DATA DICTIONARY
Provider Network Data System (PNDS)
VERSION 9 (May 2019)
- Dictionary is also available in Portable Document Format (PDF)
DATA DICTIONARY CONTENTS
Provider Network Data System
Table of Contents
- GENERAL INFORMATION
- PHYSICIAN AND OTHER PROVIDERS DETAILED RECORD FORMAT
- ANCILLARY/SERVICE CENTERS DETAILED RECORD FORMAT
- PHYSICIAN AND OTHER PROVIDERS ELEMENT DESCRIPTIONS
- ANCILLARY/SERVICE CENTERS ELEMENT DESCRIPTIONS
- CODES
- ATTESTATION
- PROVIDER & ANCILLARY FILE ERROR CODES
- CODING SCHEME SUMMARY REPORTS
Provider Network Data System
I. GENERAL INFORMATION
A. About the Provider Network Data System
The Provider Network Data System (PNDS) was implemented by the New York State Department of Health (NYS DOH) in December of 1996 to gather information about the provider and service networks contracted to Health Insurers operating in New York State. The NYS DOH is collecting data through a new submission portal at http://www.pnds.health.ny.gov/. Health Insurers electronically submit provider network data quarterly for the following lines of business: Medicaid; Child Health Plus; Fully Integrated Dual Advantage (FIDA); FIDA–I/DD; Specialized I/DD Plans (SIP); HIV Special Needs Plans (SNP); Managed Long Term Care Plans; Health and Recovery Plan(s) (HARP); New York State of Health (NYSOH) Qualified Health Plan(s) (QHPs); Essential Plan(s) (EPs); and Commercial networks outside of the NYSOH.
B. Purpose
The primary purpose for the PNDS is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Health Insurers in New York State.
C. Uses of PNDS Data
Provider eligibility assessment
PNDS data is compared to information on professional licensing, Office of Professional Medical Care sanctions, and Medicaid and Medicare provider eligibility, to assure that only qualified providers are delivering health care to plan members. Facilities are checked for valid operating certificate numbers and that operating certificate numbers match the type of facility indicated.
Comprehensive services assessment
The Department of Health conducts network assessments to assure that comprehensive health services are available as required under Section 4403 of the Public Health Law. The Office of Health Insurance Programs, Bureau of Managed Care Certification and Surveillance, and the NYSOH uses data from the PNDS to assess whether Insurers have contracted with an appropriate range of primary care practitioners, clinical specialists and service facilities (hospitals, labs, etc.) within the Insurer´s service area. Evaluations are completed on insurers serving the above listed lines of business.
Access and travel assessment
Managed care plans networks serving Medicaid recipients are evaluated against established access and travel standards using PNDS data.
NYS Provider & Health Plan Look–Up
The PNDS will be used to feed a public provider lookup tool on the NYS DOH website, allowing consumers to anonymously search multiple providers and find participating health plans, or search by county, by specialty, by language, and more.
Capacity analysis
PNDS data is used to calculate the potential capacity of a managed care plan´s primary care providers. The calculation estimates the number of full time equivalent primary care providers and assumes that each FTE can serve up to 1,500 Medicaid members.
County network review
PNDS data is provided to county Departments of Social Services for use in local network reviews.
D. Connection to the Provider Network Data System (PNDS)
Connection to the PNDS is through a secure connection at http://www.pnds.health.ny.gov/. All users must have an account and access to the PNDS page. To obtain access to the PNDS for new insurers, please send an email request to pnds@health.ny.gov or call (518) 486–1949. After the account is created, the DOH will notify the insurers about the accounts. DOH will reach out to each organization to establish a coordinator, who will then be able to create user accounts for submissions.
E. Data Submission Schedule
Provider network data is collected as network changes occur. PNDS submission frequency matches the requirements outlined in Insurance Law §§ 3217–a(a)(17), 4324(a)(17) and Public Health Law § 4408(r), and 10 NYCRR 98–1.16(j). A health plan must update their online directory, as well as their PNDS submission within 15 days of becoming aware of the addition or termination of a provider from its network, or a change in a physician´s hospital affiliation. This requirement ensures that the network information displayed on the NYS Provider & Health Plan Look–Up matches each health plan´s online directory. The Department of Health and the Department of Financial Services understand that health plans may be relying on physicians to report changes in physician hospital affiliations and the Department will take that into account with respect to this requirement.
PNDS data can be submitted at any time, and must be submitted at least quarterly, regardless of network changes. Once per quarter, the submitted network will be reviewed for adequacy. Only the most recent successful network submission will be reviewed for adequacy purposes. The due dates for quarterly network submissions are posted on the PNDS portal and are updated on an annual basis. Issuers will be notified via e– mail by each program when their deficiency reports are ready for review.
Health plans with multiple products should report all programs in a single file except HIV/SNP which must be reported separately.
As of August 1st, 2017, fixed width files are no longer supported as a format for submission in the PNDS.
|top of section| |top of page|Provider Network Data System
II. PHYSICIAN AND OTHER PROVIDERS DETAILED RECORD FORMAT
PHYSICIAN AND OTHER PROVIDERS DETAILED RECORD FORMAT
KEY TO WHO SUBMITS?
ALL REC = All Records for all payers
ALL PCPs = All PCPs
ALL Physician REC = all with type 01=MD or type 12=DO
ALL MED & SNP REC = All Medicaid and HIV SNP Records
KEY TO FORMAT
A = Alpha format only
N = Numeric format only
A/N = Alpha Numeric
Description/ Field Name |
Field Size |
Format | Who Submits? |
Critical? | Comment | Page# |
---|---|---|---|---|---|---|
IDENTIFICATION | ||||||
Last Name | 25 | A | ALL REC | YES | 30 | |
First Name | 15 | A | ALL REC | YES | 31 | |
National Provider Identifier (NPI) | 10 | A/N | ALL REC | YES | 10 digits only | 32 |
License Number | 6 | A/N | ALL REC | YES | Valid NYS License # zero–fill to the left | 34 |
Medicaid Provider Identification / MEDS ID | 8 | A/N | ALL MED, HARP, CHP & SNP REC | YES | Provider Identification. See edit application | 35 |
Managed Care Plans ID | 20 | A/N | Optional | NO | Unique Provider Identification for your Managed Care Plan | 36 |
LOCATION | ||||||
Site Name | 50 | A/N | ALL REC | YES | Office or Professional Building | 37 |
Room or Suite | 20 | A/N | ALL REC | YES | If Not Applicable enter "NA" | 38 |
Street Address | 49 | A/N | ALL REC | YES | 39 | |
Town/City | 30 | A/N | ALL REC | YES | 40 | |
State | 2 | A/N | ALL REC | YES | 41 | |
Borough/Cnty Code | 3 | A/N | ALL REC | YES | FIPS codes right justified and zero–fill | 42 |
Zip Code | 5 | A/N | ALL REC | YES | 43 | |
Zip Plus Four | 4 | A/N | ALL REC | NO | 44 | |
Wheel Chair Accessibility | 1 | A/N | ALL REC | YES | 0=No | 45 |
1=Yes | ||||||
PRACTICE | ||||||
Primary Designation | 1 | A/N | ALL REC | YES | 1=PCP | 46 |
2=Specialist | ||||||
3=PCP and Specialist | ||||||
Provider Type | 2 | A/N | ALL REC | YES | 01=MD | 50 |
02=CNP Nurse Practitioner | ||||||
03=CNM | ||||||
04=LSW | ||||||
05=Clinical Psych | ||||||
06=OD Optometrist | ||||||
08=DDS | ||||||
09=DPM Podiatrist | ||||||
10=Chiropractor | ||||||
11=Other | ||||||
12=DO | ||||||
14=Psychologist | ||||||
15=Counselor | ||||||
16=Social Work | ||||||
18=DMD | ||||||
19=OMS | ||||||
20=Acupuncturist | ||||||
22=RN | ||||||
23=Physician Assistant (PA) | ||||||
30=Audiologist | ||||||
40=CDN Dietician/Nutritionist | ||||||
50=CM (not a nurse) | ||||||
60=PT | ||||||
61=OT | ||||||
62=SLP | ||||||
63=CFY | ||||||
64=RT | ||||||
71= Licensed Behavior Analyst | ||||||
78= Certified Behavior Analyst Assistant | ||||||
Primary Specialty | 3 | A/N | ALL REC | YES | See Appendix | 52 |
Secondary Specialty | 3 | A/N | ALL REC | NO | See Appendix | 53 |
Board Status – Primary Specialty | 1 | A/N | ALL Physician REC | YES | 1=Not Board Cert; Residency Incomplete | 54 |
2=Not Board Certified; Residency Complete | ||||||
3=Board Certified | ||||||
4=No Board Cert Avail | ||||||
9=Not Applicable | ||||||
Board Status – Secondary Specialty | 1 | A/N | ALL Physician REC | NO | 1=Not Board Cert; Residency Incomplete | 56 |
2=Not Board Certified; Residency Complete. | ||||||
3=Board Certified | ||||||
4=No Board Cert Avail | ||||||
9=Not Applicable | ||||||
Residents Attending Physicians License Number | 6 | A/N | All Resident PCPs | YES | NYS Valid License Number Zero–fill to the left; non– residents should 0 fill | 58 |
Residency Status – Primary Specialty | 1 | A/N | ALL Physician REC | YES PCP ONLY | 1=PGY1 | 59 |
2=PGY2 | ||||||
3=PGY3 | ||||||
4=PGY4 – 8+ | ||||||
9=Not Applicable (for non–current residents, i.e., physicians who have completed residency, etc.) | ||||||
Residency Status – Secondary Specialty | 1 | A/N | ALL Physician REC | NO | 1=PGY1 | 61 |
2=PGY2 | ||||||
3=PGY3 | ||||||
4=PGY4 – 8+ | ||||||
9=Not Applicable (for non– current residents, i.e., physicians who have completed residency, etc.) | ||||||
Provider´s Gender | 1 | A/N | ALL REC | YES | 1=Male | 63 |
2=Female | ||||||
Physician Extenders | 5 | N | ALL PCPs | YES | *For PCPs only* | 64 |
Total #FTEs: PA/NP | ||||||
99.99=Not Applicable | ||||||
(for non–PCPs or NPs acting as PCPs) | ||||||
Commercial Provider Indicator | 1 | A/N | ALL REC | YES | 0=No | 65 |
1=Yes | ||||||
Medicaid Provider Indicator | 1 | A/N | ALL REC | YES | 0=No | 66 |
1=Yes | ||||||
Medicare Provider Indicator | 1 | A/N | ALL REC | YES | 0=No | 67 |
1=Yes | ||||||
Child Health Plus (CHP) Provider Indicator | 1 | A/N | ALL REC | YES | 0=No | 68 |
1=Yes | ||||||
HARP Indicator | 1 | A/N | ALL REC | YES | 0=No | 69 |
1=Yes | ||||||
Medicaid Advantage Indicator | 1 | A/N | ALL REC | YES | 0=No | 70 |
1=Yes | ||||||
Partial CAPS Indicator | 1 | A/N | ALL REC | YES | 0=No | 71 |
1=Yes | ||||||
MAP Indicator | 1 | A/N | ALL REC | YES | 0=No | 72 |
1=Yes | ||||||
PACE Indicator | 1 | A/N | ALL REC | YES | 0=No | 73 |
1=Yes | ||||||
FIDA Indicator | 1 | A/N | ALL REC | YES | 0=No | 74 |
1=Yes | ||||||
NYSOH Standard Essential Plan (EP) Indicator | 1 | A/N | ALL REC | YES | 0=No | 75 |
1=Yes | ||||||
NYSOH EP Plus Adult Vision/Dental Indicator | 1 | A/N | ALL REC | YES | 0=No | 76 |
1=Yes | ||||||
Commercial Non–MCO Medical Indicator 1 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Vision Indicator 1 | 1 | A/N | ALL REC | YES | 0=No | 78 |
1=Yes | ||||||
Commercial Non–MCO Dental Indicator 1 | 1 | A/N | ALL REC | YES | 0=No | 79 |
1=Yes | ||||||
Commercial Panel Status | 1 | A/N | ALL COMM. PCPs | YES | 1=Open to all new and existing | 80 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
Medicaid Panel Status | 1 | A/N | ALL MED & SNP PCPs, & OB/GYNs | YES | 1=Open to all new and existing | 81 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
Medicare Panel Status | 1 | A/N | ALL Medicare PCPs | YES | 1=Open to all new and existing | 82 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
CHP Panel Status | 1 | A/N | ALL CHP PCPs | YES | 1=Open to all new and existing | 83 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
Filler | 1 | A/N | ALL REC | YES | N/A | |
Medicaid Advantage Panel Status | 1 | A/N | ALL MA ADVAN PCPs | YES | 1=Open to all new and existing | 84 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
Partial CAPS Panel Status | 1 | A/N | YES | 1=Open to all new and existing | 85 | |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
MAP Panel Status | 1 | A/N | ALL MAP PCPs | YES | 1=Open to all new and existing | 86 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
PACE Panel Status | 1 | A/N | ALL PACE PCPs | YES | 1=Open to all new and existing | 87 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
FIDA Panel Status | 1 | A/N | ALL FIDA PCPs | YES | 1=Open to all new and existing | 88 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSOH Standard Essential Plan (EP) Indicator (EP) Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 89 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSOH EP Plus Adult Vision/Dental Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 90 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
Filler | 1 | A/N | ALL REC | YES | Space–filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space–filled | N/A |
Filler | 3 | N | ALL REC | YES | Space–filled | N/A |
Commercial Panel Size | 4 | N | ALL COMM. PCPs | YES | Total Covered commercial members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 91 |
Medicaid Panel Size | 4 | N | ALL MED & SNP REC | YES | Total Covered Medicaid members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 92 |
Medicare Panel Size | 4 | N | ALL Medicare PCPs | YES | Total Covered Medicare members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 93 |
CHP Panel Size | 4 | N | ALL CHP PCPs | YES | Total Covered CHP members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 94 |
Filler | 4 | N | ALL REC | YES | Space–filled | N/A |
Medicaid Advantage Panel Size | 4 | N | ALL MA Advan. PCPs | YES | Total Covered Medicaid Advantage members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 95 |
Partial CAPS Panel Size | 4 | N | ALL Partial CAPS PCPs | YES | Total Covered Partial CAPS members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 96 |
MAP Panel Size | 4 | N | ALL MAP PCPs | YES | Total Covered MAP members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 97 |
PACE Panel Size | 4 | N | ALL PACE PCPs | YES | Total Covered PACE members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 98 |
FIDA Panel Size | 4 | A/N | ALL FIDA PCPs | YES | Total Covered FIDA members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 99 |
NYSOH Standard Essential Plan (EP) Panel Size | 4 | A/N | ALL NYSOH Standard EP PCP´s | YES | Total Covered Standard EP members assigned to this provider at your health plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 100 |
NYSOH EP Plus Adult Vision/Dental Panel Size | 4 | A/N | ALL NYSOH EP Plus Adult Vision/Dental PCP´s | YES | Total Covered EP plus Adult Vision & Dental members assigned to this provider at your health plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 101 |
Fax Area Code | A/N–3 | A/N | Optional | NO | 102 | |
Fax Number | A/N–7 | A/N | Optional | NO | Do not include hyphens | 103 |
Filler | 12 | N | ALL REC | YES | Space–filled | N/A |
Hospital Affiliation (HA) Operating Certificate (OPCERT) #1 | 8 | A/N | ALL PCPs & OB/GYNs Optional for the others | YES | See Operating Facility codes 99999999=Not Applicable (for non–PCP, non–OB/GYN) | 104 |
