Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
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Appendix C<br />
Covered Families <strong>and</strong> Children (CFC) population<br />
Page 22<br />
includes the delivery <strong>of</strong> stillborns where the MCP incurred costs related to the delivery.<br />
Rejections<br />
If a delivery encounter is not submitted according to ODJFS specifications, it will be<br />
rejected <strong>and</strong> MCPs will receive this information on the exception report (or error report)<br />
that accompanies every file in the ODJFS-specified format. Tracking, correcting <strong>and</strong><br />
resubmitting all rejected encounters is the responsibility <strong>of</strong> the MCP <strong>and</strong> is required by<br />
ODJFS.<br />
Timing <strong>of</strong> Delivery Payments<br />
MCPs will be paid monthly for deliveries. For example, payment for a delivery<br />
encounter submitted with the required encounter data submission in March, will be<br />
reimbursed in March. The delivery payment will cover any encounters submitted with<br />
the monthly encounter data submission regardless <strong>of</strong> the date <strong>of</strong> the encounter, but will<br />
not cover encounters that occurred over one year ago.<br />
This payment will be a part <strong>of</strong> the weekly update (adjustment payment) that is in place<br />
currently. The third weekly update <strong>of</strong> the month will include the delivery payment. The<br />
remittance advice is in the same format as the capitation remittance advice.<br />
Updating <strong>and</strong> Deleting Delivery Encounters<br />
The process for updating <strong>and</strong> deleting delivery encounters is h<strong>and</strong>led differently from all<br />
other encounters. See the ODJFS Encounter Data Specifications for detailed instructions<br />
on updating <strong>and</strong> deleting delivery encounters.<br />
The process for deleting delivery encounters can be found on page 35 <strong>of</strong> the UB-92<br />
technical specifications (record/field 20-7) <strong>and</strong> page III-47 <strong>of</strong> the NSF technical<br />
specifications (record/field CA0-31.0a).<br />
Auditing <strong>of</strong> Delivery Payments<br />
A delivery payment audit will be conducted periodically. If medical records do not<br />
substantiate that a delivery occurred related to the payment that was made, then ODJFS<br />
will recoup the delivery payment from the MCP. Also, if it is determined that the<br />
encounter which triggered the delivery payment was not a paid encounter, then ODJFS<br />
will recoup the delivery payment.<br />
32. If the MCP will be using the Internet functions that will allow approved users to access<br />
member information (e.g., eligibility verification), the MCP must receive prior approval<br />
from ODJFS that verifies that the proper safeguards, firewalls, etc., are in place to protect<br />
member data.<br />
33. MCPs must receive prior written approval from ODJFS before adding any information to<br />
their website that would require ODJFS prior approval in hard copy form (e.g., provider