Furnish, as established by CHFS, copies of claim documents 344. CAB31 and associated TPL attachments for CHFS to utilize for adds and updates to the TPL Module Files. Operate the TPL Module of the MEMS, including 345. improvements as they are implemented, to meet the of CHFS and the requirements of Federal regulations. Work out a data exchange system with insurance carriers, the Department of Defense, Workmen's Compensation, Highway 346. CAB33 Patrol, and entities, as required by Federal regulations and by CHFS. Also, update TPL Files with data exchange info, as approved by CHFS. Generate and mail member inquiries from the claims payment 347. CAB34 process to aid in TPL identification. Handle the production and mailing of bills to appropriate third parties by way of hard copy documents or electronically, as 348. CAB35 specified by CHFS. Also, work with the third-party source, as necessary, to design and implement the billing procedures. Mail billing documents containing paid claims data in an 349. appropriate format, as determined by CHFS, to TPL sources for recovery purposes. Mail third party premium payment checks, as directed by 350. CAB37 CHFS and required by Federal regulations, when CHFS determines it is cost effective to the Medicaid program. Obtain, from Medicare carriers and intermediaries that are located in surrounding Commonwealths or designated as 351. CAB38 regional processors, the claims data, by tape or direct transmission, necessary to pay applicable Medicare
344. CAB31 Furnish, as established by CHFS, copies of claim documents and associated TPL attachments for CHFS to utilize for adds and updates to the TPL Module Files. 345. Operate the TPL Module of the MEMS, including improvements as they are implemented, to meet the of CHFS and the requirements of Federal regulations. 346. CAB33 Work out a data exchange system with insurance carriers, the Department of Defense, Workmen's Compensation, Highway Patrol, and entities, as required by Federal regulations and by CHFS. Also, update TPL Files with data exchange info, as approved by CHFS. 347. CAB34 Generate and mail member inquiries from the claims payment process to aid in TPL identification. 348. CAB35 Handle the production and mailing of bills to appropriate third parties by way of hard copy documents or electronically, as specified by CHFS. Also, work with the third-party source, as necessary, to design and implement the billing procedures. 349. Mail billing documents containing paid claims data in an appropriate format, as determined by CHFS, to TPL sources for recovery purposes. 350. CAB37 Mail third party premium payment checks, as directed by CHFS and required by Federal regulations, when CHFS determines it is cost effective to the Medicaid program. 351. CAB38 Obtain, from Medicare carriers and intermediaries that are located in surrounding Commonwealths or designated as regional processors, the claims data, by tape or direct transmission, necessary to pay applicable Medicare
Attachment_I_-_MEMS_Fiscal_Agent_Requirements[1].docx