Claims Notification. A. The PH-MCO will provide the Department with semi-annual files as defined by the Department that include information on applicable services. B. Each file must include all eligible procedures, including services provided by capitated providers, and must have dates of service within the applicable six month period. This file must contain all data elements as specified by the Department. C. The PH-MCO may not include an allowance for claims that have not been paid. D. Each file is due on or before a date specified by the Department, which will be at least six months following the end of the applicable six month period. E. The Department will include in its calculation only services rendered by a physician who is eligible on the date of service per the Department’s current file.
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Sources: Grant Agreement, Grant Agreement, Grant Agreement