval before HMO uses the codes.
12.2.6 HMO must use its TDH-specified identification numbers on all encounter data submissions. Please refer to the TDH Encounter Data Submission Manual for further specifications.
12.2.7 HMO must validate all encounter data using the encounter data validation methodology prescribed by TDH prior to submission of encounter data to TDH. 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 107.
Appears in 1 contract
Samples: Contract for Services (Centene Corp)
Statistical Reports. 12.2.1 HMO must electronically file the following monthly reports: (1) encounter; (2) encounter detail; (3) institutional; (4) institutional detail; and (5) claims detail for cost-reimbursed services filed, if any, with HMO. Encounter 1999 Renewal Contract Tarrant Service Area 115 August 9, 1999 116 data must include the data elements, follow the format, and use the transmission method specified by TDH in the Encounter Data Submission Manual. Encounters must be submitted by HMO to TDH no later than 45 days after the date of adjudication (finalization) of the claims.
12.2.2 Monthly reports must include current month encounter data and encounter data adjustments to the previous month's data.
12.2.3 Data quality standards will be developed jointly by HMO and TDH. Encounter data must meet or exceed data quality standards. Data that does not meet quality standards must be corrected and returned within the period specified by TDH. Original records must be made available to validate all encounter data.
12.2.4 HMO must require providers to submit claims and encounter data to HMO no later than 95 days after the date services are provided.
12.2.5 HMO must use the procedure codes, diagnosis codes and other codes contained in the most recent edition of the Texas Medicaid Provider Procedures Manual and as otherwise provided by TDH. Exceptions or additional codes must be submitted for approval before HMO uses the codes.
12.2.6 HMO must use its TDH-specified identification numbers on all encounter data submissions. Please refer to the TDH Encounter Data Submission Manual for further specifications.
12.2.7 HMO must validate all encounter data using the encounter data validation methodology prescribed by TDH prior to submission of encounter data to TDH. 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 107.
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Statistical Reports. 12.2.1 HMO must electronically file the following monthly reports: (1) encounter; (2) encounter detail; (3) institutional; (4) institutional detail; and (5) claims detail for cost-reimbursed services filed, if any, with HMO. Encounter data must include the data elements, follow the format, and use the transmission method specified by TDH HHSC in the Encounter Data Submission Manual. Encounters must be submitted by HMO to TDH HHSC no later than 45 days after the date of adjudication (finalization) of the claims.
12.2.2 Monthly reports must include current month encounter data and encounter data adjustments to the previous month's data.
12.2.3 Data quality standards will be developed jointly by HMO and TDHHHSC. Encounter data must meet or exceed data quality standards. Data that does not meet quality standards must be corrected and returned within the period specified by TDHHHSC. Original records must be made available to validate all encounter data.
12.2.4 HMO cannot submit newborn encounters to HHSC until the State-issued Medicaid ID number is received for a newborn. HMO must match the proxy ID number issued by the HMO with the State-issued Medicaid ID number prior to submission of encounters to HHSC and submit the encounter in accordance to the HMO Encounter Data Submission Manual. The encounter must include the State-issued Medicaid ID number. Exceptions to the 45-day deadline will be granted in cases in which the Medicaid ID number is not available for a newborn Member.
12.2.5 HMO must require providers to submit claims and encounter data to HMO no later than 95 days after the date services are provided.
12.2.5 12.2.6 HMO must use the procedure codes, diagnosis codes and other codes contained in the most recent edition of the Texas Medicaid Provider Procedures Manual and as otherwise provided by TDHHHSC. Exceptions or additional codes must be submitted for approval before HMO uses the codes.
12.2.6 12.2.7 HMO must use its TDHHHSC-specified identification numbers on all encounter data submissions. Please refer to the TDH HHSC Encounter Data Submission Manual for further specifications.
12.2.7 12.2.8 HMO must validate all encounter data using the encounter data validation methodology prescribed by TDH HHSC prior to submission of encounter data to TDH. 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 107HHSC.
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