Medi-Cal Point Of Service (POS) Network-Internet Agreement | Pdf Fpdf Doc Docx | California

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Medi-Cal Point Of Service (POS) Network-Internet Agreement | Pdf Fpdf Doc Docx | California

Last updated: 5/2/2022

Medi-Cal Point Of Service (POS) Network-Internet Agreement

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Description

MEDI-CAL POINT OF SERVICE (POS) NETWORK/INTERNET AGREEMENT This agreement is required for all providers and non-providers (provider representatives) who intend to use the Medi-Cal POS Network or Medi-Cal website applications at www.medi-cal.ca.gov. I. (a). The following is required only for enrolled Medi-Cal providers: The Department of Health Care Services (DHCS) will permit the use of the California POS Network and Medi-Cal website by the following Medi-Cal provider subject to the terms and conditions of this agreement. Provider Name: Provider Number/NPI: Owner Number: _______________________________ (If applicable) Tax ID: ________________________ (b). The following is required only if intending to use a device and/or software that is not obtained through Medi-Cal: Vendor/Developer Company Name: _________________________________________ CMC Submitter Number (if applicable): ___ ___ ___ Contact Person: _________________________________ Phone Number: (___ ___ ___) ___ ___ ___ ___ ___ ___ ___ (c). The following is required only for non-provider users [provider representatives] of the POS Network/Medi-Cal website: DHCS will permit the use of the Medi-Cal POS Network and/or Medi-Cal website by the authorized provider representative _____________________________________ (Representative) subject to the terms of this agreement. When applicable, please attach to this agreement a list of all provider numbers/NPIs and corresponding Tax Identification Numbers (TINs) for which the non-provider user is also the authorized representative. (d). Provider/Representative is requesting to delete access and usage of the POS Network and/or Medi-Cal website to the following provider representative _____________________________________ (Representative) subject to the terms of this agreement. When applicable, please attach to this agreement a list of all provider numbers/NPIs and corresponding TINs for deletion. II. Provider/Representative agrees to limit the usage of the POS Network and Medi-Cal website to the following Medi-Cal eligibility and claims-related transactions: A. Verification of Medi-Cal eligibility B. Share of Cost (Spend Down) clearance C. Medi-Service reservations D. Submission of Pharmacy claims (may only be performed by providers enrolled to submit claims on the Pharmacy/Medical Supplies Claim Form): applies to Medi-Cal website only E. Submission of ANSI ASC X12N 837 professional claims (may only be performed by providers enrolled to submit claims on the Medi-Cal Medical Services claim form): applies to Medi-Cal website only F. Submission of electronic Treatment Authorization Requests (i.e. eTAR and Pharmacy NCPDP) G. Submission of other transactions as may be subsequently permitted by DHCS and as documented in one or more of the user manuals in the Publications area of the Medi-Cal website H. Browsing of Medi-Cal website Provider/Representative acknowledges that failure to limit the usage of the POS Network and/or Medi-Cal website to the transactions described above may, at a minimum, result in DHCS revoking the privilege to use the POS Network and/or Medi-Cal website. Provider/Representative acknowledges abuse of transactions available on the Medi-Cal website may result in DHCS revoking provider access to Medi-Cal website. 1 ­ point PROPubs 1/17 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com III. The Provider/Representative agrees that the following constitutes the only authorized methods of accessing the POS Network: A. Medi-Cal-provided toll-free (800) line or 916-prefix phone line as documented in the POS Device User Guide B. Provider- or Representative-provided leased phone lines IV. Any computer accessing the Medi-Cal website is required to abide by all applicable State and Federal laws enacted today or in the future. V. The Provider/Representative agrees to the following security requirements. All computers that access Medi-Cal data must meet the following requirements, in addition to any State and Federal required administrative, technical, physical, and organizational safeguards: A. Antivirus software. All workstations, laptops and other systems that access the Medi-Cal website or process and/or store Medi-Cal Protected Health Information (PHI) must install and actively use comprehensive anti-virus software solution with automatic updates scheduled at least daily. B. Patch Management. All workstations, laptops and other systems that access the Medi-Cal Web site or process and/or store Medi-Cal PHI must have critical security patches applied, with system reboot if necessary. There must be a documented patch management process, which determines installation timeframe based on risk assessment and vendor recommendations. At a maximum, all applicable patches must be installed within 30 days of vendor release. C. System Timeout. The systems that access the Medi-Cal website or process and/or store Medi-Cal PHI must provide an automatic timeout, requiring re-authentication of the user session. It is recommended that the automatic timeout be after no more than 20 minutes of inactivity. D. User Name and Password Controls. Systems that access the Medi-Cal website or process and/or store Medi-Cal PHI should be accessed using a unique user name and password combination. The user name must be promptly disabled, deleted, or the password changed upon the transfer or termination of an employee with knowledge of the password. Passwords are not to be shared. Passwords must be: (1) At least eight characters, (2) A non-dictionary word, (3) Not be stored in readable format on the computer, (4) Be changed every 90 days, preferably 60 days, (5) Be changed if revealed or compromised, and (6) Be composed of characters from at least three of the following four groups from the standard keyboard: · Upper case letters (A-Z) · Lower case letters (a-z) · Arabic numerals (0-9) · Non-alphanumeric characters (punctuation symbols) E. Workstation/Laptop encryption. All workstations and laptops that access the Medi-Cal website or process and/or store Medi-Cal PHI are recommended to be encrypted using a FIPS 140-2 certified algorithm, which is 128-bit or higher, such as Advanced Encryption Standard (AES); full disk encryption is recommended. VI. The Provider/Representative agrees to pay the following fees associated with the use of the POS Network: A. For eligibility transactions, including Share of Cost clearance and Medi-Service reservations submitted through Medi-Cal-provided phone lines, there will

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