HA Permanent Facility Identifier (PFI) #1 | 6 | A/N | ALL PCPs & OB/GYNs Optional for the others | YES | Corresponds to HA OPCERT #1 | 105 |
Hospital Affiliation (HA) Operating Certificate (OPCERT) #2 | 8 | A/N | ALL PCPs & OB/GYNs Optional for the others | NO | See Operating Facility codes 99999999=Not Applicable (for non–PCP, non–OB/GYN) | 104 |
HA Permanent Facility Identifier (PFI) #2 | 6 | A/N | ALL PCPs & OB/GYNs Optional for the others | NO | Corresponds to HA OPCERT #2 | 105 |
Hospital Affiliation (HA) Operating Certificate (OPCERT) #3 | 8 | A/N | ALL PCPs & OB/GYNs Optional for the others | NO | See Operating Facility codes 99999999=Not Applicable (for non–PCP) | 104 |
HA Permanent Facility Identifier (PFI) #3 | 6 | A/N | ALL PCPs & OB/GYNs Optional for the others | NO | Corresponds to HA OPCERT #3 | 105 |
Provider Location Facility Operating Number | 8 | A/N | ALL PCPs | NO | 106 | |
Provider Location Permanent Facility Identifier (PFI) | 6 | A/N | ALL PCPs | NO | For PCPs only See Operating Facility Codes | 107 |
OFFICE HOURS | ||||||
Total Office Hours | 3 | A/N | MED & SNP PCPs Only | YES | Enter the average hours worked per week during the submission period. Non– PCPs zero–fill | 108 |
After Hours Indicator | 1 | A/N | MED & SNP REC PCPs Only | YES | 0=No | 109 |
1=Yes | ||||||
9=Not Applicable | ||||||
LANGUAGES | ||||||
Language 1 | 3 | A/N | MED & SNP PCPs Only | YES | See Appendix VI | 110 |
Language 2 | 3 | A/N | MED & SNP PCPs Only | YES | See Appendix VI | 110 |
Language 3 | 3 | A/N | MED & SNP PCPs Only | YES | See Appendix VI | 110 |
Language 4 | 3 | A/N | MED & SNP PCPs Only | YES | See Appendix VI | 110 |
Language 5 | 3 | A/N | MED & SNP PCPs Only | YES | See Appendix VI | 110 |
Language 6 | 3 | A/N | MED & SNP PCPs Only | YES | See Appendix VI | 110 |
Language 7 | 3 | A/N | MED & SNP PCPs Only | YES | See Appendix VI | 110 |
CONTACT INFO | ||||||
Area Code | 3 | A/N | ALL REC | YES | 111 | |
Phone Number | 7 | A/N | ALL REC | YES | Do not include hyphen | 112 |
Provider Email Address | 40 | A/N | ALL REC | YES | Enter valid email address | 113 |
Federal Employer Identification Number (FEIN) | 9 | A/N | ALL REC | YES | 9 digits. Do not include hyphen | 114 |
EXCHANGE PRACTICE | ||||||
NYSoH Medical Network Indicator 1 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Medical Network Indicator 2 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Medical Network Indicator 3 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Medical Network Indicator 4 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Medical Network Indicator 5 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Medical Network Indicator 6 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Medical Network Indicator 7 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Medical Network Indicator 8 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Medical Network Indicator 9 | 1 | A/N | ALL REC | YES | 0=No | 115 |
1=Yes | ||||||
NYSoH Dental Network Indicator 1 | 1 | A/N | ALL REC | YES | 0=No | 116 |
1=Yes | ||||||
NYSoH Dental Network Indicator 2 | 1 | A/N | ALL REC | YES | 0=No | 116 |
1=Yes | ||||||
NYSoH Dental Network Indicator 3 | 1 | A/N | ALL REC | YES | 0=No | 116 |
1=Yes | ||||||
NYSoH Dental Network Indicator 4 | 1 | A/N | ALL REC | YES | 0=No | 116 |
1=Yes | ||||||
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Commercial Non–MCO Medical Indicator 2 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Medical Indicator 3 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Medical Indicator 4 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Medical Indicator 5 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Medical Indicator 6 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Medical Indicator 7 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Medical Indicator 8 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Vision Indicator 2 | 1 | A/N | ALL REC | YES | 0=No | 77 |
1=Yes | ||||||
Commercial Non–MCO Vision Indicator 3 | 1 | ALL REC | YES | 0=No | 78 | |
1=Yes | ||||||
Commercial Non–MCO Vision Indicator 4 | 1 | A/N | ALL REC | YES | 0=No | 78 |
1=Yes | ||||||
Commercial Non–MCO Vision Indicator 5 | 1 | ALL REC | YES | 0=No | 78 | |
1=Yes | ||||||
Commercial Non–MCO Vision Indicator 6 | 1 | A/N | ALL REC | YES | 0=No | 78 |
1=Yes | ||||||
Commercial Non–MCO Dental Indicator 2 | 1 | ALL REC | YES | 0=No | 79 | |
1=Yes | ||||||
Commercial Non–MCO Dental Indicator 3 | 1 | A/N | ALL REC | YES | 0=No | 79 |
1=Yes | ||||||
Commercial Non–MCO Dental Indicator 4 | 1 | ALL REC | YES | 0=No | 79 | |
1=Yes | ||||||
Commercial Non–MCO Dental Indicator 5 | 1 | A/N | ALL REC | YES | 0=No | 79 |
1=Yes | ||||||
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
NYSoH Medical Network 1 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSoH Medical Network 2 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSoH Medical Network 3 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSoH Medical Network 4 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSoH Medical Network 5 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSoH Medical Network 6 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSoH Medical Network 7 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSoH Medical Network 8 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
NYSoH Medical Network 9 Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 117 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
NYSoH Medical Network 1 Panel Size | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
NYSoH Medical Network 2 Panel Size | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
NYSoH Medical Network 3 Panel Size | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
NYSoH Medical Network 4 Panel Size | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
NYSoH Medical Network 5 Panel Status | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
NYSoH Medical Network 6 Panel Status | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
NYSoH Medical Network 7 Panel Status | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
NYSoH Medical Network 8 Panel Status | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
NYSoH Medical Network 9 Panel Status | 4 | A/N | ALL NYSoH QHP PCPs | YES | Total Covered NYSoH Medical QHP Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 118 |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
Filler | 1 | N | ALL REC | YES | Space filled | NA |
SIP–PL Indicator | 1 | A/N | ALL REC | YES | 0=No | 119 |
1=Yes | ||||||
SIP–PL Panel Status | 1 | A/N | ALL SIP_PL PCPs | YES | 1=Open to all new and existing | 120 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
SIP–PL Panel Status | 4 | N | ALL SIP_PL PCPs | YES | Total Covered SIP–PL Product members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 121 |
FIDA IDD Indicator | 1 | A/N | ALL REC | YES | 0=No | 122 |
1=Yes | ||||||
FIDA IDD Panel Status | 1 | A/N | ALL FIDA IDD PCPs | YES | 1=Open to all new and existing | 123 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
FIDA IDD Panel Size | 4 | A/N | ALL FIDA IDD PCPs | YES | Total Covered FIDA IDD members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 124 |
HARP Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 125 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
HARP Panel Size | 4 | A/N | ALL HARP PCPs | YES | Total Covered HARP members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 126 |
HIV SNP Indicator | 1 | N | All REC | YES | 0=No | 127 |
1=Yes | ||||||
HIV SNP Panel Status | 1 | A/N | ALL REC | YES | 1=Open to all new and existing | 128 |
2=Open to existing only | ||||||
3=Closed | ||||||
9=NA (for non–PCPs) | ||||||
HIV SNP Panel Size | 4 | A/N | ALL HIV SNP PCPs | YES | Total Covered HIV SNP members assigned to this provider at your managed care plan. Zero–fill to the left, 9999=Not Applicable (for non–PCPs) | 129 |
Site National Provider Identifier (NPI) | 10 | A/N | ALL REC | YES | 10 digits only. If NA then enter 9999999999 | 130 |
Provider Network Data System
III. ANCILLARY/SERVICE CENTERS DETAILED RECORD FORMAT
III. ANCILLARY/SERVICE CENTERS DETAILED RECORD FORMAT
KEY TO WHO SUBMITS
ALL REC=All Records
ALL Hosp and Clinics = All Hospitals ((Designated Service 011) and (Designated Service 321, Article 28 Clinic))
KEY TO FORMAT
A = Alpha format only
N = Numeric format only Clinics
A/N = Alpha Numeric
(Numbers in text format)
Description/ Field Name |
Field Size |
Format | Who Submits? |
Critical? | Comment | Page# |
---|---|---|---|---|---|---|
LOCATION | ||||||
Site Name | 50 | A/N | ALL REC | YES | Office or professional building | 132 |
Room or Suite Number | 20 | A/N | ALL REC | YES | If Not Applicable enter "NA" | 133 |
Street Address | 49 | A/N | ALL REC | YES | 134 | |
Town/City | 30 | A/N | ALL REC | YES | 135 | |
State | 2 | A/N | ALL REC | YES | 136 | |
Borough/County | 3 | A/N | ALL REC | YES | 137 | |
Zip Code | 5 | A/N | ALL REC | YES | 138 | |
Zip Plus Four | 4 | A/N | ALL REC | YES | 139 | |
SERVICE | ||||||
Designated Service | 3 | A/N | ALL REC | YES | See attached codes | 140 |
Number of Providers at Service Center | 5 | N | ALL REC | NO | 141 | |
National Provider Identifier (NPI) | 10 | A/N | ALL REC | YES | 10 digits only | 142 |
License Number/Facility Operating Cert. | 8 | A/N | ALL REC | YES | If Applicable to Service Provider | 143 |
Permanent Facility Identifier | 6 | A/N | ALL REC | YES | If Applicable to Service Provider | 145 |
Medicaid Provider Identification Number | 8 | A/N | ALL MED, HARP, CHP & SNP REC | YES | Provider Identification | 147 |
Managed Care Plan´s Facility ID | 20 | A/N | ALL REC | NO | Unique Provider Identification | 148 |
Commercial Provider Indicator | 1 | A/N | ALL REC | YES | 149 | |
Medicaid Provider Indicator | 1 | A/N | ALL REC | YES | 150 | |
Medicare Provider Indicator | 1 | A/N | ALL REC | YES | 151 | |
Child Health Plus Indicator | 1 | A/N | ALL REC | YES | 152 | |
HARP Indicator | 1 | A/N | ALL REC | YES | 153 | |
Medicaid Advantage Indicator | 1 | A/N | ALL REC | YES | 154 | |
Partial CAPS Indicator | 1 | A/N | ALL REC | YES | 155 | |
MAP Indicator | 1 | A/N | ALL REC | YES | 156 | |
PACE Indicator | 1 | A/N | ALL REC | YES | 157 | |
FIDA Indicator | 1 | A/N | ALL REC | YES | 158 | |
NYSoH Standard Essential Health Plan (EP) Indicator | 1 | A/N | ALL REC | YES | 159 | |
NYSoH EP Plus Adult Vision/Dental Indicator | 1 | A/N | ALL REC | YES | 160 | |
Commercial Non–MCO Medical Indicator 1 | 1 | A/N | ALL REC | YES | 0=No | 161 |
1=Yes | ||||||
Filler | 1 | A/N | ALL REC | YES | N/A | |
PHONE | ||||||
Area Code | 3 | A/N | ALL REC | YES | 162 | |
Phone Number | 7 | A/N | ALL REC | YES | Do not include hyphen | 163 |
ADDITIONAL SERVICES | ||||||
Service 1 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 2 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 3 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 4 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 5 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 6 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 7 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 8 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 9 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 10 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 11 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 12 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 13 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 14 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 15 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 16 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 17 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 18 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 19 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 20 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 21 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 22 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 23 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 24 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
Service 25 | 3 | A/N | All Hosp & Clinics | YES | See Appendix | 164 |
EXCHANGE SERVICE | ||||||
NYSoH Medical Network Indicator 1 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
NYSoH Medical Network Indicator 2 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
NYSoH Medical Network Indicator 3 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
NYSoH Medical Network Indicator 4 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
NYSoH Medical Network Indicator 5 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
NYSoH Medical Network Indicator 6 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
NYSoH Medical Network Indicator 7 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
NYSoH Medical Network Indicator 8 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
NYSoH Medical Network Indicator 9 | 1 | A/N | ALL REC | YES | 0=No | 166 |
1=Yes | ||||||
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Commercial Non–MCO Medical Indicator 2 | 1 | A/N | ALL REC | YES | 0=No 1=Yes | 161 |
Commercial Non–MCO | 1 | A/N | ALL REC | YES | 0=No | 161 |
Medical Indicator 3 | 1=Yes | |||||
Commercial Non–MCO | 1 | A/N | ALL REC | YES | 0=No | 161 |
Medical Indicator 4 | 1=Yes | |||||
Commercial Non–MCO | 1 | A/N | ALL REC | YES | 0=No | 161 |
Medical Indicator 5 | 1=Yes | |||||
Commercial Non–MCO | 1 | A/N | ALL REC | YES | 0=No | 161 |
Medical Indicator 6 | 1=Yes | |||||
Commercial Non–MCO | 1 | A/N | ALL REC | YES | 0=No | 161 |
Medical Indicator 7 | 1=Yes | |||||
Commercial Non–MCO | 1 | A/N | ALL REC | YES | 0=No | 161 |
Medical Indicator 8 | 1=Yes | |||||
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
Filler | 1 | A/N | ALL REC | YES | Space filled | N/A |
SIP–PL Indicator | 1 | A/N | ALL REC | YES | 0=No | 167 |
1=Yes | ||||||
FIDA IDD Indicator | 1 | A/N | ALL REC | YES | 0=No | 168 |
1=Yes | ||||||
HIV SNP Indicator | 1 | N | All REC | YES | 0=No | 169 |
1=Yes | ||||||
Servicing County Code 1 | 3 | N | ALL REC | YES | If NA then enter 999 | 170 |
Servicing County Code 2 | 3 | N | ALL REC | YES | If NA then enter 999 | 170 |
Servicing County Code 3 | 3 | N | ALL REC | YES | If NA then enter 999 | 170 |
Servicing County Code 4 | 3 | N | ALL REC | YES | If NA then enter 999 | 170 |
Servicing County Code 5 | 3 | N | ALL REC | YES | If NA then enter 999 | 170 |
OASAS PRU | 10 | A/N | All REC | YES | If NA then leave blank | 172 |
OASAS Provider Number | 10 | A/N | All REC | YES | If NA then leave blank | 174 |
OMH ID | 10 | A/N | All REC | YES | If NA then leave blank | 176 |
Provider Network Data System
IV. PHYSICIAN AND OTHER PROVIDERS ELEMENT DESCRIPTIONS
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Last Name Required For: Identification
Format – Length: A–25 Layout Field Location: A
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The last name of an individual provider contracted with the health plan to provide services to enrollees.
