§11-188-13 - General requirements for data submission.

§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.

        [Eff MAR 17 2018 ] (Auth: HRS §§323D-12, 323D-18.5, 323D-62) (Imp: HRS §§323D-12, 323D-18.5)

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