DATA TO BE SUBMITTED Clause Samples
The "Data to be Submitted" clause defines the obligation of one or both parties to provide specific information or documentation as required under the agreement. Typically, this clause outlines the types of data that must be delivered, the format in which it should be submitted, and the deadlines for submission. For example, a contractor may be required to submit progress reports, technical specifications, or compliance certificates to the client at designated project milestones. The core function of this clause is to ensure that all necessary information is exchanged in a timely and organized manner, thereby supporting transparency, accountability, and smooth project execution.
DATA TO BE SUBMITTED. When submitting a debt to the Setoff Program the Municipality shall submit to the State such data as the State may prescribe, in a form acceptable to the State. The Municipality shall provide, at a minimum, the name and last known address of the debtor, a 30 character description of the debt (e.g., parking fine, library book fine, property tax debt), and the current dollar amount of the debt. It is preferable that the SSN or EIN of the debtor be submitted as well. In addition, the Municipality shall certify that at least three attempts (oral or written communication) have been made to collect the debt prior to its submission to the Setoff Program.
DATA TO BE SUBMITTED. 1.2.1 MEDICAL CLAIMS DATA
a) Payers shall report health care service paid claims and encounters for all resident members. Payers may be required to identify encounters corresponding to a capitation payment (Exhibit A-2).
b) Payers must provide information to identify the type of service and setting in which the service was provided. Each submitted data file shall have control totals and transmission control data (see Exhibits for specifics) Claim data is required for submission for each month during which some action has been taken on that claim (ie payment, adjustment or other modification). Any claims that have been “soft” denied (denied for incompleteness, incorrect or other administrative reasons) which the data supplier expects to be resubmitted upon correction, do not have to be submitted until corrections have been completed and the claim paid. It is desirable that payers provide a reference that links the original claim to all subsequent actions associated with that claim (see Exhibit A-2 for specifics).
c) ICD-9/ICD-10 Diagnosis and Procedure Codes are required to accurately report risk factors related to the Episode of Care. CPT/HCPCS codes are also required.
d) For historical data submitted during the on boarding process, payers shall provide as a separate report monthly totals of covered members for the periods associated with the Historical Data.
1.2.2 PHARMACY CLAIMS
a) Health Care Payers must provide data for all pharmacy paid claims for prescriptions that were actually dispensed to members and paid (Exhibit A-3).
b) If your health plan allows for medical coverage without pharmacy (or vice versa), ME018 – ME020 in Exhibit A-1 provides data elements in which such options must be identified in order to effectively and accurately aggregate claims based on Episodes of Care.
1.2.3 MEMBER ELIGIBILITY DATA
a) Health Care Payers must provide a data set that contains information on every covered plan member whether or not the member utilized services during the reporting period. The file must include member identifiers, subscriber name and identifier, member relationship to subscriber, residence, age, race, ethnicity and language, and other required fields to allow retrieval of related information from pharmacy and medical claims data sets (Exhibit A).
b) If dual coverage exists, send coverage of eligible members where payer insurance is primary, secondary, or tertiary. ME028 is a flag to indicate whether this insurance is primary, secondary, or tert...
DATA TO BE SUBMITTED. 2 File Submission Methods 5 3 Submission Schedule 5
DATA TO BE SUBMITTED