Edit Applications:
- Last name is a critical data element. An entry for last name must be on the record in order for the record to be accepted.
- Must be left justified.
Example:
- Dr. Allan Smith is a Pediatrician. The last name "Smith" should be entered in this field. There is no need for spacing.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Last Name Required For: Identification
Format – Length: A–15 Layout Field Location: B
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The first name of an individual provider contracted with the health plan to provide services to enrollees.
Edit Applications:
- The first name is a critical data element. An entry for first name must be on the record in order for the record to be accepted.
- If in the rare instance a provider does not have a first name, ‘NONAME’ should be entered in the first name data field.
- Must be left justified.
Example:
- Dr. Allan Smith is a Pediatrician. The first name "Allan" should be entered in this field. There is no need for spacing.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: National Provider Identifier (NPI) Required For: Identification
Format – Length: A/N–10 Layout Field Location: C
Version Number\Effective Date: 6.5 – Feb 2010
_____________________________________________________________________________________________
Definition:
The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The Federal Government mandated the use of only NPI for electronic healthcare transactions. The NPI number is issued under the direction of the Centers for Medicare & Medicaid Services (CMS). Unless exempt from NPI, all health plans must report the NPI of all their participating providers during the quarterly or annual Provider Network Data submission. For additional information on NPI, visit here.
Edit Applications:
- Must be a valid National Provider Identifier (NPI) number. The NPI is a 10–position numeric identifier (10–digit number).
- This is a critical data element. An entry must be made for every participating provider record for the record to be accepted. Do not leave blank.
- The NPI is validated for each record on the entire submission. If your submission’s NPI error percentage is higher than the allowable threshold of 5%, your entire submission will be rejected.
- For providers who have not received an NPI, please enter "9999999999". Do not leave blank.
- For providers exempt from NPI, you should enter "8888888888" and provide documentation of the exempt status. Do not leave blank.
- Site NPI will cause a hard error. Only submit an individual provider NPI in this field.
Example:
- Dr. Kehinde participates in Medicaid & HIV SNP and his NPI is 0987654321. Enter "0987654321" in this field.
- Dr. Betty participates in Commercial & Child Health Plus and her NPI is 1224445655. Enter "1224445655" in this field.
- Dr. Kathy participates in Medicaid, HIV SNP, Commercial & Child Health Plus but has not yet received an NPI. Enter "9999999999" in this field. Do not leave blank.
- Heather Rose, CNM participates in Medicaid, HIV SNP, Commercial & Child Health Plus but exempt from NPI. Enter "8888888888" in this field and provide documentation.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: License Number Required For: Identification
Format – Length: A/N–6 Layout Field Location: D
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The professional license number is issued by the NYS Department of Education. It is used to assure that the health care providers are licensed to practice. Non–New York State licensed providers may be submitted with ‘999999´ in the license number field.
Edit Applications:
- Must be a valid professional license number issued by the New York State Department of Education. There are ONLY numbers 0–9 in a valid license number. The number must be right justified.
- This is a critical data element. Do not leave blank.
- The license number is validated for each record on the entire submission. If more than the allowable threshold of the entire submission does not have a valid license number, the entire submission will be rejected.
- For non–licensed providers, including non–licensed Counselors (provider type = 15) and non–licensed Social Workers (provider type = 16), you should enter "888888" for license number.
Example:
- For a single record: A provider whose license number is "3619" should zero–fill to the left (right justify the number), thus "003619" should be entered. The license number for this individual will be validated for his/her profession (physician, nurse practitioner, dentist, etc.) using the first three digits of the last name.
- For the entire submission: If you submit 5,000 provider records and 4,900 have a valid license number, the entire submission will pass to the second phase of the edit process (i.e., each data element will be checked individually.) If only 4,895 records were valid (97.9%), the entire submission will fail and not proceed to the second phase of the edit process.
- If your managed care plan contracts with an individual provider, you are responsible for assuring that this provider is licensed to practice in New York State. If your managed care plan contracts with a service facility such as a clinic, nursing home, or home health care agency, you are not required to report the individual providers (who are paid employees of the facility) on the provider file. You may request that your contracted clinic or vendor supply them to you, but must submit the service facility name and required information in the ancillary/service file.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Medicaid Provider ID (MMIS) Required For: Identification
Format – Length: A/N–8 Layout Field Location: E
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 9.0 – May 2019
_____________________________________________________________________________________________
Definition:
The Medicaid Provider Identification number is an 8–digit number (MMIS ID) assigned to an individual or service facility, for identification purposes. The MMIS ID is assigned to an individual provider or service facility at the time of enrollment in the fee–for–service Medicaid Program (i.e., the provider has been approved to submit claims to the NYS Medicaid Program). Historically, an individual provider who did not participate in the fee–for–service Medicaid program, but who was a member of a managed care network serving Medicaid recipients would be assigned a MEDS ID, which was needed for the Medicaid Encounter Data System and was a non–billable Medicaid identifier. As of 2018, the 21st Century Cures Act requires all Medicaid Managed Care and Children's Health Insurance Program network providers to be enrolled with the State fee–for– service Medicaid program. In the PNDS, this data element is referring only to the MMIS assigned to an individual provider.
Edit Applications:
- MMIS Provider ID is a unique 8–digit number. The MMIS Provider ID is assigned to the individual provider. It must be a valid entry.
- This is a critical data element. Do not leave blank.
- The MMIS is validated for each record that contains a provider type 01, 02, 03, 05, 06, 08, 09, 10, 12, 14, 18, 19, 23, 30, 50, 60, 61, or 62 and contains one or more of the Medicaid product indicators.
- This validation edit is processed by comparing the submitted MMIS ID to Medicaid Provider Enrollment (reference data). If no match is found, a Part A error will occur. If a match is found, but the submitted NPI–MMIS combination does not match the reference data´s NPI–MMIS combination, a Part B error will occur.
- Fill in "99999999" for providers that are Commercial.
Example:
- A provider´s Medicaid Provider ID is "00085801". This number should be entered in this element. The Medicaid Provider ID is always 8 digits; zero padding optional.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Managed Care Plan Provider ID Required For: Identification
Format – Length: A/N–20 Layout Field Location: F
Version Number\Effective Date: 2.0 – Oct. 1997
_____________________________________________________________________________________________
Definition:
The Managed Care Plan (MCP) Provider ID number refers to the internal coding of the provider used by the managed care plan. This data element is for the purpose of matching to internal computer systems, used by managed care plans. If your managed care plan does not have an internal coding scheme, you DO NOT have to create one for this data element. This is an optional element requested by some managed care plans.
Edit Application:
- None. This is an optional data element for the use of individual managed care plans.
- You may leave this data element blank or zero–fill if you do not intend to use.
Example:
- Managed care plan XYZ has an internal identification process for their providers. Dr. White, an ophthalmologist, who started working for XYZ in March 1990 is coded as: "WH762932OP390". This code would be entered for Dr. White in the MCP´s Provider ID Number.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Provider´s Site Name Required For: Location
Format – Length: A–50 Layout Field Location: G
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The Provider´s Site Name is the office or professional building name of the location where the provider works. List each site separately.
Edit Applications:
- This is a critical data element. Do not leave blank.
- If the room or suite number does not fit in the appropriate record positions, additional information can be added to the site name field.
Example:
- Dr. Patrick Smith is located in the St. Luke´s Professional Building. Therefore, "St. Luke´s Professional Building" or some abbreviation of the building name should be given.
- Not all providers may have a site name. This data element is different from the "site name" data element on the service/ancillary data file. However, the site name on the provider file may be the same name as the contracted facility on the service center file if your plan is able to report the individual providers at the contracted facility on the provider file.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Room or Suite Number Required For: Location
Format – Length: A/N–20 Layout Field Location: H
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The room or suite number associated with the individual provider´s address. Most often the room or suite number coincides with the providers who are located in an office or professional building. List each location separately.
Edit Applications:
- This is a critical data element. Do not leave blank.
- Room or suite number is a critical data element (implemented Quarter 1, 2009). An entry for room or suite number must be on the record in order for the record to be accepted.
- Room or suite number information should never go in the street address field. If the room or suite number does not fit in the appropriate record positions, additional information can be added to the site name field.
- If Not Applicable enter "NA".
Example:
- Dr. Patrick Smith is located in Suite 610 of the St. Luke´s Professional Building. The entry for this data element would be "Suite 610" or "Room 610" (other location information could be entered: e.g., floor, wing, etc.).
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Street Address Required For: Location
Format – Length: A/N–49 Layout Field Location: I
Version Number\Effective Date: 9.0 – May 2019
_____________________________________________________________________________________________
Definition:
The street number and street name associated with the individual provider´s location. If the provider has more than one location, each location should be listed separately.
Edit Applications:
- This is a critical data element. Do not leave blank.
- Should never include room or suite number.
- Must be left justified.
- PO Box is not acceptable as a valid street address. Submitting a PO box in this field will result in a hard error.
Example:
- Dr. Josberger is located at 95–27 Western Blvd would be entered as "95–27 Western Boulevard".
- Dr. Miller is located at 329 West Seventh Street would be entered as "329 West 7th Street".
- Dr. Tanner is located at 1646 Third Street would be entered as "1646 3rd Street".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Town/City Required For: Location
Format – Length: A/N–30 Layout Field Location: J
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The name of the town or city associated with the office address of the provider; most often this is the town/city designation given by the U.S. Postal Service. When the town/city location of the office is not the same as the mailing address; use the mailing address. There should be one record for each provider location.
Edit Applications:
- This is a critical data element. Do not leave blank.
- Must be left justified.
Example:
- Dr. Smith´s office is located in North Greenbush, NY. His mailing address is Rensselaer, NY. Dr. Smith´s town/city should be entered as "Rensselaer".
- Dr. Baker´s office is located in New York City. This is located in the Bronx. The Post Office recognizes the Bronx as the town/city designation address. Enter "Bronx" for the Town/City.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: State Required For: Location
Format – Length: A/N–2 Layout Field Location: K
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
The name of the state in which the provider is located. These providers must be under contract to serve New York State residents.
Edit Applications:
- Must be a valid state code.
- Should be a valid U.S. Postal Service state code.
"NY" – New York
"PA" – Pennsylvania
"VT" – Vermont
"CT" – Connecticut
"NJ" – New Jersey - This is a critical data element. Do not leave blank.
Example:
- Dr. Smith has one office in New York and another office in Pennsylvania. There should be one record with the state of "NY" and another separate record for Dr. Smith that has his Pennsylvania address and the state as "PA".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Borough/County Code Required For: Location
Format – Length: A/N–3 Layout Field Location: L
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The federal government has identified a code for each county in the United States. The Federal Information Processing Standards (FIPS) code is a five–digit code for each county. We are using the last three digits of the FIPS code to distinguish the counties for the provider.
Edit Application:
- Must be a valid NYS county code (FIPS). This is a critical data element. Do not leave blank.
- Must be right justified. Zero padding is optional.
Example:
- Dr. Roohan´s office is located in Orange County. The FIPS code for Orange County is "071"; this code/number should be entered in the appropriate positions for the Borough/County Code.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Zip Code Required For: Location
Format – Length: A/N–5 Layout Field Location: M
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The zip code associated with the provider´s mailing address. The zip code is assigned by the United States Postal Service for the location of the provider´s office. There should be one record for each provider location.
Edit Applications:
- Must be a valid zip code.
- Must be right justified. Zero padding optional.
- This is a critical data element. Do not leave blank.
Example:
- Dr. Smith´s zip code is "14792"; this should be entered in the appropriate positions for the zip code.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Zip Plus Four Required For: Location
Format – Length: A/N–4 Layout Field Location: N
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The Zip Plus Four Code associated with the provider´s mailing address. The Zip Plus Four Code is assigned by the U.S. Postal Service for the location of the provider´s office. There should be one record for each provider location.
Edit Applications:
- Should be a valid Zip Plus Four Code.
- Must be right justified. Zero padding is optional.
Example:
- Dr. Smith´s Zip Plus Four Code is "14742–0012"; the Zip Plus Four Code "0012" should be entered in the correct position on the file layout.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Wheel Chair Accessibility Required For: Location
Format – Length: A/N–1 Layout Field Location: O
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
Wheel chair accessibility is defined as the access available at a provider´s location for disabled persons to obtain unassisted access to the office within the building under the Americans with Disabilities Act of 1990. Places of public accommodation are required to remove barriers to ensure access.
Further guidance can be found in the Americans with Disabilities Act of 1990 (ADA) and the Americans with Disabilities Act Accessibility Guidelines (ADAAG).
Edit Applications:
- Must use valid codes:
- 0 = No
- 1 = Yes
- Do not leave blank. This is a critical data element for all payers.
Example:
- Dr. Smith´s (a Medicaid provider) office has a permanent wheel chair ramp. Therefore, "Yes" would be selected and a "1" would be entered in the correct position.
- Dr. Piddock, who serves both Commercial and Medicaid patients, is located in a historic building that is not permitted to alter the structure. Therefore," No" would be selected and "0" would be entered.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Primary Designation Required For: Practice
Format – Length: A/N–1 Layout Field Location: P
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 5.0 – Nov. 2000
_____________________________________________________________________________________________
Definition:
Primary Care Provider (PCP) is defined as a provider with the following primary care specialties:
Provider Type Specialty Code
Provider Type | Specialty Code | |
---|---|---|
Family Practice | 01, 12 | 050 |
General Practice | 01, 12 | 776 |
Pediatrics | 01, 12 | 150 |
Internal Medicine | 01, 12 | 060 |
Nurse practitioner practicing under NYS laws | 02 | any of the above codes |
Special Needs Plan (SNP) for HIV ONLY
For the purpose of defining a Primary Care Provider on the PNDS, the same coding scheme will be used for the HIV–SNP plans. Further clarifications can be obtained from the Division of HIV Health Care at (518) 486–1383.
Edit Application:
- Must use valid codes.
- 1 = Primary Care Provider only
- 2 = Specialist
- 3 = PCP and Specialist (HIV–SNP plans should use this for PCPs that are HIV Specialists)
- Do not leave blank. This is a critical data element for all providers.
Exceptions to the above for ALL PLANS are:
Specialist and Sub–Specialist Exception: Specialists and Subspecialists are permitted to serve as PCPs when it is considered medically appropriate and cost–effective. For purposes of the physician/provider data file, you should only use the primary designation for PCP and Specialist (primary designation code = "3") when a provider serves sixteen or more hours as a PCP. Use the Specialist Only code (primary designation code = "2") if the provider has less than sixteen hours of primary care.
Shortage Area Exception: PCPs that are practicing in Shortage Areas (areas that are defined by the DOH as areas in need of Medicaid primary care physicians) may be excluded from the 16–hour requirement.
Under unique circumstances the State will waive the 16–hour requirement for a primary care provider (PCP) working with a Medicaid managed care plan. To request a formal waiver for a PCP, a letter must be submitted to:
Medical DirectorOffice of Health Insurance Programs
New York State Department of Health
One Commerce Plaza–720
Albany, NY 12237
The following information must be provided in the letter:
- Primary Provider´s Name
- License Number
- Current Address requested for exception
- Current office hours
In addition, the request for a waiver should affirm the following information:
- The PCP is available at least eight (8) hours/week;
- The PCP is participating in a Health Provider Shortage Area (HPSA) or other similarly determined shortage area;
- The PCP is able to fulfill the responsibilities of a PCP;
- The waiver request must demonstrate there are systems in place to guarantee continuity of care and meet all access and availability standards, (24–hr/7–day week coverage, appointment availability, etc.).
