Timing of Data Submittal Clause Samples

Timing of Data Submittal. Claims must be submitted by Providers to the Contractor within one hundred eighty (180) days after the date of service. It is acceptable for the Contractor to include a requirement for more prompt submissions of Claims or encounter records in Provider Agreements. Claims adjudicated by a third party vendor must be provided to the Contractor by the end of the month following the month of adjudication. An encounter must be submitted and found acceptable by the Department on or before the last calendar day of the third month after the encounter's Contractor payment/adjudication calendar month in which the Contractor paid/adjudicated the encounter. References to "accepted by the Department" refer to encounter records sent to DPW by the Contractor that have passed all Department edits; records that fail any Department edits are returned to the Contractor and must be corrected, resubmitted to the Department, and pass all edits before they are accepted by the Department. One "initial" file and one "correction" file may be submitted each weekday. If a file is received at the DPW mainframe computer before 6 p.m. (Eastern Time), it will be processed

Timing of Data Submittal. Claims must be submitted by Providers to the Contractor within one hundred and eighty (180) days after the date of service. It is acceptable for the Contractor to include a requirement for more prompt submissions of claims or encounter records in Provider Agreements. Claims adjudicated by a third party vendor must be provided to the Contractor by the end of the month following the month of adjudication. An encounter must be submitted and found acceptable by the Department on or before the last calendar day of the third month after the encounter's Contractor payment/adjudication calendar month in which the Contractor paid/adjudicated the encounter. References to "accepted by the Department" refer to encounter records send to DPW by the Contractor that have passed all Department edits: records that fail any Department 122 edits are returned to the Contractor and must be corrected, resubmitted to the Department, and pass all edits before they are accepted by the Department. One "initial" file and one "correction" file may be submitted each weekday. If a file is received at the DPW mainframe computer before 6 p.m. (Eastern Time), it will be processed that weekday. If a file is received at the DPW mainframe computer after 6 p.m. (Eastern Time), it will be processed on the next weekday. Files received at the DPW mainframe computer after 6 p.m. on Friday are not processed until the following Monday. Acceptable subcapitation data must be submitted to the Department within thirty (30) days after the end of the month of the subcapitation payment data.