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 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.

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

Examples of Encounter Data in a sentence

• Encounter Data: Party shall provide encounter data to the Agency of Human Services and/or its departments and ensure further that the data and services provided can be linked to and supported by enrollee eligibility files maintained by the State.

• CMS encourages MAOs and other entities to utilize the Tier II testing environment when they have questions or issues regarding edits received on EDFES Acknowledgement Reports or MAO-002 Encounter Data Processing Status reports; and when they have new submission scenarios that they wish to test prior to submitting to production.

• WII 415/416 TRICARE Encounter Data (TED) records shall be coded with the WII 415/416 HCDP Plan Coverage Code; however, the Enrollment/Health Plan Code data element on the TED record shall reflect the appropriate value for the primary HCDP Plan Coverage Code.

• The Encounter Data System (EDS) Companion Guide contains information to assist Medicare Advantage Organizations (MAOs) and other entities in the submission of encounter data.

• After a DME encounter passes translator and CEM level editing and receives an ICN on a 277CA, the EDFES then transfers the encounter to the Encounter Data DME Processing and Pricing System (EDDPPS) where editing, processing, pricing, and storage occur.

More Definitions of Encounter Data

Encounter Data means information documenting a service to an Enrollee.

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 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. 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.

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 means the compilation of data elements, as specified by the Department in written notice to Contractor, identifying an Encounter that includes information similar to that required in a claim for Fee-For-Service payment under the HFS Medical Program.

Encounter Data means information, data, and/or reports about clinical encounters and Covered Services rendered and supported by documentation in the Covered Person’s medical record.