MODEL MIS REQUIREMENTS Sample Clauses
The MODEL MIS REQUIREMENTS clause defines the obligations and standards for the provision and maintenance of a Management Information System (MIS) within the context of the agreement. It typically outlines the types of data and reports that must be generated, the frequency of reporting, and the technical or security specifications the MIS must meet. By setting these requirements, the clause ensures that all parties have access to accurate, timely, and relevant information necessary for monitoring performance, compliance, and decision-making, thereby promoting transparency and accountability.
MODEL MIS REQUIREMENTS. Section 10.1.3.6 is replaced with the following language:
MODEL MIS REQUIREMENTS. HMO must have a system that can be adapted to the change in Business Practices/Policies within the timeframe negotiated between HHSC and the HMO.
MODEL MIS REQUIREMENTS. 93 10.2 SYSTEM-WIDE FUNCTIONS ......................................................95 10.3 ENROLLMENT/ELIGIBILITY SUBSYSTEM ...........................................96 10.4
MODEL MIS REQUIREMENTS. 10.1.1 HMO must maintain an MIS that will provide support for all functions of HMO's processes and procedures related to the flow and use of data within HMO. The MIS must enable HMO to meet the requirements of this contract. The MIS must have the capacity and capability of capturing and utilizing various data elements to develop information for HMO administration.
10.1.2 HMO must maintain a claim retrieval service processing system that can identify date of receipt, action taken on all provider claims or encounters (i.e., paid, denied, other), and when any action was taken in real time.
10.1.3 HMO must have a system that can be adapted to the change in Business Practices/Policies within a short period of time.
10.1.4 HMO is required to submit and receive data as specified in this contract and HMO Encounter Data Submissions Manual. HMO must provide complete encounter data of all capitated services within the scope of services of the contract between HMO and TDH. Encounter data must follow the format, data elements and method of transmission specified in the contract and HMO Encounter Data Submissions Manual. HMO must submit encounter data, including adjustments to encounter data. The Encounter transmission will include all encounter data and encounter data adjustments processed by HMO for the previous month. Data quality validation will incorporate assessment standards developed jointly by HMO and TDH. Original records will be made available for inspection by TDH for validation purposes. Data which do not meet quality standards must be corrected and returned within a time period specified by TDH.
10.1.5 HMO must use the procedure codes, diagnosis codes, and other codes used for reporting encounters and fee-for-service claims in the most recent edition of the Medicaid Provider Procedures Manual or as otherwise directed by TDH. Any exceptions will be considered on a code-by-code basis after TDH receives written notice from HMO requesting an exception. HMO must also use the provider numbers as directed by TDH for both encounter and fee-for-service claims submissions.
10.1.6 HMO must have hardware, software, network and communications system with the capability and capacity to handle and operate all MIS subsystems.
10.1.7 HMO must notify TDH of any changes to HMO's MIS department dedicated to or supporting this contract by Phase I of Renewal Review. Any 1999 Renewal Contract Tarrant Service Area 101 August 9, 1999 102 updates to the organizational chart and the...
MODEL MIS REQUIREMENTS. 10.1.1 HMO must maintain a MIS that will provide support for all functions of HMO's processes and procedures related to the flow and use of data within HMO. The MIS must enable HMO to meet the requirements of this contract. The MIS must have the capacity and capability of capturing and utilizing various data elements to develop information for HMO administration. 88 Dallas Service Area Contract 95 10:1.2 HMO must maintain a claim retrieval service processing system that can identify date of receipt, action taken on all provider claims or encounters (i.e., paid, denied, other), and when any action was taken in real time.
MODEL MIS REQUIREMENTS. Section 10.1.3.3 of Section 10.1, Model MIS Requirements, is being amended to be consistent with STAR contract language.
MODEL MIS REQUIREMENTS. HMO must have a system that can be adapted to the change in Business Practices/Policies WITHIN THE TIMEFRAME NEGOTIATED BETWEEN TDHS AND THE HMO. 10.1.3.1 HMO MUST NOTIFY TDHS OF MAJOR SYSTEMS CHANGES AND IMPLEMENTATIONS. HMO IS REQUIRED TO PROVIDE AN IMPLEMENTATION PLAN AND SCHEDULE OF PROPOSED SYSTEM CHANGE AT THE TIME OF THIS NOTIFICATION.
MODEL MIS REQUIREMENTS. 10.1.1 HMO must maintain an MIS that will provide support for all functions of HMO's processes and procedures related to the flow and use of data within HMO. The MIS must enable HMO to meet the requirements of this contract. The MIS must have the capacity and capability of capturing and utilizing various data elements to develop information for HMO administration.
10.1.2 HMO must maintain a claim retrieval service processing system that can identify date of receipt, action taken on all provider claims or encounters (i.e., paid, denied, other), and when any action was taken in real time.
10.1.3 HMO must have a system that can be adapted to the change in Business Practices/Policies within a short period of time.
MODEL MIS REQUIREMENTS. 10.1.1 HMO must maintain an MIS that will provide support for all functions of HMOs processes and procedures related to the flow and use of data within HMO. The MIS must enable HMO to meet the requirements of this Contract. The MIS must have the capacity and capability of capturing and utilizing various data elements to develop information for HMO administration.
10.1.2 HMO must maintain a claim retrieval service processing system that can identify date of receipt, action taken on all provider claims or encounters (i.e., paid, denied, etc.), and when any action was taken in real time.
10.1.3 HMO must have a system that can be adapted to changes in Business Practices/Policies within a short period of time.
10.1.4 HMO is required to submit and receive data as specified in this contract and HMO Encounter Data Submissions Manual. The MIS must provide complete acute and long term care encounter data of all capitated services within the scope of services of the contract between HMO and TDHS. Encounter data must follow the format, data elements and method of transmission specified in the contract and HMO Encounter Data Submissions Manual. HMO must submit encounter data, including adjustments to encounter data. The Encounter transmission will include all encounter data and encounter data adjustments processed by HMO TDHS/HMO CONTRACT August 11, 1999
MODEL MIS REQUIREMENTS. HMO must have a system that can be adapted to the change in Business Practices/Policies WITHIN THE TIMEFRAME NEGOTIATED BETWEEN TDHS AND THE HMO. 10.1.3.1 HMO MUST NOTIFY TDHS OF MAJOR SYSTEMS CHANGES AND IMPLEMENTATIONS. HMO IS REQUIRED TO PROVIDE AN IMPLEMENTATION PLAN AND SCHEDULE OF PROPOSED SYSTEM CHANGE AT THE TIME OF THIS NOTIFICATION.