Common use of Pharmacy Encounter Data Clause in Contracts

Pharmacy Encounter Data. 1. Health Plans shall submit pharmacy encounter data on an ongoing quarterly payment schedule. For example, all claims paid between 04/01/06 and 06/30/06 is due to the Agency by 07/31/06. The Health Plan should submit the data using the following: a. The Health Plan must submit any claims paid during the payment period within thirty (30) days after the end of the quarter. b. The Health Plan should submit only the final adjudication of claims. c. The File Naming Convention is: [health plan abbreviation]_[current date]_[file type]_[Production]_[file#]_[total # of files].format. For example: ABC_07312006_Rx_Production_1_7.txt d. The Health Plan must include accompany the files with a field layout and the records must have carriage-returns and line-feeds for record/file separation. e. The Health Plan must submit all Medicaid pharmacy data via CD to the Bureau of Health Systems Development. The Health Plan shall ensure that it submits the data to the Agency timely, accurately and completely. The Health Plan must include a certification letter as to the accuracy and completeness of the information contained on the CD. f. At a minimum, the Health Plan must include the following data requirements - the Plan ID, Transaction Reference number (claim identifier), NDC code, Date of Service (CCYYMMDD), Medicaid ID as assigned by the State, and process/payment date (CCYYMMDD). g. The Agency anticipates changing the format to reflect the NCPDP and is in the process of developing the companion guide. The Health Plan shall conform to this change upon notification.