Haw. Code R. § 11-188-13 - General requirements for data submission
(a) All
data shall be submitted to the agency or the agency's designee, as separate
files in the format described in the data submission guide.
(b) Files shall be encrypted and submitted in
the method specified by the data submission guide.
(c) All submissions shall include the
following:
(1) Adjustment records with the
appropriate positive or negative fields with the medical, pharmacy, and dental
claims file submissions,*
(2)
Claims for services under capitation or other alternative payment arrangement
shall be reported with claims file submissions;
(3) Records for the medical, pharmacy, and
dental claims file submissions shall be reported pursuant to the data
submission guide;
(4) Claims where
multiple parties have financial responsibility shall be included with all
medical, pharmacy, and dental claims file submissions; and
(5) Wholly denied claims shall be excluded
from all medical, pharmacy, and dental claims file submissions. However, when a
claim contains both fully processed and paid service lines and partially
processed or partially denied service lines, all lines shall be included as
part of the health care claims data submission.
(d) Records within medical, pharmacy, and
dental claims files shall be selected and submitted according to the data
submission guide.
Notes
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