Processing Requirements Sample Clauses
Processing Requirements. You agree to submit only any transactions for processing which represent a bona fide, permissible transaction free of liens, claims, and encumbrances other than ordinary sales taxes; as outlined in this Agreement and in the Card Company Rules, or which accurately describes the product or services being sold or the charitable donations being made. You authorize PayPal to submit transactions to and receive settlement from American Express and to disclose transaction and merchant information to American Express to perform analytics and create reports, and for any other lawful business purposes, including commercial marketing communications purposes and important transactional or relationship communications. You also agree to ensure data quality and that any Data is processed promptly, accurately and completely, and complies with the Card Companies’ technical specifications. You agree not to process transactions or receive payments on behalf of any other party or redirect payments to any other party. You agree not to bill or collect from any cardholder for any purchase or payment on the card unless you have the right to do so under the Card Company Rules.
Processing Requirements.
1. BCRC receives external files from a data sharing partner through a dedicated T-1 line (AT&T Global Network Services [AGNS]), HTTPS, or Secure File Transfer Protocol (SFTP).
2. The input files are checked to ensure they are in the correct format.
3. A check is performed to detect and bypass duplicate files.
4. Records are edited for required fields and data format.
5. Records received are matched to the exiting BCRC tables.
6. Transactions are created to add new records that were received, update existing records or delete records that were not received on the input file.
7. Transactions are sent to the Medicare Beneficiary Part D Database (MBD).
8. Results from MBD are used to create the response files.
9. Beneficiary Part D eligibility/enrollment information will be retrieved and added to the response files.
10. Response files are transmitted to the DSA partner.
Processing Requirements. Partner will:
a. Process Personal Data (i) only for the purpose of providing, supporting and improving the services (including to provide insights and other reporting), using appropriate technical and organizational security measures; and (ii) in compliance with the instructions received from CampusLogic. Partner will not use or process the Personal Data for any other purpose. Partner will promptly inform CampusLogic in writing if it cannot comply with the requirements under Sections 5-8 of this DPA, in which case CampusLogic may terminate the Agreement or take any other reasonable action, including suspending data processing operations;
b. Inform CampusLogic promptly if, in Partner’s opinion, an instruction from CampusLogic violates applicable Data Protection Requirements;
c. If Partner is collecting Personal Data from individuals on behalf of CampusLogic, follow CampusLogic’s instructions regarding such Personal Data collection (including with regard to the provision of notice and exercise of choice);
d. Take commercially reasonable steps to ensure that (i) persons employed by it and (ii) other persons engaged to perform on Partner’s behalf comply with the terms of the Agreement and this DPA;
e. Ensure that its employees, authorized agents and any Subprocessors are required to comply with and acknowledge and respect the confidentiality of the Personal Data, including after the end of their respective employment, contract or assignment;
f. If it intends to engage Subprocessors to help it satisfy its obligations in accordance with this DPA or to delegate all or part of the processing activities to such Subprocessors, (i) obtain the prior written consent of CampusLogic to such subcontracting, such consent to not be unreasonably withheld; (ii) remain liable to CampusLogic for the Subprocessors’ acts and omissions with regard to data protection where such Subprocessors act on Partner’s instructions; and (iii) enter into contractual arrangements with such Subprocessors binding them to provide the same level of data protection and information security to that provided for herein; and
g. Upon request, provide CampusLogic with a summary of Partner’s privacy and security policies.
Processing Requirements. The primary processes of Claims Operations Management are to maintain sufficient on-line claims information, provide on-line access to this information, and produce claims processing reports. The claims operations management function of the MIS must:
1. Maintain Claim history at the level of service line detail.
2. Maintain all adjudicated (paid and denied) claims history. Claims history must include at a minimum: All submitted diagnosis codes (including service line detail, if applicable); Line item procedure codes, including modifiers; Member ID and medical coverage group identifier; Billing, performing, referring, and attending provider Ids and corresponding provider types; All error codes associated with service line detail, if applicable; Billed, allowed, and paid amounts; TPL and Member liability amounts, if any; Prior Authorization number; Procedure, drug, or other service codes; Place of service; Date of service, date of entry, date of adjudication, date of payment, date of adjustment, if applicable.
3. Maintain non-claim-specific financial transactions as a logical component of Claims history.
4. Provide access to the adjudicated and Claims in process, showing service line detail and the edit/audits applied to the Claim.
5. Maintain accurate inventory control status on all Claims.
Processing Requirements. The Claims Pricing function for the Fee for Service contracts the vendor has with providers of the MIS must have the capabilities to:
1. Calculate payment amounts according to the fee schedules, per diems, rates, formulas, and rules established by the Contractor.
2. Maintain access to pricing and reimbursement methodologies to appropriately price claims at the Contractor’s allowable amount.
3. Maintain flexibility to accommodate future changes and expanded implementation of co pays.
4. Deduct Member liability amounts from payment amounts as defined by the Department.
5. Deduct TPL amounts from payments amounts.
6. Provide adjustment processing capabilities.
Processing Requirements. On the effective date, the Company will process Purchase Payments and requested transfers or withdrawals received in the Home Office in good order. Good order means complete and accurate instructions are provided by the Owner in accordance with the Company’s then current procedures. The Company also reserves the right to require a Contract Owner or other persons providing a signature in connection with a disbursement of proceeds or a change in ownership or beneficial rights under this Contract to provide a signature guarantee, unless expressly prohibited by applicable law, whenever required by the Company’s then-effective procedures.