Medical Resident Exception: Effective July 1998, medical residents are not permitted to be designated as Medicaid Primary Care Provider. They will not count toward the total number of Medicaid PCPs. For purposes of submitting on the PNDS, the Primary Designation should be used ("1"=PCP or "2"=Specialist) to indicate how the resident is participating. Residents may be counted as participants in the care of enrollees as long as the following conditions are met.
- A resident is part of a patient care team headed by a fully licensed and MCO credentialed attending physician serving patients in one or more training sites in an "up weighted" or "designated priority" residency program. Residents in a training program that was disapproved as a designated priority, solely due to the outcome measurement requirement for graduates, may be eligible to participate in such patient care teams.
- Only attending physicians and nurse practitioners on the training team, NOT RESIDENTS, may be credentialed by the MCO and may be empaneled with enrollees. Enrollees must be assigned an attending physician or nurse practitioner to act as their PCP, though residents on the team may perform all or many of the visits for the enrollee as long as the majority of these visits are under the direct supervision of the enrollee´s designated PCP. Enrollees have the right to request care by their PCP in addition or instead of being seen by a resident.
- Residents may work with attending physicians and nurse practitioners to provide care to patients under the supervision of the patient´s PCP. Patients must be made aware of the resident/attending relationship and be informed of their rights to be cared for directly by their PCP.
- Residents eligible to be involved in a continuity relationship with patients must be available at least 20% of the total training time in the care setting and no less than 10% of training time in any training year must be in the setting. No fewer than nine (9) months a year must be spent in the continuity care setting.
- Residents meeting these criteria provide increased Medicaid capacity for enrollment to their team according to the following formula:
- PGY–1 300 per FTE
- PGY–2 750 per FTE
- PGY–4 1500 per FTE
- PGY–3 1125 per FTE
- In order for a resident to provide continuity of care to an enrollee, both the resident and the attending PCP must have regular hours in the continuity site and must be scheduled to be in the site, together, the majority of the time.
- A preceptor/attending is required to be present a minimum of sixteen (16) hours of combined precepting and direct patient care in the primary care setting to be counted as a team supervising PCP and accept an increased number of enrollees based upon the residents working on his/her team. Time spent in patient care activities at other clinical sites or in other activities off–site is not counted towards this requirement.
- A 16–hour per week attending may have no more than four (4) residents on his/her team. Each attending spending twenty–four (24) hours per week in patient care/supervisory activity, at the continuity site, could have six (6) residents per team. Attendings spending 32 hours per week could have eight residents on their team. Two or more attendings may join together to form a larger team as long as the ratio of attending to residents does not exceed 1:4 and all attendings comply with the sixteen (16) hour minimum.
- Specialty consults must be performed or directly supervised by a MCO credentialed specialist. The specialist may be assisted by a resident or fellow.
- Responsibility for the care of the enrollee remains with the attending physician. All attending/resident teams must provide adequate continuity of care, twenty–four (24) seven (7) day coverage and appointment and availability access which meets RFP standards.
- Residents who do not qualify to act as continuity providers as part of an attending/resident team may still participate in the episodic care of enrollees as long as that care is under the supervision of an attending physician credentialed to a MCO. Such residents would not add to the capacity of that attending to empanel enrollees, however.
- Nurse practitioners may not act as attending preceptors for resident physicians.
- Enrollees must be granted access to the attending physician if they request an appointment with this individual.
Example:
- Dr. Smith is a pediatrician. His primary designation would be "1".
- Dr. Bones is a full–time Orthopedic Surgeon. His primary designation would be "2" for Specialist.
- Sally Brown is a certified midwife. Her primary designation would be "2" for Specialist.
- Dr. Lannon is an OB/GYN physician. His primary designation would be a "2" for Specialist.
- Dr. Sawyer is licensed as an Internal Internist and Cardiologist. He works sixteen (16) hours a week or more in both capacities. His primary designation would be a "3".
- Dr. McConnell is a second–year resident enrolled in an "up–weighted" primary care program that has an attending physician. His primary designation would be a "1".
- Dr. Guy is an HIV PCP Internal Medicine provider. He would be coded with a primary designation of "3" and would have code Primary Specialty of "060" and a secondary specialty of "303".
- Dr. Phillips is a pediatrician who is not an HIV specialist working with an HIV–SNP. He should be coded as a primary designation as "1"; his primary code would be "150".
- Dr. Nadler is an internal medicine, primary care provider, working in a managed long term care plan (MLTC). Her primary designation would be "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Provider Type Required For: Practice
Format – Length: A/N–2 Layout Field Location: Q
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 4.0 – Oct. 1999
_____________________________________________________________________________________________
Definition:
Provider type refers to the general degree and licensure received by the provider. Provider type is NOT the same as the category of service used in the Medicaid Encounter Data System (MEDS) and is coded differently in the Provider Network than by the State Education Department.
Edit Applications:
- Must be a valid entry. Must be right justified. Zero padding is optional.
- Do not leave blank. This is a critical data element for all providers.
- Valid codes are in following table:
Provider Type | Code | Licensure | Degree (at a minimum) |
---|---|---|---|
Physician | 01 | Medicine | MD |
12 | Medicine | DO (Doctor of Osteopathy) | |
Physician Assistant | 23 | Medicine | PA |
Acupuncturist | 20 | Acupuncture | BS with training & experience |
Audiologist | 30 | AUD or (A) | Audiology |
Chiropractor | 10 | Chiropractic | DC (Doctor of Chiropractic´s) |
Counselor | 04 | LSW (Licensed Social Worker) | MSW |
05 | Clinical Psychologist(licensed) | Ph.D. | |
14 | Psychologist (licensed) | MS (Master of Science) | |
15 | Counselor (non–licensed) | Bachelors | |
16 | Social Worker (non–licensed) | BSW or MSW (Master in Social Work) | |
Dentist | 08 | Dentistry | DDS (Doctor of Dentistry) |
18 | Dentistry | DMD (Doctor of Medical Dentistry) | |
19 | Dentistry | OMS (Oral and Maxillofacial Surgeon) | |
Dietician/Nutriti onist | 40 | CDN (Certified Dietician Nutritionist) | Associates with training & experience |
Registered Nurse | 22 | Nursing | RN |
Provider Type | Code | Licensure | Degree (at a minimum) |
Nurse Practitioner | 02 | CNP (Certified Nurse Practitioner) | NP |
Nurse Midwife | 03 | CNM (Certified Nurse Midwife) | Nursing Degree |
50 | CM (Certified Midwife; not a nurse) | Program approved by NYS Ed. Dept. | |
Optometrist | 06 | Optometrist | OD (Doctor of Optometry) |
Podiatrist | 09 | POD (Podiatry) | DPM |
Therapist | 60 | PT (Physical Therapist) | Degree in appropriate field and licensure |
61 | OT (Occupational Therapist) | Degree in appropriate field and licensure | |
62 | SLP (Speech and Language Pathologist) | Degree in appropriate field and licensure | |
63 | CFY (Clinical Fellowship Year) | Degree in appropriate field and licensure | |
64 | Respiratory Therapist (RT) | Degree in appropriate field and licensure | |
Applied Behavior Analyst | 71 | Licensed Behavior Analyst | Master´s degree or higher in appropriate field and licensure |
78 | Certified Behavior Analyst Assistant | Bachelor´s degree or higher in appropriate field and licensure | |
Other | 11 |
Example:
- Dr. Smith is a Pediatrician. He received a Medical Degree to practice as a pediatrician. His provider type would be "01" for MD.
- Sally Brown is a certified nurse midwife. She received a registered professional nursing degree and a certificate in Nurse Midwifery (ACNM). Her provider type would be "03".
- Melody Bell received a license to practice as an Occupational Therapist (OT). She has completed an approved occupational therapy program satisfactory to the Department of Education. Her provider type would be "61".
- Elaine Weir is a registered nurse (RN). Her provider type would be ‘22´.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Primary Specialty Required For: Practice
Format – Length: A/N–3 Layout Field Location: R
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
Physicians and other providers are licensed or certified in select specialty fields. These providers contract with the managed care plan to provide specialty services. The codes used for this data element will distinguish what type of specialty the provider is practicing. The Primary Specialty should reflect the specialty in which the provider practices approximately 60% of his time.
Edit Applications:
- Codes must be valid. See Section VI for complete listing of codes.
- Do not leave blank. This is a critical data element for all providers.
- Zero padding is optional.
Example:
- Dr. Shields is a Plastic Surgeon. The primary specialty code to be used is "170".
- Dr. Gesten is an Internal Medicine Physician. The code for Internal Medicine is "060."
- Dr. Fahrenkopf is an Endodontist. The code for this specialty is "802".
- Dr. Dellehunt is a Psychiatrist. Depending upon the practice, the code for this is "191" for Child Psychiatrist or "192" for Adult Psychiatrist.
- A certified nurse midwife would be coded with a provider type code of ‘03´ and a primary specialty code of "782".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Secondary Specialty Required For: Practice
Format – Length: A/N–3 Layout Field Location: S
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
See Primary Specialty. This uses the same codes and definition.
Edit Applications:
- If providers do not have a second specialty, enter "999".
- Not a critical data element.
- Must be right justified. Zero padding is optional.
Example:
- See Primary Specialty.
- If the provider´s primary designation is "3" for a PCP/Specialist, a secondary specialty must be filled in. Do not use "999" as the secondary specialty.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Board Status – Primary Specialty Required For: Practice
Format – Length: A/N–1 Layout Field Location: T
Version Number\Effective Date: 1.0 – Oct. 1996 Revision Date: 4.0 – Oct. 1999
_____________________________________________________________________________________________
Definition:
The Board Status indicates the level of education/training completed towards a recognized medical specialty certificate.
Not Board–Certified (code= "1"), refers to a physician who did not complete a residency program. A physician must take the board examination within specified time frame after completing the residency program. If the physician does not take the Boards within the appropriate time frame, they will no longer be considered board eligible. If this is the scenario, the provider should be coded as "1", not board certified. All current residents should be coded as "1".
Completed Residency Program (code= "2") refers to a physician who has met all the educational requirements for a certificate program with the following scenarios:
- Provider has completed their accredited residency program, but has yet to take the Boards
Or - Provider has completed their accredited residency program, but has not heard the results of their Boards
Or - Provider has completed their accredited residency program, but has not passed the Boards
Or - Provider has completed their accredited residency program but does not plan on taking the Boards.
Board–Certified (code= "3") refers to a physician who has passed all the requirements for the certificate. This includes people who are grandfathered.
No Board Certification Available (code= "4") is for physicians who have completed a fellowship or training program in a specialty field that does not have a recognized board certificate.
Not Applicable (code= "9") is for non–physicians.
Edit Applications:
- Codes must be a valid code:
- 1=Not Board Certified – Residency not complete
- 2=Not Board Certified – Residency complete
- 3=Board Certified and/or grandfathered
- 4=No board certification available in this specialty
- 9=Not Applicable (use for non–physicians)
- This data element is soft edit for all physicians, i.e., provider type of "01" (MD) or "12" (DO).
Example:
- Dr. Mertz has completed all requirements for education and training. He has not taken his Boards. His board status equals "2".
NOTE: A Board Certified provider (code="3") should have a Residency Status "1", "2", "3", "4" if they are a current resident, "9" otherwise. Physicians licensed prior to the Board Certification process should be coded as "3" (grandfathered) according to HEDIS guidelines and for the purposes of coding on the PNDS system.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Board Status – Primary Specialty Required For: Practice
Format – Length: A/N–1 Layout Field Location: U
Version Number\Effective Date: 1.0 – Oct. 1996 Revision Date: 4.0 – Oct. 1999
_____________________________________________________________________________________________
Definition:
The Board Status indicates the level of education/training completed towards a recognized medical specialty certificate.
Not Board Certified (code= "1"), refers to a physician who did not complete a residency program. A physician must take the board examination within specified time frame after completing the residency program. If the physician does not take the Boards within the appropriate time frame, they will no longer be considered board eligible. If this is the scenario, the provider should be coded as "1", not board certified. All current residents should be coded as "1".
Completed Residency Program (code= "2") refers to a physician who has met all the educational requirements for a certificate program with the following scenarios:
- Provider has completed their accredited residency program, but has yet to take the Boards
Or - Provider has completed their accredited residency program, but has not heard the results of their Boards
Or - Provider has completed their accredited residency program, but has not passed the Boards
Or - Provider has completed their accredited residency program, but does not plan on taking the Boards.
Board Certified (code= "3") refers to a physician who has passed all the requirements for the certificate. This includes people who are grandfathered.
No Board Certification Available (code= "4") is for physicians who have completed a fellowship or training program in a specialty field that does not have a recognized board certificate.
Not Applicable (code= "9") is for non–physicians.
Edit Applications:
- Codes must be a valid code:
- 1=Not Board Certified – Residency not complete
- 2=Not Board Certified – Residency complete
- 3=Board Certified and/or grandfathered
- 4=No board certification available in this specialty
- 9=Not Applicable (use for non–physicians)
- This data element is currently a soft edit for all physicians, i.e., provider type of "01" (MD) or "12" (DO)
Example:
- Dr. Mertz has completed all requirements for education and training. He has not taken his Boards. His board status= "2".
NOTE: A Board Certified provider (code="3") should have a Residency Status "9" (non– resident). Physicians licensed prior to the Board Certification process should be coded as "2" (grandfathered) according to HEDIS guidelines and for the purposes of coding on the PNDS system.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Resident´s Attending Physician License No. Required For: Practice
Format – Length: A/N–6 Layout Field Location: V
Version Number\Effective Date: 2.0 – Oct. 1997 Revision Date: 4.0 – Oct. 1999
_____________________________________________________________________________________________
Definition:
The resident´s attending physician license number is the professional license number issued by the NYS Department of Education for the physician or preceptor that is associated with the resident in training. Every individual who is in a residency program should be assigned an attending physician. This applies to residents in post–graduate years of education years 1–8. All residents must have their attending physician´s license number entered into this data element.
Edit Applications:
- This is a critical data element for records with "Residency Status" equal to "1", "2", "3", or "4". All other records must be zero–filled.
- This is a critical data element. Do not leave blank.
- Must be a valid professional license number issued by the New York State Department of Education.
- Zero padding is optional.
- For non–residents, zero–fill the data element.
Example:
- Dr. Smith is a pediatric resident in his post–graduate year 3 who is under the supervision of Dr. Alfred. Dr. Alfred has the license number of 234782; this number should be entered in the resident´s attending physician license number.
NOTE: The preceptor/attending physician must have their own record on the file transmitted to the Department of Health. There may be no more than four residents per an attending physician who has sixteen (16) hours per week per location.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Residency Status – for Primary Specialty Required For: Practice
Format – Length: A/N–1 Layout Field Location: W
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 5.0 – Nov. 2000
_____________________________________________________________________________________________
Definition:
This data element is to be primarily used for persons CURRENTLY in a residency program.
