Common use of Trading Partner Obligations Clause in Contracts

Trading Partner Obligations. (a) Trading Partner accepts and agrees to the terms and conditions for EDI transactions as stated in this Agreement, its attachments and the Parent Company EDI User Guide Manual which is incorporated by reference herein. Trading Partner agrees and understands that there exists the possibility new HIPAA transactions may be adopted in the future and thus agrees to test all new transaction sets. (b) Trading Partner will submit transactions only on behalf of those individuals who have given their written authorization to do so. Upon request from PARENT COMPANY, Trading Partner shall furnish to Parent Company certification, including when requested by Parent Company, the signature of each individual on whose behalf Trading Partner submits transactions, certifying that Trading Partner is so authorized. (c) Trading Partner will ensure that every electronic entry can be readily associated and identified with an original source document. Each source document must reflect the following information: individual’s name; individual’s health insurance identification number; date(s) of service; diagnosis/nature of illness; and procedure/service(s) performed. (d) Trading Partner will affix the Parent Company assigned unique identifier number of the Provider on each claim electronically transmitted to Parent Company in the appropriate data segment. (e) Trading Partner will limit the number of claims in a single ST to SE segment to a maximum of 5,000. (f) Trading Partner will transmit claims placing Trading Partner’s submitter number at the ISA 06 (Interchange Sender ID), GS 02 (Application Senders Code) and at the Loop 1000A NM109 (Identification Code). This means that a clearinghouse or billing agent’s submitter number will be populated in the ISA 06, GS 02 and Loop 1000A NM109 unless a business need has been identified by either the original provider of services or Parent Company. (g) Should a trading partner, Provider of services or Parent Company identify a business need, the sender of claims, i.e. the clearinghouse or billing agent, must transmit a separate file for each trading partner so identified using the clearinghouse or billing agent’s submitter number populated in the ISA 06, GS 02 and the individual Provider trading partner’s submitter number in the 1000A NM109. (h) It is the Trading Partner’s obligation to review all EDI reports supplied by Parent Company and to contact Parent Company regarding any discrepancies identified. (i) Trading Partner will notify Parent Company within 2 business days if any transmitted data is received in an unintelligible or garbled form. (j) Trading Partner must complete and furnish to Parent Company a Letter of Authorization before transmitting any Provider’s data. Should Trading Partner fail to do so, any files transmitted will be rejected from the front-end systems and no claims from such files will be forwarded to the payment system.