Common use of Data Exchange Requirements Clause in Contracts

Data Exchange Requirements. The Contractor must be able to receive, maintain, and utilize data extracts from the Division and/or its Agents. These data extract files will be used for obtaining necessary information to properly identify members, reimburse providers for services rendered, and/or to reconcile records accordingly. The Contractor must systematically update its database within five (5) calendar days of receipt of the files and shall ensure that its Subcontractors update within five (5) calendar days of receipt of the files, unless otherwise directed by the Division to update more frequently. Data extract files include but are not limited to the following: 1. Daily Active Provider Extract; 2. Weekly Provider Affiliation Details Extract; 3. 834 Enrollment Files; 4. 835 Claims Payment Remittance Advice Transaction; 5. 277 Claims Acknowledgement; 6. Third Party Liability (TPL) Resource/Policy Information File, etc.; 7. Claims History Extracts; 8. Prior Authorization Extracts; 9. Denials Report; 10. Any files related to pharmacy and/or drug benefits and/or services as directed by and in a timeframe determined by the Division; and 11. Beneficiary Health Management Program (BHMP) to include but not be limited to: beneficiary, prescriber, and pharmacy lock-in information as requested by the Division’s Office of Program Integrity. The Contractor shall utilize the most current version of the Division’s Universal Preferred Drug List (PDL). The Division or its designee will continue to send to Contractor a weekly Formulary Drug file. The Contractor will have access to the Division’s up-to-date PDL through the Division’s website. The Division may impose liquidated damages under Section 15, Non-Compliance and Termination, of the Base CHIP Contract for non-compliance with these requirements.