Common use of Monthly File Clause in Contracts

Monthly File. The Department will provide a Monthly 834 Eligibility File to the CHC-MCO on the next to the last Saturday of each month. The file contains the MA Eligibility Period, CHC-MCO coverage, BH-MCO coverage, and Participant demographic information. It will contain only the most current record for each CHC Participant where the Participant is both MA and CHC eligible at some point in the following month. The CHC-MCO must reconcile this Participant file against its internal Participant information. If discrepancies are found, the CHC-MCO must first check eCIS and subsequent Daily 834 files to see if the discrepancy has been resolved prior to reaching out to the Department. If the MCO cannot resolve the discrepancy, the MCO must notify the Department within thirty (30) business days of receipt of the Monthly 834 file with the discrepancy. Participants not included on this file with an indication of prospective coverage will not be the responsibility of the CHC-MCO unless a subsequent Daily 834 Membership File indicates otherwise.

Monthly File. The Department will provide a Monthly 834 Eligibility File to the CHC-MCO on the next to the last Saturday of each month. The file contains the MA Eligibility Period, CHC-MCO coverage, BH-MCO coverage, and Participant demographic information. It will contain only the most current record for each CHC Participant where the Participant is both MA and CHC eligible at some point in the following month. The CHC-MCO must reconcile this Participant file against its internal Participant information. If discrepancies are found, the CHC-MCO must first check eCIS and subsequent Daily 834 files to see if the discrepancy has been resolved prior to reaching out to the Department. If the MCO cannot resolve the discrepancy, the MCO must notify the Department within thirty (30) business days of receipt of the Monthly 834 file with the discrepancy. Participants not included on this file the Monthly 834 Eligibility File with an indication a specification of prospective coverage will not be the responsibility of the CHC-MCO unless a subsequent Daily 834 Membership File indicates otherwise.