Maintain procedures to accept and ensure the integrity of 420. CAB107 electronic pharmacy claim records submitted by the PBM, including adjustments and reversals. Operate and maintain the Encounter Processing function of 421. CAB108 the MEMS system. Send encounter reject notices to Managed Care 422. CAB109 Organizations (MCOs) for encounters failing Establish balancing processes to ensure control within the 423. CAB110 MEMS encounter processing cycles. Reconcile all encounter records entered into the system to 424. CAB111 batch processing cycle input and output figures. Maintain procedures to ensure the integrity of electronic encounter records submitted by MCO(s) and pharmacy 425. CAB112 encounters submitted by the PBM, including adjustments and replacements. Produce online and hardcopy balancing and control 426. CAB113 reports/information, according to CHFS, or its designee, specifications for encounter data. Perform presence and format editing on all encounter records 427. CAB114 according to CHFS, or its designee, specifications. Perform validity editing on all entered encounter records, using current information on Provider, Member eligibility, and 428. CAB115 Reference data, pursuant to CHFS, or its designee, specifications. Produce all encounter entry statistics reports/information and 429. CAB116 submit (email or hand delivery) to the CHFS, or its designee. 430. CAB117 Propose edit and audit criteria for encounter processing.
420. CAB107 Maintain procedures to accept and ensure the integrity of electronic pharmacy claim records submitted by the PBM, including adjustments and reversals. 421. CAB108 Operate and maintain the Encounter Processing function of the MEMS system. 422. CAB109 Send encounter reject notices to Managed Care Organizations (MCOs) for encounters failing 423. CAB110 Establish balancing processes to ensure control within the MEMS encounter processing cycles. 424. CAB111 Reconcile all encounter records entered into the system to batch processing cycle input and output figures. 425. CAB112 Maintain procedures to ensure the integrity of electronic encounter records submitted by MCO(s) and pharmacy encounters submitted by the PBM, including adjustments and replacements. 426. CAB113 Produce online and hardcopy balancing and control reports/information, according to CHFS, or its designee, specifications for encounter data. 427. CAB114 Perform presence and format editing on all encounter records according to CHFS, or its designee, specifications. 428. CAB115 Perform validity editing on all entered encounter records, using current information on Provider, Member eligibility, and Reference data, pursuant to CHFS, or its designee, specifications. 429. CAB116 Produce all encounter entry statistics reports/information and submit (email or hand delivery) to the CHFS, or its designee. 430. CAB117 Propose edit and audit criteria for encounter processing.
Attachment_I_-_MEMS_Fiscal_Agent_Requirements[1].docx