As part of their education/license requirements physicians must complete a specified number of post–graduate (PG) years of additional on the job training. This variable refers to the providers currently in a training program. It does not need to be completed for a provider´s residency training history, i.e., the highest level of training completed by a provider. PGY1 refers to post graduate year one. PGY2 refers to post graduate year two, etc. Residency status refers to the year of residency that a physician in training is currently enrolled.
Edit Application:
- Codes must be valid:
- 1=PGY1;
- 2=PGY2;
- 3=PGY3;
- 4=PGY4–8+;
- 9=Not Applicable (use for non–residents, i.e., physicians who have completed their residency, physicians not currently in a residency program, and other provider types.).
- Do not leave blank. For all physicians, with a provider type equal to "01" or "12", you should complete the residency status. For physicians who are PCPs this is a critical data element and must be completed. For physicians who are Non–PCPs, primary designation is "2"; this is a soft error. (Edit modification July 1999)
- For Residents that are acting as participants in the care of enrollees (i.e., not designated as PCPs) and who have been coded as a "1" or "3" in the primary designation field, they should have the corresponding appropriate sum of office hours. (The PGY1 and PGY2s who are acting as participants in the care of enrollees should have a total of eight (8) continuous office hours at one site to be a Primary Care Participant. PGY3 and above should have a total of twelve (12) continuous office hours at one site to be an active member of a patient care team(s) and a primary care participant.)
- For Residency Status coded 1–4, the corresponding Board Status should be coded as "1"=not board certified.
Example:
- Dr. Rusk is currently in his second year of training as a behavioral pediatrician specialist. His residency status = "2".
- Dr. Anarella was in a three–year residency program in 1994. After two years of the program, he decided to stop. He is not in a current residency program. He should be coded as "9" = not currently in a residency program. (His Board Status for specialty would be coded as "1" = Not Board Certified).
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Residency Status – for Secondary Specialty Required For: Practice
Format – Length: A/N–1 Layout Field Location: X
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 4.0 – Oct. 1999
_____________________________________________________________________________________________
Definition:
This data element is to be primarily used for persons CURRENTLY in a residency program. As part of their education/license requirements physicians must complete a specified number of post–graduate (PG) years of additional on the job training. This variable refers to the providers currently in a training program. It does not need to be completed for a provider´s residency training history, i.e., the highest level of training completed by a provider. PGY1 refers to post graduate year one. PGY2 refers to post graduate year two, etc. Residency status refers to the year of residency that a physician in training is currently enrolled.
Edit Application:
- Codes must be valid:
- 1=PGY1;
- 2=PGY2;
- 3=PGY3;
- 4=PGY4–8+;
- 9=Not Applicable (use for non–residents, i.e., physicians who have completed their residency, physicians not currently in a residency program, and other provider types.).
- Do not leave blank. For all physicians, with a provider type equal to "01" or "12", you should complete the residency status. For physicians who are PCPs this is a critical data element and must be completed. For physicians who are Non–PCPs, primary designation is "2"; this is a soft error. (Edit modification July 1999)
- For Residents that are acting as participants in the care of enrollees (i.e., not designated as PCPs) and who have been coded as a "1" or "3" in the primary designation field, they should have the corresponding appropriate sum of office hours. (The PGY1 and PGY2s who are acting as participants in the care of enrollees should have a total of eight (8) continuous office hours at one site to be a Primary Care Participant. PGY3 and above should have a total of twelve (12) continuous office hours at one site to be an active member of a patient care team(s) and a primary care participant.)
- For Residency Status coded 1–4, the corresponding Board Status should be coded as "1"=not board certified.
Example:
- Dr. Rusk is currently in his second year of training as a behavioral pediatrician specialist. His residency status = "2".
- Dr. Anarella was in a three–year residency program in 1994. After two years of the program, he decided to stop. He is not in a current residency program. He should be coded as "9" = not currently in a residency program. (His Board Status for specialty would be coded as "1" = Not Board Certified).
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Provider´s Gender Required For: Practice
Format – Length: N–1 Layout Field Location: Y
Version Number\Effective Date: 4.0 – Oct. 1999 Revision Date: 6.1 – July 2002
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Definition:
The provider´s gender.
Edit Applications:
- Should use valid codes:
- 1=Male
- 2=Female
- This is a critical data element. You may NOT leave this blank.
Example:
- Dr. Panagiotis Psalidas is male. Enter "1" in the data field for gender.
- Marylyn Monroe is an RN. Her gender code should be ‘2´.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Physician Extenders (PCPs only) Required For: Practice
Format – Length: N–5 Layout Field Location: Z
Version Number\Effective Date: 1.0 Dec. 1996 Revision Date: 6.1 – Sep. 2004
_____________________________________________________________________________________________
Definition:
Physician Extenders are defined as individuals who are medical care professionals such as Physician Assistants (PAs) or Nurse Practitioners (NPs). They are supervised by and associated with a physician, and they extend the physicians" role as primary care providers within a limited scope of procedures. Primary care providers other than physicians should not have physician extenders.
The total number of PA and NP Full Time Equivalents (FTEs) associated with the PCP should be entered in this data element.
Edit Applications:
- Do not leave blank. This is a critical data element for ALL PCPs. If the PCP does not have any physician extenders, enter zero (00.00).
- For non–PCPs, "9 fill" the data element, for Not Applicable (99.99).
- For PCP Nurse Practitioners, enter (99.99).
- Must be right justified. Zero padding is optional.
Example:
- Dr. Dean has a full–time nurse practitioner on his staff (the nurse practitioner´s not serving as a PCP). He also has a physician assistant who works thirty (30) hours a week. The total FTE count for Dr. Dean is 1.75; one full–time and one part–time employee. The FTE entry would be "01.75".
- Dr. Hu does not have any physician extenders as defined above. He has an LPN on his staff. The FTE entry would be "00.00".
- Dr. Fohl has a nurse practitioner (who is not serving as a PCP) that works twenty (20) hours each week. The FTE entry would be "00.50".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Commercial Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AA
Version Number\Effective Date: 2.0–Oct. 1997 Revision Date: 5.0 – Nov. 2000
_____________________________________________________________________________________________
Definition:
The Commercial Provider Indicator is used to determine if a provider (PCP and/or Specialist) serves Commercial members of the managed care plan. The Commercial members that the provider serves are not receiving Medicaid, SNP or Child Health Plus coverage.
Edit Applications:
- Codes must be valid:
- 0 = Not a Commercial Provider
- 1 = Commercial Provider; provides direct care to Commercial members
- Do not leave blank. This is a critical data element for ALL Records.
Example:
- Dr. Franko is a member of the XYZ managed care plan that is a licensed Article 44 HMO. This data element for Dr. Franko would be coded with a "1".
- Dr. Frankel is a member of the HealthAll Medicaid Managed Care plan. Dr. Frankel only sees Medicaid members in this managed care plan. This data element for Dr. Frankel would be coded with a "0".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Medicaid Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AB
Version Number\Effective Date: 2.0–Oct. 1997 Revision Date: 5.0 – Nov. 2000
_____________________________________________________________________________________________
Definition:
The Medicaid Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members of their managed care plan who receive Medicaid.
Edit Applications:
- Codes must be valid:
- 0 = Not a Medicaid Provider
- 1 = Medicaid Provider; provides direct care to Medicaid members
- Do not leave blank. This is a critical data element for ALL Records.
Example:
- Dr. Piddock works at the Pyramid Health Plan, a Commercial HMO that also participates in Medicaid Managed Care. He provides direct care to the Medicaid members. He would be considered a Medicaid Provider and coded as "1" in the Medicaid Provider Indicator data element.
- Dr. McCall also works for the Pyramid Health Plan, but only provides care for members insured by Long Island Railroad, Long Island Shore Company and Long Island Telephone Company. She is coded as a "0" because she does not provide care to Medicaid members.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Medicare Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AC
Version Number\Effective Date: 2.0–Oct. 1997 Revision Date: 5.0 – Nov. 2000
_____________________________________________________________________________________________
Definition:
The Medicare Provider Indicator is used to determine if a provider (PCP and/or specialists) provides care to members receiving Medicare.
Edit Applications:
- Codes must be valid:
- 0 = Not a Medicare Provider
- 1 = Medicare Provider; provides direct care to Medicare members
- Do not leave blank. This is a critical data element for ALL Records.
Example:
- Dr. Williams, a gerontologist, is in an IPA that is contracted with New Health Managed Care Plan. He provides care to Medicare members of New Health. He would be coded as "1" because he provides direct care to Medicare members.
- Dr. Curran works in a managed long–term care plan, where he providers care of Medicare members. He would be coded as "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Child Health Plus Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AD
Version Number\Effective Date: 2.0–Oct. 1997 Revision Date: 5.0 – Nov. 2000
_____________________________________________________________________________________________
Definition:
The Child Health Plus Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members of their managed care plan who receive Child Health Plus (CHP).
Edit Applications:
- Codes must be valid:
- 0 = Not a Child Health Plus Provider
- 1 = Child Health Plus Provider; provides direct care to CHP members
- Do not leave blank. This is a critical data element for ALL Records.
Example:
- Dr. Smith, a pediatrician, belongs to the Health All Medicaid Managed Care Plan that has been certified participation in the NYS Child Health Plus insurance program. He provides direct care to CHP children. This data element for Dr. Smith would be coded with a "1."
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: HARP Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AE
Version Number\Effective Date: 6.9–July 2015
_____________________________________________________________________________________________
Definition:
The HARP Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members in a HARP program.
Edit Applications:
- Codes must be valid:
- 0 = Not a HARP Provider;
- 1 = HARP Provider; provides direct care to enrollees in a HARP program.
- Do not leave blank. This is a critical data element for all records.
Example:
- Dr. Hart provides direct care to individuals enrolled in a HARP program. This data element would be coded with a "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Medicaid Advantage Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AF
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
The Medicaid Advantage Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members in a Medicaid Advantage program.
Edit Applications:
- Codes must be valid:
- 0 = Not a Medicaid Advantage Provider
- 1 = Medicaid Advantage Provider; provides direct care to enrollees in a Medicaid Advantage program
- Do not leave blank. This is a critical data element for all records.
Example:
- Dr. Cole provides direct care to individuals enrolled in a Medicaid Advantage program. This data element would be coded with a "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Partial CAPS Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AG
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
The Partial CAPS Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members in a Partial CAPS program.
Edit Applications:
- Codes must be valid:
- 0 = Not a Partial CAPS Provider
- 1 = Partial CAPS Provider; provides direct care to enrollees in a Partial CAPS program
- Do not leave blank. This is a critical data element for all records.
Example:
- Dr. Lesh provides direct care to individuals enrolled in a Partial CAPS program. This data element would be coded with a "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: MAP Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AH
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
The MAP Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members in a MAP program.
Edit Applications:
- Codes must be valid:
- 0 = Not a MAP Provider;
- 1 = MAP Provider; provides direct care to enrollees in a MAP program.
- Do not leave blank. This is a critical data element for all records.
Example:
- Dr. Garcia provides direct care to individuals enrolled in a MAP program. This data element would be coded with a "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: PACE Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AI
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
The PACE Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members in a PACE program.
Edit Applications:
- Codes must be valid:
- 0 = Not a PACE Provider;
- 1 = PACE Provider; provides direct care to enrollees in a PACE program.
- Do not leave blank. This is a critical data element for all records.
Example:
- Dr. Hart provides direct care to individuals enrolled in a PACE program. This data element would be coded with a "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: FIDA Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AJ
Version Number\Effective Date: 6.8 – October 2014
_____________________________________________________________________________________________
Definition:
The FIDA Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members in a FIDA program.
Edit Applications:
- Codes must be valid:
- 0 = Not a FIDA Provider;
- 1 = FIDA Provider; provides direct care to enrollees in a FIDA program.
- Do not leave blank. This is a critical data element for all records.
Example:
- Dr. Hart provides direct care to individuals enrolled in a FIDA program. This data element would be coded with a "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: NYSoH Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: AK
Version Number\Effective Date: 6.9 – May 2015
_____________________________________________________________________________________________
Definition:
The NYSOH Standard Essential Health Plan (EP) Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members enrolled in the Standard Essential Health Plan (EP) within the New York State of Health (NYSOH).
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
Codes:
0 = Not a NYSOH Standard EP Provider;
1 = NYSOH Standard EP Provider; provides direct care to enrollees in a NYSOH Standard EP within the Individual Exchange Market.
Example:
- Dr. Blue provides direct care to individuals enrolled in a NYSOH Standard EP. This data element would be coded with a "1".
Notes:
- Please ensure that the Standard EP network(s) submitted through the PNDS system align(s) with the Standard EP(s) submitted in the Health Insurer Participation Proposal.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: NYSoH EP plus Adult Vision & Dental Ind Required For: Practice
Format – Length: A/N–1 Layout Field Location: AL
Version Number\Effective Date: 6.9 – May 2015
_____________________________________________________________________________________________
Definition:
The NYSOH Indiv Essential Health Plan (EP) plus Adult Vision and Dental Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members enrolled in the EP plus Adult Vision and Dental within the New York State of Health (NYSOH).
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
Codes:
0 = Not a NYSOH EP plus Adult Vision and Dental Provider;
1 = NYSOH EP plus Adult Vision and Dental Provider; provides direct care to enrollees in a NYSOH EP plus Adult Vision and Dental within the Individual Exchange Market.
Example:
- Dr. Blue provides direct care to individuals enrolled in a NYSOH EP plus Adult Vision and Dental. This data element would be coded with a "1".
Notes:
- Please ensure that the EP plus Adult Vision and Dental network(s) submitted through the PNDS system align(s) with the EP(s) submitted in the Health Insurer Participation Proposal.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Commercial Non–MCO Medical Indicator 1–8 Required For: Practice
Format – Length: A/N–1 Layout Field Location: AM, DF–DL
Version Number\Effective Date: 7.5 – Sept. 2016
_____________________________________________________________________________________________
Definition:
Commercial Non–MCO Medical Indicator is used to determine if a specific product is a non– government, non–managed care product (medical only).
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
Codes:
0 = Not a Not a Commercial Non–MCO (vision only);
1 = Commercial Non–MCO Vision product.
Example:
- Dr. Blue provides direct care to individuals enrolled in an ABC Health Inc. medical network. The network associated with Commercial Non–MCO Medical Indicator 1 should be coded with a "1".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Commercial Non–MCO Vision Indicator 1–6 Required For: Practice
Format – Length: A/N–1 Layout Field Location: AN, DM–DQ
Version Number\Effective Date: 7.5 – Sept. 2016
_____________________________________________________________________________________________
Definition:
Commercial Non–MCO Vision Indicator is used to determine if a specific product is a non– government, non–managed care product (vision only).
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
Codes:
0 = Not a Commercial Non–MCO (vision only);
1 = Commercial Non–MCO Vision product.
Example:
- Dr. Blue provides direct care to individuals enrolled in an XYZ Inc., vision product. The network associated with Commercial Non–MCO Vision Indicator 1 should be coded with a "1"
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Commercial Non–MCO Dental Indicator 1–5 Required For: Practice
Format – Length: A/N–1 Layout Field Location: AO, DR–DU
Version Number\Effective Date: 7.5 – Sept. 2016
_____________________________________________________________________________________________
Definition:
Commercial Non–MCO Dental Indicator is used to determine if a specific product is a non– government, non–managed care product (dental only).
