Test Requirement. The Contractor shall be responsible for passing a test process for each of the HIPAA transaction types prior to submitting production encounter data. The Contractor shall pass the testing phase for all encounter claim type submissions prior to the effective date of the contract. The Contractor shall not be permitted to provide services under this contract, nor shall the Contractor receive capitation payment, until it has passed the testing and production submission of encounter data. The details of the testing process and handling of errors are provided in the HMO Systems Guide. The Contractor shall submit the testing encounter data to the Department’s fiscal agent electronically according to the specifications in the HMO Systems Guide.
Test Requirement. The contractor shall be required to pass a testing phase for each of the eight encounter claim types before production encounter data will be accepted. The contractor shall pass the testing phase for all encounter claim type submissions within twelve (12) calendar weeks from the award date of the contract. Contractors with prior contracting experience with DHS who have successfully passed test phases and have successfully submitted approved production data may be exempted at DHS's option. The contractor shall submit the test encounter data to the Department's fiscal agent electronically, via diskette, tape, or electronic transmission, according to the specifications of the Electronic Media Claims (EMC) Manual found in Section B.3.3 of the Appendices. The contractor shall be responsible for passing a two-phased test for each encounter claim type. The first phase requires that each submitted file follows the prescribed format, that header and trailer records are present and correctly located within the file, and that the key fields are present. The second phase requires that the required data elements are present and properly valued. Following each submission, an error report will be forwarded to the contractor identifying the file and record location of each error encountered for both testing phases. The contractor shall analyze the report, complete the necessary corrections, and re-submit the encounter data test file(s). The contractor shall utilize production encounter data, systems, tables, and programs when processing encounter test files. The contractor shall submit error free production data once testing has been approved for all of the encounter claims types.
Test Requirement. The contractor shall be required to pass a testing phase for each of the eight encounter claim types before production encounter data will be accepted. The contractor shall pass the testing phase for all encounter claim type submissions within twelve (12) calendar weeks from the effective date of the contract. Contractors with prior contracting experience with DHS who have successfully submitted approved production data may be exempted at DHS’s option. The contractor shall submit the test encounter data to the Department’s fiscal agent electronically, via diskette, tape, or electronic transmission according to the specifications of the Electronic Media Claims Manual issued by the Division HIPAA Implementation and Companion Guides. The contractor shall be responsible for passing a two-phased test for each encounter claim type. The first phase requires that each submitted file follows the prescribed format that header and trailer records are present and correctly located within the file, and that the key fields are present. The second phase requires that the required data elements are present and properly valued. The contractor shall be responsible for passing a phased-in test process prior to submitting production encounter data. The details of the testing process and handling of errors are provided in the New Jersey Medicaid Companion Guide. Following each submission and error report will be forwarded to the contractor identifying the file and record location of each error encountered for both testing phases. The contractor shall analyze the report, complete the necessary corrections, and re-submit the encounter data test file(s). The contractor shall utilize production encounter data, systems, tables, and programs when processing encounter test files. The contractor shall submit error-free production data once testing has been approved for all of the encounter claims types.
