Membership Data and Reconciliation Clause Samples

Membership Data and Reconciliation. Prospective MCPs must complete the Membership Data Maintenance and Reconciliation questionnaire and demonstrate the following membership data and reconciliation requirements: a. Capability to accept and utilize consumer contact record (CCR) data; b. Capability to accept and maintain membership data contained on the monthly member roster (MMR); c. Capability to accept and reconcile premium and delivery payments with the monthly remittance advice; d. Capability to reconcile membership data with remittance advice; e. Capability to accept and maintain pending member-provided information, such as PCP choice, hospitalization reporting, etc., prior to receiving and reconciling the CCR and MMR; and f. Identification of new members hospitalized prior to and remaining hospitalized on the effective date of MCP membership.
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