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
Codes:
0 = Not a Commercial Non–MCO (dental only);
1 = Commercial Non–MCO Dental product.
Example:
- Dr. Blue provides direct care to individuals enrolled in a commercial JKL, Inc. dental product. The network associated with Commercial Non–MCO Dental Indicator 1 should be coded with a "1"
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Commercial Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AP
Version Number\Effective Date: 1.0 Dec. 1996
_____________________________________________________________________________________________
Definition:
Commercial Panel Status refers to the availability of a PCP to accept new members who may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a PCP cannot accept new members at the present time. An existing panel indicates that a PCP will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1 = Open to new and existing Commercial members 2 = Existing Commercial members/enrollees only
- 3 = Closed Commercial Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
Example:
- Dr. Sturn has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are Child Health Plus. He has decided not to accept any more Commercial members at this time. His Commercial Panel Status would be "3".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Medicaid Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AQ
Version Number\Effective Date: 2.0 – Oct. 1997
_____________________________________________________________________________________________
Definition:
Medicaid Panel Status refers to the availability of a PCP or designated OB/GYN Specialist to accept new Medicaid or HIV SNP members. These may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members and properly handle their health concerns. A closed panel indicates that a physician cannot accept new members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1=Open to new and existing Medicaid and/or HIV SNP members 2=Existing Medicaid and/or SNP members only
- 3=Closed Medicaid and/or HIV SNP Panel
- 9=Not Applicable for Non–PCP and non–Medicaid/SNP OB/GYNs
- Do not leave blank. This is a critical data element for ALL Medicaid and HIV SNP PCPs and OB/GYNs.
Example:
- Dr. Schenk has 3,000 managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare, 300 are Child Health Plus and 200 are HIV SNP. He has decided not to accept any more Commercial members at this time, but will accept new Medicaid and HIV SNP members. His Medicaid Panel Status would be "1", he will be open to new Medicaid members at the clinic.
- Dr. McFerran has 500 Commercial members and 1,000 Medicaid fee–for–service (FFS) patients. His FFS patients are joining the managed care plan in which he participates. He has decided not to accept any new members from the plan. His Medicaid Panel status would be "2".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Medicare Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AR
Version Number\Effective Date: 2.0 – Oct. 1997
_____________________________________________________________________________________________
Definition:
Medicare Panel Status refers to the availability of a PCP to accept new members who may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a PCP can´t accept new members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1 = Open to new and existing Medicare members 2 = Existing Medicare members/enrollees only
- 3 = Closed Medicare Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
Example:
- Dr. Albertson has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are Child Health Plus. He has decided not to accept any more Commercial members at this time but will accept Medicare members. His Medicare Panel Status would be "1", he will accept more Medicare members.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Child Health Plus Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AS
Version Number\Effective Date: 2.0 – Oct. 1997
_____________________________________________________________________________________________
Definition:
Child Health Plus (CHP) Panel Status refers to the availability of a physician to accept new CHP members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new CHP members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1 = Open to new and existing Child Health Plus members 2 = Existing Child Health Plus members only
- 3 = Closed Child Health Plus Panel 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
Example:
- Dr. Gilstrap has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are Child Health Plus. He has decided not to accept any more Commercial members at this time but will accept additional Child Health Plus members. His Child Health Plus Panel Status would be "1", he will accept more Child Health Plus members at the clinic.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Medicaid Advantage Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AU
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
Medicaid Advantage Panel Status refers to the availability of a physician to accept new Medicaid Advantage members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new Medicaid Advantage members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1 = Open to new and existing Medicaid Advantage members 2 = Existing Medicaid Advantage members only
- 3 = Closed Medicaid Advantage Panel 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
Example:
- Dr. Joplin has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are Medicaid Advantage. He has decided not to accept any more Commercial members at this time but will accept additional Medicaid Advantage members. His Medicaid Advantage Panel Status would be "1", he will accept more Medicaid Advantage members at the clinic.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Partial CAPS Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AV
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
Partial CAPS Panel Status refers to the availability of a physician to accept new Partial CAPS members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new Partial CAPS members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1 = Open to new and existing Partial CAPS members 2 = Existing Partial CAPS members only
- 3 = Closed Partial CAPS Panel 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
Example:
- Dr. DiFranco has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are Partial CAPS. He has decided not to accept any more Commercial members at this time but will accept additional Partial CAPS members. His Partial CAPS Panel Status would be "1", he will accept more Partial CAPS members at the clinic.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: MAP Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AW
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
MAP Panel Status refers to the availability of a physician to accept new MAP members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new MAP members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1 = Open to new and existing MAP members 2 = Existing MAP members only
- 3 = Closed MAP Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
Example:
- Dr. Marley has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are MAP. He has decided not to accept any more Commercial members at this time but will accept additional MAP members. His MAP Panel Status would be "1", he will accept more MAP members at the clinic.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: PACE Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AX
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
PACE Panel Status refers to the availability of a physician to accept new PACE members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new PACE members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1 = Open to new and existing PACE members 2 = Existing PACE members only
- 3 = Closed PACE Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
Example:
- Dr. Morrison has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are PACE. He has decided not to accept any more Commercial members at this time but will accept additional PACE members. His PACE Panel Status would be "1", he will accept more PACE members at the clinic.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: FIDA Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AY
Version Number\Effective Date: 6.8 – October 2014
_____________________________________________________________________________________________
Definition:
FIDA Panel Status refers to the availability of a physician to accept new FIDA members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new FIDA members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
- Codes must be valid:
- 1 = Open to new and existing FIDA members 2 = Existing FIDA members only
- 3 = Closed FIDA Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
Example:
- Dr. Morrison has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are FIDA. He has decided not to accept any more Commercial members at this time but will accept additional FIDA members. His FIDA Panel Status would be "1", he will accept more FIDA members at the clinic.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: NYSOH Standard EP Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: AZ
Version Number\Effective Date: 6.9 – May 2015
_____________________________________________________________________________________________
Definition:
The NYSOH Standard EP Panel Status refers to the availability of a physician to accept new NYSOH Standard EP members. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new NYSOH Standard EP members at the present time. An existing panel indicates that a physician will only accept members that are not newly enrolled with the Insurer.
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for ALL PCPs.
Codes:
1 = Open to new and existing NYSOH Standard EP members 2 = Existing NYSOH Standard EP members only
3 = Closed NYSOH Standard EP Panel 9 = Not Applicable for Non–PCP
Example:
- Dr. Nicks has 1,500 patients enrolled in a health plan; 700 are Medicaid, 500 are Medicare and 300 are NYSOH Standard EP. He has decided not to accept any more Medicare members at this time but will accept additional NYSOH Standard EP members. His NYSOH Standard EP Panel Status would be "1", he will accept more NYSOH Standard EP members.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: NYSOH EP plus Adult Vision & Dental Ind Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: BA
Version Number\Effective Date: 6.9 – May 2015
_____________________________________________________________________________________________
Definition:
The NYSOH EP plus Adult Vision and Dental Panel Status refers to the availability of a physician to accept new NYSOH EP plus Adult Vision and Dental members. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new NYSOH EP plus Adult Vision and Dental members at the present time. An existing panel indicates that a physician will only accept members that are not newly enrolled with the Insurer.
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for ALL PCPs.
Codes:
1 = Open to new and existing NYSOH EP plus Adult Vision and Dental members 2 = Existing NYSOH EP plus Adult Vision and Dental members only
3 = Closed NYSOH EP plus Adult Vision and Dental Panel 9 = Not Applicable for Non–PCP
Example:
- Dr. Nicks has 1,500 patients enrolled in a health plan; 700 are Medicaid, 500 are Medicare and 300 are NYSOH EP plus Adult Vision and Dental. He has decided not to accept any more Medicare members at this time but will accept additional NYSOH EP plus Adult Vision and Dental members. His NYSOH EP plus Adult Vision and Dental Panel Status would be "1", he will accept more NYSOH EP plus Adult Vision and Dental members.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Commercial Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BE
Version Number\Effective Date: 1.0 – Dec. 1996
_____________________________________________________________________________________________
Definition:
Panel size is the total number of capitated Commercial members assigned to this provider at your managed care plan. Do NOT include members in other products in the total number of Commercial members. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry. Do not leave blank.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP/Dentistry Specialists or "Not Applicable" enter "9999".
Example:
- Dr. Riviello has 600 Medicaid, 800 Medicare, and 2,500 "other" members. These "other" enrollees are assumed to be the Commercial members; his Commercial panel size would be 2,500, entered as "2500".
- Dr. McFerran has 500 Commercial members and 1000 Medicaid fee–for–service patients. His FFS patients are joining the managed care plan in which he is participating. He has decided not to accept any more new members from the plan. His Commercial panel size would be "0500".
- Dr. Donnelly has only 200 Commercial members assigned to him at the HMO. He does not provide care to Medicaid members. His panel size would be "0200" for Commercial (and zero for Medicaid). He would be considered a Commercial–only provider.
- If Dr. McConnell has two office locations, (i.e., the Madison Ave. office has 300 Commercial members and the Albany Ave. office has 500 Medicaid members) and you are able to report the number of members he serves at each location, then enter one record for each office location and the corresponding number of members in each location. If you cannot determine the number of members per office location; enter one record for Dr. McConnell with his total members (enter Madison Ave. with 0800) and zero–fill the other office location (zero–fill Albany Ave.).
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Medicaid Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BF
Version Number\Effective Date: 1.0 – Dec. 1996
_____________________________________________________________________________________________
Definition:
Panel size is the total number of capitated Medicaid and HIV SNP members assigned to this PCP at your managed care plan. For purposes of this report, persons that are dually eligible in Medicaid and Medicare should only be counted once; they should be entered under the Medicare panel size. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry. Zero–fill to the left.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Example:
- Dr. O´Conner has approximately 800 Medicaid members assigned to him. His Medicaid panel size would be 800, entered as "0800".
- If Dr. McConnell has two office locations, (i.e., the Madison Ave. office has 300 Commercial members and the Albany Ave. office has 500 Medicaid members) and you are able to report the number of members he serves at each location, enter one record for each office location and the corresponding number of members in each location. If you cannot determine the number of members per office location, enter one record for Dr. McConnell with his total members (enter Madison Ave. with "0800") and zero–fill the other office location (enter Albany Ave. with"0000").
- Dr. Hobson has just joined an HMO. She was assigned 2,000 members by the plan; none of them are Medicaid enrollees. Her Medicaid Panel Size would be zero "0000". She would be considered a Commercial–only provider.
- Dr. Kosek has 300 Medicaid members and 200 HIV SNP members assigned to her. Her Medicaid panel size would be 500. Enter as "0500".
- Dr. Wu has 900 HIV SNP members assigned. She has no Medicaid Managed Care enrollees at this time. Her Medicaid Panel Size would be 900. Enter as "0900".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Medicaid Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BG
Version Number\Effective Date: 2.0 – Oct. 1997
_____________________________________________________________________________________________
Definition:
Total number of capitated Medicare members assigned to this provider at your managed care plan. For purposes of this report, persons that are dually eligible in Medicaid and Medicare should be included under the Medicare panel size. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs.
- For Non–PCP or "Not Applicable" enter "9999".
Example:
- Dr. Boyle works for XYZ managed care plan as a primary care provider. He provides care to 800 members of XYZ; 600 members are Commercial and 200 receive Medicare health coverage. His Medicare Panel Size would be "200".
- Dr. Hobson has just joined an HMO. She was assigned 2,000 members by the plan; none of them are Medicare enrollees. Her Medicare panel size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Child Health Plus Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BH
Version Number\Effective Date: 2.0 – Oct. 1997
_____________________________________________________________________________________________
Definition:
Total number of capitated Child Health Plus enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Example:
- Dr. Knopf works for Good Apple Managed Care Plan. He currently provides care to 800 Medicaid members, 400 Medicare, and 100 Child Health Plus members. His Child Health Plus panel size would be "0100".
- Dr. Hobson has just joined an HMO. She was assigned 2,000 members by the plan; none of them are Child Health Plus enrollees. Her Child Health Plus Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Medicaid Advantage Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BJ
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
Total number of capitated Medicaid Advantage enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Example:
- Dr. Grisman works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 Medicaid Advantage members. His Medicaid Advantage panel size would be "0100".
- Dr. Rice has just joined an HMO. She was assigned 2,000 members by the plan; none of them are Medicaid Advantage enrollees. Her Medicaid Advantage Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Partial CAPS Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BK
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
Total number of Partial CAPS enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Example:
- Dr. Cole works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 Partial CAPS members. His Partial CAPS panel size would be "0100".
- Dr. Nadler has just joined an HMO. She was assigned 2,000 members by the plan; none of them are Partial CAPS enrollees. Her Partial CAPS Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: MAP Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BL
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
Total number of MAP enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Example:
- Dr. Purple works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 MAP members. His MAP panel size would be "0100".
- Dr. Brown has just joined an HMO. She was assigned 2,000 members by the plan; none of them are MAP enrollees. Her MAP Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: PACE Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BM
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
Total number of PACE enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Example:
- Dr. Toga works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 PACE members. His PACE panel size would be "0100".
- Dr. Albany has just joined an HMO. She was assigned 2,000 members by the plan; none of them are PACE enrollees. Her PACE Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: FIDA Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: BN
Version Number\Effective Date: 6.8 – October 2014
_____________________________________________________________________________________________
Definition:
Total number of FIDA enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Example:
- Dr. Toga works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 FIDA members. His FIDA panel size would be "0100".
- Dr. Albany has just joined an HMO. She was assigned 2,000 members by the plan; none of them are FIDA enrollees. Her FIDA Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: NYSOH Standard EP Panel Size Required For: Practice
Format – Length: A/N–4 Layout Field Location: BO
Version Number\Effective Date: 6.9 – May 2015
_____________________________________________________________________________________________
Definition:
Total number of NYSOH Standard EP enrollees assigned to this provider at your plan. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Examples:
- Dr. Graves works for Good Apple Health Plan. He provides care to 800 Medicaid members, 400 Medicare members, and 100 NYSOH Standard EP members. His NYSOH Standard EP Panel Size would be "0100".
- Dr. Granola has just joined an HMO. She was assigned 2,000 members by the plan; none of them are NYSOH Standard EP enrollees. Her NYSOH Standard EP Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: NYSOH EP plus Adult Vision and Dental Panel Size Required For: Practice
Format – Length: A/N–4 Layout Field Location: BP
Version Number\Effective Date: 6.9 – May 2015
_____________________________________________________________________________________________
Definition:
Total number of NYSOH EP plus Adult Vision and Dental enrollees assigned to this provider at your plan. This should be specific to provider´s site location.
Edit Applications:
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Examples:
- Dr. Graves works for Good Apple Health Plan. He provides care to 800 Medicaid members, 400 Medicare members, and 100 NYSOH EP plus Adult Vision and Dental members. His NYSOH EP plus Adult Vision and Dental Panel Size would be "0100".
- Dr. Granola has just joined an HMO. She was assigned 2,000 members by the plan; none of them are NYSOH EP plus Adult Vision and Dental enrollees. Her NYSOH EP plus Adult Vision and Dental Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: NYSOH EP plus Adult Vision and Dental Panel Size Required For: Practice
Format – Length: A/N–4 Layout Field Location: BQ
Version Number\Effective Date: 9.0 – May 2019
_____________________________________________________________________________________________
Definition:
The fax area code for the provider´s office fax.
