Encounter Data definition

Encounter Data. Any Contractor accessing payments for services through the Global Commitment to Health Waiver and Vermont Medicaid programs must provide encounter data to the Agency of Human Services and/or its departments and ensure that it can be linked to enrollee eligibility files maintained by the State.

Encounter Data. Any Grantee accessing payments for services through the Global Commitment to Health Waiver and Vermont Medicaid programs must provide encounter data to the Agency of Human Services and/or its departments and ensure that it can be linked to enrollee eligibility files maintained by the State.

Encounter Data means information reflecting a face-to-face meeting or other billable service furnished by a provider to a person served through the Iowa Plan. Medicaid encounter data must be submitted by the contractor to the department in an electronic format specified by the department.

Examples of Encounter Data in a sentence

• OHA has the right to Monitor Encounter Data to identify these Members who have ceased receiving treatment services.

• If the Parties are unable to resolve Encounter Data systems issues prior to calculation of the MLR, the Parties will agree on an alternative method of calculating paid claims expense.

• If Contractor fails to submit any report or other material required by this Contract to be submitted to the Department, other than Encounter Data, by the date due, the Department will give notice to Contractor of the late report or material and Contractor must submit it within thirty (30) days following the notice.

• Any service provided directly to an Enrollee not capable of being sent as Encounter Data due to there not being appropriate codes or similar issues may be sent to the Department on a report identifying the Enrollee, the service and the cost.

• The Department shall use Encounter Data claims for all dates of service during the Coverage Year and accepted by the Department within six (6) months after the end of the Coverage Year.

More Definitions of Encounter Data

Encounter Data means encounter information, data and reports for Covered Services provided to a Member that meets the requirements for Clean Claims.

Encounter Data means records of health care services submitted as electronic data files created by the Contractor’s system in the standard 837 format and the National Council for Prescription Drug Programs (NCPDP) Batch format.

Encounter Data. MCPs indicated whether an encounter is sub-capitated and “shadow priced” at the detail and header level, depending on how the encounter was paid. In the payment arrangement field (‘CDE_PAY_ARR’), code ‘05’ indicates sub-capitated arrangements. This field was used to separate sub-capitated encounter data from the non-sub-capitated encounter data. The MCPs provided additional information related to sub-capitated services through their CY 2018 MCP Survey submissions. These submissions provide insight into areas where a sub-capitated arrangement is present, yet the claims are not “shadow priced” in the submitted encounter data. We relied on this information for the purpose of properly identifying sub-capitated MCP encounter data.

Encounter Data means information documenting a service to an Enrollee.

Encounter Data means certain information required to be submitted to OHA under OAR 410-141-3570 and related to services that were provided to Members regardless of whether the services provided: (i) were Covered Services, non-covered services, or other Health-Related services; (ii) were not paid for; (iii) paid for on a Fee- For-Service or capitated basis; (iii) were performed by a Participating Provider, Non-Participating Provider, Subcontractor, or Contractor; and (iv) were performed pursuant to Subcontractor agreement, special arrangement with a facility or program, or other arrangement.

Encounter Data means the record submitted to CMS about an enrollee receiving any item(s) or service(s) provided through Medicaid or Medicare under a prepaid, capitated, or any other risk based payment methodology. Encounter Data records are maintained in the CMS Encounter Data System (EDS).

Encounter Data. MCPs indicated whether an encounter is sub-capitated and “shadow priced” at the detail and header level, depending on how the encounter was paid. In the payment arrangement field (‘CDE_PAY_ARR’), code ‘05’ indicates sub- capitated arrangements. This field was used to separate sub-capitated claims from the non-sub-capitated encounter data.