Respond correctly to written correspondence, with at least an interim answer, within five business days of receipt of the 187. PRB87 correspondence, and provide a final response within 15 business days of receipt of the correspondence. Test and report the results of electronic billing, automated 188. PRB88 remittance, and electronic fund transfer option testing within ten business days of the provider’s written request to test. Produce and transmit a provider update (for PCP) file to 189. PRB89 KAMES/PA62 by 7:00 p.m. ET. Apply approved batch and real-time updates to the Provider 190. PRB90 Module, within 24 clock hours of receipt. Provide support and guidance via research and testimony at 191. PRB91 Dispute Resolution Meetings and in other legal forums. Support Annual Disclosure of Ownership 192. PRB92 (ADO) Electronic Process. 193. PRB93 Support multiple languages spoken by the provider. MANAGED CARE (MC) The Vendor should perform all functional requirements as 194. MCB1 needed to support capitated payment for Commonwealth managed care programs. Accept and process encounter claim data from any 195. MCB2 Commonwealth-approved Contractors, or other contractual entities. Create and publish a manual that specifies requirements for 196. MCB3 the submission of encounter claims and fee-for-service by an MCO or other Commonwealth-approved Contractors.
187. PRB87 Respond correctly to written correspondence, with at least an interim answer, within five business days of receipt of the correspondence, and provide a final response within 15 business days of receipt of the correspondence. 188. PRB88 Test and report the results of electronic billing, automated remittance, and electronic fund transfer option testing within ten business days of the provider’s written request to test. 189. PRB89 Produce and transmit a provider update (for PCP) file to KAMES/PA62 by 7:00 p.m. ET. 190. PRB90 Apply approved batch and real-time updates to the Provider Module, within 24 clock hours of receipt. 191. PRB91 Provide support and guidance via research and testimony at Dispute Resolution Meetings and in other legal forums. 192. PRB92 Support Annual Disclosure of Ownership (ADO) Electronic Process. 193. PRB93 Support multiple languages spoken by the provider. MANAGED CARE (MC) 194. MCB1 The Vendor should perform all functional requirements as needed to support capitated payment for Commonwealth managed care programs. 195. MCB2 Accept and process encounter claim data from any Commonwealth-approved Contractors, or other contractual entities. 196. MCB3 Create and publish a manual that specifies requirements for the submission of encounter claims and fee-for-service by an MCO or other Commonwealth-approved Contractors.
Attachment_I_-_MEMS_Fiscal_Agent_Requirements[1].docx