Edit Application:
- This is an optional data element for all providers.
- Must be a valid area code number. The following fills will be rejected: all zeros, like digits such as "999" and number series, such as "123" or "876".
Example:
- Dr. Brown´s office is located in NYC where the area code is 212. Enter "212" into this field.
- Dr. Bennett´s office does not have a fax number. Leave this field blank.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: NYSOH EP plus Adult Vision and Dental Panel Size Required For: Practice
Format – Length: A/N–4 Layout Field Location: BQ
Version Number\Effective Date: 9.0 – May 2019
_____________________________________________________________________________________________
Definition:
The fax number for the provider´s office site.
Edit Application:
- This is an optional data element for all providers.
- Must be a valid fax. The following fills will be rejected: all zeros, like digits such as "8888888" and number series, such as "1234567" or "8765432".
- Do not include hyphens.
- Must be 7 digits.
Example:
- Dr. Brown´s office is located in NYC and his fax number is 523–1449. Enter "5231449" into this field.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Required For: Practice
Hospital Affiliation (HA) Operating Number #1
Hospital Affiliation (HA) Operating Number #2
Hospital Affiliation (HA) Operating Number #3
Format – Length: A/N–4 Layout Field Location: BT, BV, BX
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
The Hospital Affiliation (HA) Operating Numbers identify the hospitals that the provider has admitting privileges to and will use for patient care. Each hospital is given an Operating Certificate Number (OPCERT) and corresponding unique Permanent Facility Identifier (PFI) when they are licensed as an Article 28 facility. The operating certificate number is used to identify the provider´s hospital affiliation. A provider may have up to three unique hospital affiliations on their record.
Edit Applications:
- Codes must be valid. The OPCERT for all hospitals are posted on the PNDS portal. The eight–character operating certificate number for a hospital will end in an "H" or "C".
- Do not leave blank. All three fields must be filled in. It is a critical data element for primary care and OB/GYN physicians (MD/DO). This data element is for ALL providers.
- If you do not know the hospital for your non–PCP and non–OB/GYN physician, you may enter "99999999" to avoid a soft error.
- Enter an "Out of State" Hospital Operating Number as "99999999".
- For PCPs (or other providers) who have no inpatient care, enter an "99999999" in the Hospital Operating number.
Example:
- Dr. Coleman is affiliated with two hospitals; he predominately works at the Beth Israel Medical Center/North Division (OPCERT #7002002H) and is associated with the Adirondack Medical Center–Saranac Lake Site (OPCERT #1623000H). His hospital affiliation is with both Hospitals; the code "7002002H" would be entered for this first HA data element and ""623000H" would be entered in the second HA data element. The third HA is "99999999" filled.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Required For: Practice
Hospital Affiliation (HA) Permanent Facility Identifier #1
Hospital Affiliation (HA) Permanent Facility Identifier #2
Hospital Affiliation (HA) Permanent Facility Identifier #3
Format – Length: A/N–6 Layout Field Location: BU, BW, BY
Version Number\Effective Date: 5.0 – Nov. 2000 Revision Date: 8– Aug.2017
_____________________________________________________________________________________________
Definition:
The Hospital Affiliation (HA) Permanent Facility Identifier (PFI) is the number associated with each hospital that the provider has admitting privileges to and will use for patient care. Each hospital is provided with a PFI number and a corresponding operating certificate (OPCERT) number when they are licensed as an Article 28 facility. The PFI is used in conjunction with the Operating number for identifying the Hospital Affiliation. A provider may have up to three unique hospital affiliations on their record.
Edit Applications:
- Codes must be valid. The PFI numbers for all hospitals are posted on the PNDS portal. Make sure you are using the PFI for the hospital (not another type of facility such as a clinic, nursing home, etc., that might be at the same address, or, have a similar, or, even the same name).
- Do not leave blank. All three fields must be filled in. This is a critical data element for Primary care and OB/GYN physicians (MD/DO). This data element should be completed for ALL providers.
- Enter an "Out of State" Hospital PFI as "999999".
- For PCPs (or other providers) who have no inpatient care, enter "999999" in the Hospital PFI number.
- Must be right justified. Zero padding is optional.
Example:
- Dr. McPhillips works at an Article 28 comprehensive clinic, Soundview Health Center, Bronx, New York. He is affiliated with three area hospitals;
- Our Lady of Mercy Medical Center at 233rd Street, Bronx, Operating Certificate #7000005H and PFI number 1168;
- Our Lady of Mercy Medical Center at 1870 Pelham Parkway, South Bronx (same OPCERT) and PFI 1181, and
- St. Barnabas Hospital at 4422 3rd Avenue, Bronx, OPCERT 7000014H, PFI 1176.
The following PFI numbers: 1168, 1181 and 1176 should be entered in the corresponding data elements HA PFI #1 – #3 as 001168, 001181 and 001176. They must correspond to the appropriate HA OPCERT.
NOTE: The Hospital Affiliation PFI is associated with the hospital where the provider has privileges and provides care; not the various office locations that the provider may have.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Provider Location Facility Operating Certificate Required For: Practice
Format – Length: A/N–8 Layout Field Location: BZ
Version Number\Effective Date: 5.0 – Nov. 2000 Revision Date: 5.0 – Nov. 2000
_____________________________________________________________________________________________
Definition:
If a primary care provider works in a clinic, the clinic must be identified by OPCERT and PFI (see page 112–113 for description of OPCERT and PFI). The two data elements are needed to identify the facility location for each primary care provider. The full list of OPCERTs and PFIs is posted on the PNDS portal.
Edit Applications:
- Must be a valid operating certificate number as listed on the PNDS portal (originally from Health Facilities Information System). The eight–character operating certificate number for a hospital will end in "H" or "C".
- This data element is required for PCPs only. The PCPs must work at the designated facility.
- For everyone other than a PCP, you should "9" fill the data element ("99999999").
- For PCPs located at private office settings this data element is not required. You should "9" fill the data element.
- For PCPs that are working in an out of state facility, you should "8" fill the data element.
Example:
- Dr. Russ works at an Article 28 comprehensive clinic, Whitney M. Young Jr. Health Center, in Albany, NY, that has the operating certificate number 0101205R. This number should be entered into positions 315–322 on the data file.
- Dr. McDevitt has a private office. The data element is "9" filled.
- Dr. Sulger is located at a hospital–based clinic called Fordham Plaza Primary Care Clinic which is associated with St. Barnabas Hospital. The Operating Number is "7000014H" and the PFI number is "4713".
NOTE: Some clinics affiliated with hospitals have their own OPCERT numbers, ending in "R".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Provider Location Permanent Facility Identifier Required For: Practice
Format – Length: A/N–6 Layout Field Location: CA
Version Number\Effective Date: 5.0 – Nov. 2000 Revision Date: 8– Aug. 2017
_____________________________________________________________________________________________
Definition:
If a primary care provider works in a clinic, the clinic must be identified by OPCERT and PFI. The Provider Location Permanent Facility Identifier (PFI) is the number associated with the specific location for an Article 28 licensed clinic or hospital. The full list of OPCERTs and PFIs is posted on the PNDS portal.
Edit Applications:
- Must be a valid PFI as listed on the PNDS portal. Be sure to use the PFI that corresponds to the OPCERT. In addition, make sure you have the appropriate facility, such as a clinic. (Different types of facilities may share the same address or similar name.)
- This data element is critical for PCPs only. The PCPs must work at the designated facility.
- For everyone other than a PCP, you should "9" fill the data element ("999999").
- For PCPs located at private office settings this data element is not required. You should "9" fill the data element ("999999").
- For PCPs that are working in an out of state facility, "8" fill the data element ("888888").
Example:
- Dr. McPhillips works at an Article 28 comprehensive clinic, Whitney M. Young, Jr. Health Care Center, Albany, NY, that has the PFI number of "0011". This number should be entered in the correct position on the data file.
- Dr. McDevitt has a private office. The data element is "9" filled.
- Dr. Sulger is located at a hospital–based clinic called Fordham Plaza Primary Care Clinic which is associated with St. Barnabas Hospital. The Operating Number is "7000014H" and the PFI number is "004713".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Total Office Hours Required For: Office Hours
Format – Length: A/N–3 Layout Field Location: CB
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 9.0– May 2019
_____________________________________________________________________________________________
Definition:
Total office hours worked by the individual provider in an average week at a site. Enter the actual number of hours worked during the week.
Edit Applications:
- Must use a valid entry (between 001 and 168 hours).
- This is a critical data element for Medicaid, HIV SNP and Child Health Plus PCPs; DO NOT leave blank or zero–fill.
- Zero–fill for non–PCP and Commercial only providers.
Example:
- Dr. Butch works from 8 a.m. until 4 p.m., M–F. The total office hours the doctor works is seven hours a day (one hour is lunchtime). A total of 35 would be entered into the total office hours data element. Enter this as "035".
- Dr. Novak works a rotating schedule from 3 p.m. until 11 p.m., M–F with every other Friday off. In an average week he works 35 hours. A total of "035" would be entered for Dr. Novak in the Total Office Data element.
- Dr. Williams, who works the alternate Friday, worked four days that week, 7 hours each day. Enter "028" in the Total Office Hours for Friday for Dr. Novak.
NOTE: To be considered a Medicaid and HIV SNP PCP, total office hours must be equal to or greater than 16 hours per week per location. If a provider has less than 16 hours at a site, they are not considered a PCP at that location. However, the location with less than 16 hours may still be used by the PCP, as long as the PCP maintains 16 hours at another site. The site with less than 16 hours can be listed on the Provider Network Data System (PNDS) as long as the following conditions are adhered to:
- The provider maintains another site with 16 or more hours
- The enrollees assigned to the PCP are ONLY assigned to the site that has 16 or more hours. (The site with 16 or more hours may be referred to as the primary site.)
- Enrollees are instructed that they are assigned to a primary site and that other "non–primary" sites are available for access.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: After Hours Indicator Required For: Office Hours
Format – Length: A/N–1 Layout Field Location: CC
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
Evening office hours after 5 p.m. on any of the seven days (Sunday–Saturday) during the snapshot time frame.
Edit Applications:
- Codes must be valid:
- 0=No evening hours
- 1=Yes, evening hours on any day are available (Sunday through Saturday)
- 9=Not Applicable (all other providers, i.e., non–PCP and Commercial–only)
- DO NOT leave blank. This is a critical data element for Medicaid, HIV SNP and Child Health Plus PCPs.
Example:
- Dr. Butch rotates her schedule every other weekend in the local hospital. She works the evening shift from 9 p.m. Saturday until 4 a.m. Sunday and 9 p.m. Sunday till 4 a.m. Monday. The "snapshot" of Dr. Butch´s schedule should capture the general pattern of her work routine. Her entry for the evening hours indicator would be "1"=Yes.
- Dr. Novak, who works the 3 p.m. to 11 p.m. shift, would be considered to have evening hours; the evening hours indicator would be "1"=Yes.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Language 1–7 Required For: Languages
Format – Length: A/N–3 Layout Field Location: CD–CJ
Version Number\Effective Date: 3.0 – Nov. 1998 Revision Date: 8.0 Feb. 2018
_____________________________________________________________________________________________
Definition:
The languages that a provider or clinical staff member can speak to a member.
Edit Applications:
- Do not leave blank. This is a critical data element.
- Codes must be valid. Language code must be found in the PNDS dictionary. See Language Codes in Section VI.
- This is a critical data element for Medicaid, HIV SNP or CHP PCPs. These providers must have a valid language code in one of the seven language data elements. Language fields not needed should be "999" filled.
- For Non–PCPs you may enter the appropriate language code or "999" fill for Not Applicable. Do not leave blank.
Example:
- In addition to speaking English, Dr. Franko speaks Spanish. His clinical office staff (not a secretary) also speaks Italian. You should enter "ENG" in Language 1 and "SPA" in Language 2 and "ITA" in Language 3. The remaining languages (Language 4–7) should be "999" filled.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Area Code Required For: Contact Info
Format – Length: A/N–3 Layout Field Location: CK
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 Dec. 2001
_____________________________________________________________________________________________
Definition:
The telephone area code for the provider´s office phone.
Edit Application:
- This is a critical edit data element for all providers.
- Must be a valid area code number. The following fills will be rejected: all blanks, all zeros, like digits such as "999" and number series, such as "1234567" or "8765432".
Example:
- Dr. Brown´s office is located in NYC where the area code is 212. Enter "212" into this field.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Phone Number Required For: Contact Info
Format – Length: A/N–7 Layout Field Location: CL
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 Dec. 2001
_____________________________________________________________________________________________
Definition:
The telephone number for the provider´s office site.
Edit Applications:
- This is a critical edit data element for all providers.
- Must be a valid telephone number. The following fills will be rejected: all blanks, all zeros, like digits such as "8888888" and number series, such as "1234567" or "8765432".
- Do not include hyphens.
- Must be 7 digits.
Example:
- Dr. Brown´s office is located in NYC and his telephone number is 523–1449. Enter "5231449" into this field.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Provider Email Address Required For: Contact Info
Format – Length: A/N–40 Layout Field Location: CM
Version Number\Effective Date: 6.2 – Dec. 2008
_____________________________________________________________________________________________
Definition:
The email address the provider uses for work purposes (e.g. communication with patients).
Edit Applications:
- This is a critical data element for all providers.
- Must be a valid email address.
- If the provider does not have an email address, or the email address is unknown, leave blank.
- Must be left–justified.
Example:
- Dr. Kay´s office email address is skay@hospcare.org. Enter "skay@hospcare.org" in this field.
- Dr. Greene does not have an office email address. Leave this field blank.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Federal Employer Identification Number Required For: Contact Info
Format – Length: A/N–9 Layout Field Location: CN
Version Number\Effective Date: 6.2 – Dec. 2008
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Definition:
The Federal Identification Number (FEIN) is a nine–digit unique identification number that the Internal Revenue Service (IRS) assigns business entities. This should be the same number that the plan submits to the IRS (e.g. Form 099–MISC) whenever payments are made to the provider.
For providers having multiple FEINs, use the following hierarchy to select the FEIN for submission:
- FEIN of largest group
- FEIN most frequently used by plan for payment
Edit Applications:
- This is a critical data element for all providers.
- Must be a valid FEIN.
- Must be right justified. Zero padding is optional.
Example:
- Dr. Ray´s Federal Employer Identification Number is 548331872. Enter "548331872" in this field.
- Dr. Patterson´s Federal Employer Identification Number is 244111451. Enter "244111451" in this field.
- Dr. Noble has two FEINs. He has a FEIN for the group practice and a FEIN for seeing patients outside of the group. Submit the FEIN for the group practice.
- Dr. Lee does not have a FEIN. Enter "888888888" in this field.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: NYSoH Medical Network Indicator 1–9 Required For: Practice
Format – Length: A/N–1 Layout Field Location: CO–CW
Version Number\Effective Date: 6.6 – Apr. 2013 Revision Date: 9.0– May 2019
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Definition:
The NYSoH Medical Network Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members enrolled in the Qualified Health Plan (QHP) within the New York State of Health (NYSoH). Submissions are now network specific.
