deductible and coinsurance for Medicare/Medicaid eligible members. Process TPL data received from sources of eligibility and the Child Support Enforcement Agency. Also, maintain online 352. work files for CHFS, which allows automatic updates to TPL module files. Produce and mail all appropriate party queries to potential carriers and members for CHFS's use in updating TPL Files, 353. CAB40 as a result of the claims payment process, data matches, and other events specified by CHFS. Produce and mail billing documents, to insurance carriers, 354. CAB41 comprised of paid claims data for recovery purposes. Provide CHFS with financial control numbers for TPL recovery 355. CAB42 checks received by CHFS. Print and maintain an inventory of forms, such as prior 356. CAB43 authorization forms, and send requested forms to providers within five calendar days of the receipt of the request. Print routine and special request reports/information, in a 357. CAB44 media as determined by CHFS. Produce all claims entry statistics reports/information and 358. CAB45 submit to CHFS or its designee, in agreed upon and approved format and media. 359. CAB46 Propose edit and audit criteria for claims processing. Report suspected fraud and abuse, identified during audits, 360. onsite visits, or any other communication with providers, to CHFS.
deductible and coinsurance for Medicare/Medicaid eligible members. 352. Process TPL data received from sources of eligibility and the Child Support Enforcement Agency. Also, maintain online work files for CHFS, which allows automatic updates to TPL module files. 353. CAB40 Produce and mail all appropriate party queries to potential carriers and members for CHFS's use in updating TPL Files, as a result of the claims payment process, data matches, and other events specified by CHFS. 354. CAB41 Produce and mail billing documents, to insurance carriers, comprised of paid claims data for recovery purposes. 355. CAB42 Provide CHFS with financial control numbers for TPL recovery checks received by CHFS. 356. CAB43 Print and maintain an inventory of forms, such as prior authorization forms, and send requested forms to providers within five calendar days of the receipt of the request. 357. CAB44 Print routine and special request reports/information, in a media as determined by CHFS. 358. CAB45 Produce all claims entry statistics reports/information and submit to CHFS or its designee, in agreed upon and approved format and media. 359. CAB46 Propose edit and audit criteria for claims processing. 360. Report suspected fraud and abuse, identified during audits, onsite visits, or any other communication with providers, to CHFS.
Attachment_I_-_MEMS_Fiscal_Agent_Requirements[1].docx