Processing Requirements. The Provider Data Maintenance function must have the capabilities to:
1. Transmit a provider enrollment file to the Department in a specified format;
2. Maintain current and historical provider enrollment applications from receipt to final disposition (approval only);
3. Maintain on-line access to all current and historical provider information, including Provider rates and effective dates, Provider program and status codes, and summary payment data;
4. Maintain on-line access to Provider information with inquiry by Provider name, partial name characters, provider number, NPI, SSN, FEIN, CLIA number, Provider type and specialty, County, Zip Code, and electronic billing status;
5. Edit all update data for presence, format, and consistency with other data in the update transaction;
6. Edits to prevent duplicate Provider enrollment during an update transaction;
7. Accept and maintain the National Provider Identification (NPI);
8. Provide a Geographic Information System (GIS) to identify Member populations, service utilization, and corresponding Provider coverage to support the Provider recruitment, enrollment, and participation;
9. Maintain on-line audit trail of Provider names, Provider numbers (including old and new numbers, NPI), locations, and status changes by program;
10. Identify by Provider any applicable type code, NPI/TAXONOMY code, location code, practice type code, category of service code, and medical specialty and sub-specialty code which is used in the Kentucky Medicaid program, and which affects Provider billing, claim pricing, or other processing activities;
11. Maintain effective dates for Provider membership, Enrollment status, restriction and on-review data, certification(s), specialty, sub-specialty, claim types, and other user-specified Provider status codes and indicators;
12. Accept group provider numbers, and relate individual Providers to their groups, as well as a group to its individual member Providers, with effective date ranges/spans. A single group provider record must be able to identify an unlimited number of individuals who are associated with the group;
13. Maintain multiple, provider-specific reimbursement rates, including, but not necessarily limited to, per diems, case mix, rates based on licensed levels of care, specific provider agreements, volume purchase contracts, and capitation, with beginning and ending effective dates for a minimum of sixty (60) months.
14. Maintain provider-specific rates by program, type of cap...
Processing Requirements. The MIS must perform three types of financial processing: 1) payment processing; 2) adjustment processing;
Processing Requirements. 2.1. MaintainX acknowledges and agrees that, for purposes of this DPA, Customer is the sole owner of all Customer Personal Data and only Customer (including on behalf of its end clients, where applicable) shall have the right to direct MaintainX in connection with MaintainX’s Pro- cessing of the Customer Personal Data.
2.2. MaintainX represents and warrants, with respect to all Customer Personal Data that it Processes on behalf of Customer, that at all times, unless otherwise expressly permitted under the Agreement:
(a) it shall Process such Customer Personal Data only for the purposes of providing the Services and as may subsequently be agreed between the Parties in writing and, in so doing, shall act solely on the instructions of Customer;
(b) it shall not Process, apply, or use, the Customer Personal Data for any purpose other than as required and necessary to provide the Services; and
(c) it shall not create or maintain identifiable data derived from the Customer Per- xxxxx Data, except for the purposes of providing the Services. For the avoidance of doubt, nothing set forth herein shall prevent MaintainX from creating aggregate, non-identifiable data which is derived from the Customer Personal Data.
2.3. MaintainX shall have in place, and maintain, appropriate processes and any associated technical measures that will ensure that Customer’s reasonable and lawful instructions, as they relate to the Processing of Customer Personal Data, can be complied with.
2.4. MaintainX shall comply with Applicable Privacy Law, to the extent applicable to Main- tainX’s Processing of the Customer Personal Data.
2.5. MaintainX shall provide to Customer such co-operation, assistance and information as Customer may reasonably request to enable it to comply with its obligations under any Applicable Privacy Law and co-operate and comply with the directions or decisions of a relevant Privacy Authority, in each case within such reasonable time as would enable Customer to meet any time limit imposed by the Privacy Authority. MaintainX shall provide Customer with all reasonable assistance and information with respect to any notifications to, or registration with, Privacy Au- thorities as required by Applicable Privacy Law.
2.6. The Parties acknowledge and agree that MaintainX shall not be entitled to reimbursement of any costs which MaintainX may incur as a result of or in connection with complying with Cus- tomer’s instructions for the purposes of providing the Services and/or...
Processing Requirements. The Utilization/Quality Improvement function must include the following capabilities:
1. Maintain Provider credentialing and recredentialing activities.
2. Maintain Contractor’s processes to monitor and identify deviations in patterns of treatment from established standards or norms. Provide feedback information for monitoring progress toward goals, identifying optimal practices, and promoting continuous improvement.
3. Maintain development of cost and utilization data by Provider and services.
4. Provide aggregate performance and outcome measures using standardized quality indicators similar to Medicaid HEDIS as specified by the Department.
5. Support focused quality of care studies.
6. Support the management of referral/utilization control processes and procedures.
7. Monitor PCP referral patterns.
8. Support functions of reviewing access, use and coordination of services (i.e. actions of peer review and alert/flag for review and/or follow-up; laboratory, x-ray and other ancillary service utilization per visit).
9. Store and report Member satisfaction data through use of Member surveys, Grievance/Appeals processes, etc.
10. Provide Fraud, Waste and Abuse detection, monitoring and reporting.