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for all providers.
Codes:
0 = Not a NYSoH Medical Network QHP Provider;
1 = NYSoH Medical Network QHP Provider; provides direct care to enrollees in a QHP within the Individual Exchange Market.
Example:
- This data element would be coded with a "1".
Notes:
- Please ensure that the QHP network(s) submitted through the PNDS system align(s) with the QHP network(s) submitted in the Health Insurer Participation Proposal, along with your Network Template submitted through the System for Electronic Rate and Form Filing (SERFF).
- NYSoH Individual Network 1, submitted to the DOH through the SERFF Network Template, must coincide with the network submitted through the PNDS system for the NYSoH Medical Network 1 Indicator.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: NYSoH Dental Network Indicator 1–4 Required For: Practice
Format – Length: A/N–1 Layout Field Location: CX–DA
Version Number\Effective Date: 6.6 – Apr. 2013
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Definition:
The NYSoH Dental Network Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members enrolled in the Individual Market´s Dental Health Plan (QHP) within the New York State of Health (NYSoH). Submissions are now network specific.
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for all providers.
Codes:
0 = Not a NYSoH Dental QHP Provider;
1 = NYSoH Dental QHP Provider; provides direct care to enrollees in a Dental QHP within the Individual Exchange Market.
Example:
- Dr. Blue provides direct care to individuals enrolled in a NYSoH Dental QHP. This data element would be coded with a "1".
Notes:
- Please ensure that the QHP network(s) submitted through the PNDS system align(s) with the QHP network(s) submitted in the Health Insurer Participation Proposal, along with your Network Template submitted through the System for Electronic Rate and Form Filing (SERFF).
- NYSoH Dental Network 1, submitted to the DOH through the SERFF Network Template, must coincide with the network submitted through the PNDS system for the NYSoH Dental Network 1 Indicator.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: NYSoH Medical Network Indicator 1–9 Required For: Practice
Format – Length: A/N–1 Layout Field Location: EH–EP
Version Number\Effective Date: 6.6 – Apr. 2013 Revision Date: 9.0– May 2019
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Definition:
The NYSoH Medical Network 1–9 Panel Status refers to the availability of a physician to accept new NYSoH Medical QHP members. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new NYSoH Medical QHP members at the present time. An existing panel indicates that a physician will only accept members that are not newly enrolled with the Insurer.
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for ALL PCPs.
Codes:
1 = Open to new and existing NYSoH Medical QHP members 2 = Existing NYSoH Medical QHP members only
3 = Closed NYSoH Medical QHP Panel 9 = Not Applicable for Non–PCP
Example:
- Dr. Nicks has 1,500 patients enrolled in a health plan; 700 are Medicaid, 500 are Medicare and 300 are members of the NYSoH Medical QHP network. He has decided not to accept any more Medicare members at this time but will accept additional NYSoH Medical QHP members. His NYSoH Medical Network 1 Panel Status would be "1", he will accept more NYSoH Medical QHP members.
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: NYSoH Medical Network Indicator 1–9 Required For: Practice
Format – Length: A/N–4 Layout Field Location: FS–GA
Version Number\Effective Date: 6.6 – Apr. 2013 Revision Date: 9.0– May 2019
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Definition:
Total number of NYSoH Medical Network enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
- Codes must be valid.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
Examples:
- Dr. Graves works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare members, and 100 NYSoH Medical members. His NYSoH Medical Panel Size 1 would be "0100".
- Dr. Granola has just joined an HMO. She was assigned 2,000 members by the plan; none of them are NYSOH medical enrollees. Her NYSoH Medical Panel Size would be zero "0000".
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
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Data Element Name: Specialized I/DD Plans – Provider Led (SIP–PL) Indicator Required For: Provider
Format – Length: A/N–1 Layout Field Location: HQ
Version Number\Effective Date: 9.0 – May 2019
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Definition:
The SIP–PL (specialized I/DD plans– provider led) Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members in a SIP–PL program.
Edit Applications:
- Codes must be valid:
- 0 = Not a SIP–PL Provider;
- 1 = SIP–PL Provider; provides direct care to enrollees in a SIP–PL program.
- Dr. Hart provides direct care to individuals enrolled in a SIP–PL program. This data element would be coded with a "1".
- Codes must be valid:
- 1 = Open to new and existing SIP–PL members
- 2 = Existing SIP–PL members only
- 3 = Closed SIP–PL Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
- Dr. Morrison has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are SIP–PL. He has decided not to accept any more Commercial members at this time but will accept additional SIP– PL members. His SIP–PL Panel Status would be "1", he will accept more SIP–PL members at the clinic.
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs.
- For Non–PCP or Not Applicable enter "9999".
- Dr. Toga works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 SIP–PL members. His SIP–PL panel size would be "0100".
- Codes must be valid:
- 0 = Not a FIDA IDD Provider;
- 1 = FIDA IDD Provider; provides direct care to enrollees in a FIDA IDD program.
- Do not leave blank. This is a critical data element for all records.
- Dr. Hart provides direct care to individuals enrolled in a FIDA IDD program. This data element would be coded with a "1".
- Codes must be valid:
- 1 = Open to new and existing FIDA IDD members 2 = Existing FIDA IDD members only
- 3 = Closed FIDA IDD Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
- Dr. Morrison has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are FIDA IDD. He has decided not to accept any more Commercial members at this time but will accept additional FIDA IDD members. His FIDA IDD Panel Status would be "1", he will accept more FIDA IDD members at the clinic.
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
- Dr. Toga works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 FIDA IDD members. His FIDA IDD panel size would be "0100".
- Dr. Albany has just joined an HMO. She was assigned 2,000 members by the plan; none of them are FIDA IDD enrollees. Her FIDA IDD Panel Size would be zero "0000".
- Codes must be valid:
- 1 = Open to new and existing HARP members 2 = Existing HARP members only
- 3 = Closed HARP Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
- Dr. Morrison has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are HARP. He has decided not to accept any more Commercial members at this time but will accept additional HARP members. His HARP Panel Status would be "1", he will accept more HARP members at the clinic.
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
- Dr. Toga works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 HARP members. His HARP panel size would be "0100".
- Dr. Albany has just joined an HMO. She was assigned 2,000 members by the plan; none of them are HARP IDD enrollees. Her HARP Panel Size would be zero "0000".
- Codes must be valid:
- 0 = Not in HIV SNP
- 1 = HIV SNP provider
- Do not leave blank. This is a critical data element for ALL Records.
- Dr. Hart provides direct care to individuals enrolled in a HIV SNP program. This data element would be coded with a "1".
- Codes must be valid:
- 1 = Open to new and existing HIV SNP members 2 = Existing HIV SNP members only
- 3 = Closed HIV SNP Panel
- 9 = Not Applicable for Non–PCP
- Do not leave blank. This is a critical data element for ALL PCPs.
- Dr. Morrison has 3,000 current managed care members; 1,500 of these members are Commercial, 700 are Medicaid, 500 are Medicare and 300 are HIV SNP. He has decided not to accept any more Commercial members at this time but will accept additional HIV SNP members. His HIV SNP Panel Status would be "1", he will accept more HIV SNP members at the clinic.
- Must be a valid entry.
- Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
- For Non–PCP or Not Applicable enter "9999".
- Dr. Toga works for Good Apple Managed Care Plan. He provides care to 800 Medicaid members, 400 Medicare, and 100 HIV SNP members. His HIV SNP panel size would be "0100".
- Dr. Albany has just joined an HMO. She was assigned 2,000 members by the plan; none of them are HIV SNP enrollees. Her HIV SNP Panel Size would be zero "0000".
- Must be a valid National Provider Identifier (NPI) number. The NPI is a 10–position numeric identifier (10–digit number).
- This is a critical data element. Do not leave blank. If not applicable, enter "9999999999".
- DO NOT enter a provider´s individual NPI in this field, it will result in a hard error.
- Dr. Kehinde participates in Medicaid & HIV SNP and his site´s NPI is 0987654321. Enter "0987654321" in this field.
- Must be a valid entry. Left justify.
- Do not leave blank. This is a critical data element. This element must be completed for the record to be accepted.
- Some examples of valid names are:
- Catholic Med Ctr of Bklyn & Queens @ St. Joseph´s Hospital Div. Champlain Valley Physicians Hospital Medical Ctr.
- Buffalo General Hospital
- Terrance Cardinal Cooke Health Care Center Foot Clinics of NY
- Eastern Star Home and Infirmary
- Room or suite number is a critical data element (implemented Quarter 1, 2009). An entry for room or suite number must be on the record in order for the record to be accepted.
- If Not Applicable enter "NA".
- The radiology center is located in Suite 100 of the Professional Office Center. Enter "Suite 100" or "Room 100".
- Must be a valid entry.
- Do not leave blank. This is a critical data element.
- Do not include room or suite number. Use the Room or Suite Number element for these.
- The Service Center located at 95–27 Western Blvd would be entered as "95–27 Western Boulevard".
- The Service Center located at 329 West Seventh Street would be entered as "329 West 7th Street".
- The Service Center located at 1646 Third Street would be entered as "1646 3rd Street".
- Must be a valid entry.
- Do not leave blank. This is a critical element.
- The ABC Service Center is located in Syracuse, NY. The town/city should be entered as "Syracuse".
- Must be a valid US Postal Service State code:
- Example:
"NY" = New York;
"PA" = Pennsylvania;
"VT" = Vermont;
"CT" = Connecticut;
"NJ" = New Jersey.
- Example:
- Do not leave blank. This is a critical data element.
- The Doctors–R–Us Clinic is located in the State of New York. Enter "NY" for the State.
- Must be a valid FIPS county code. See the codes listed in Section VI.
- Do not leave blank. This is a critical data element.
- There is an edit check between FIPS code and zip code; records may be rejected if a zip code does not fall in the appropriate FIPS county code. This may mean you have entered either a wrong zip or a wrong FIPS County code.
- Must be right justified. Zero padding is optional.
- The Doctors–R–Us clinic is located in Columbia County. The FIPS code for Columbia County is "021".
- Must be a valid zip code.
- Do not leave blank. This is a critical data element.
- Must be right justified. Zero padding is optional.
- Doctors–R–Us have a zip code of "14308". This should be entered in the zip code field.
- The Bronx Aids Services, Inc. is a Harm Reduction Services/SEP. One of its branches is located at 226E 144th Street, Bronx, NY 10451–5909. The zip code ‘10451´ must be entered in this field.
- Remsen Pharmacy is located at 8823 Avenue L, Brooklyn, NY 11236. The zip code ‘11236´ should be entered in this field.
- Must be a valid code.
- Must be right justified. Zero padding is optional.
- This is a critical data element and cannot be left blank when reporting Harm Reduction Services/SEP.
- Doctors–R–Us has a zip–plus–four code of "1598". This should be entered in the correct position.
- The Bronx Aids Services, Inc. is a Harm Reduction Services/SEP. One of its branches is located at 226E 144th Street, Bronx, NY 10451–5909. The zip–plus–four code ‘5909´ must be entered in this field. This is a critical data element for Harm Reduction Services/SEP and cannot be left blank when reporting these sites.
- Must use valid codes. (See Section VI for codes.) Right justify and zero–fill to the left.
- Do not leave blank. This is a critical data element.
- The Doctors–R–Us Clinic is a comprehensive Article 28 clinic. The code for this clinic is "321". (If it is not an Article 28 clinic, use "914" for a "General Medicine" Clinic.)
- General Hospital is a certified Article 28 facility with which your plan has contracted to provide inpatient and radiology services. Enter "011" in the designated service for inpatient hospital. In addition, you would enter the appropriate codes in the Additional Service Segment in the record, i.e., Radiology has a code of "200" and Hospital Inpatient has a code of "001".
- Must be a valid code. Do not leave blank.
- XYZ plan contracts with Sunset Rehabilitation Center where there are 25 physical therapists on staff. ALL 25 physical therapists should be listed on the Provider File as individual providers. The "Number of Professionals at Service Center" would be "25".
- XYZ contracts with a CVS Pharmacy. Pharmacists do not need to be listed on the provider file. The "Number of Professionals at Service Center" would be "0".
- XYZ contracts with Blue Mountain Hospital. Hospitals are not included in this data element so you do not need to list the providers who work for Blue Mountain Hospital. Enter "0". You may list individuals who work at the hospital and provide services to your plan´s members individually on the provider file if you wish.
- Must be a valid National Provider Identifier (NPI) number. The NPI is a 10–position numeric identifier (10–digit number).
- This is a critical data element. An entry must be made for every participating provider record for the record to be accepted. Do not leave blank.
- The NPI is validated for each record on the entire submission. If more than 5% of the entire submission does not have a valid NPI, the entire submission will be rejected.
- For facilities/services exempt from NPI, you should enter "8888888888" and provide documentation of the exempt status.
- DO NOT enter a provider´s individual NPI in this field, it will result in a hard error.
- Albany Medical Center has the National Provider Identifier number of "5426871301". Enter "5426871301" in this field.
- Camela Home Care is exempt from NPI, enter "8888888888" in this field and provide documentation of exempt status.
- ABC Treatment Center participates in Medicaid, Commercial & Child Health Plus but has not yet received an NPI. Enter "9999999999" in this field. Do not leave blank.
- Must use valid codes.
- This is a critical element for the following Designated Services that are DOH certified facilities, except where Additional Service Code is specified as 407 (Tribal Health Centers):
- 011 – Hospitals
- 660 – Institutional Long–Term Care
- 663 – Institutional Short Term Care
- 665 – Home Care Certified (Long Term and Home Health Care)
- 321 – Clinics
- 669 – Hospices
- 599 – Laboratories reported separately, or laboratories reported in a hospital setting ("011" as the designated service, with "599" in one of the additional service codes 1–25)
- 668 – Licensed Home Health Care Agencies
- 760– Pharmacy
- 011 or 321 – Federally Qualified Health Centers (FQHC)
- 011 or 321 – Designated AIDS Centers
- This data element can be left blank for all other facilities.
- The License Number/Facility Operating Certificate for Julia L. Butterfield Memorial Hospital is "3920000H". This should be entered in the correct position.
- The registration number of Remsen Pharmacy is "14795". This number should be entered in the License/Facility Operating Certificate field.
- The License Number for a Certified Home Health Agency (CHHA) is seven characters in length. You must fill to the left and leave a blank space. For example, Village Center for Care has a license number of "7002648". This would be entered "7002648".
- The Medpath Laboratory is a certified CLIA lab. Their main headquarters are located in New Jersey. Your managed care plan uses three draw stations in New York State. Enter the local address for each draw station and the facility operating certificate number for the main facility.
- Must use valid codes.
- This is a critical element for the following Designated Services that are DOH certified facilities, except where Additional Service Code is specified as 407 (Tribal Health Centers):
- 011 – Hospitals
- 660 – Institutional Long Term Care 663 – Institutional Short Term Care
- 665 – Home Care Certified (Long Term and Home Health Care) 321 – Clinics
- 669 – Hospices
- 599 – Laboratories reported separately or laboratories reported in a hospital setting (011 as the designated service, with 599 in one of the additional services codes 1–25)
- 011 or 321 – Federally Qualified Health Centers (FQHC) 011 or 321 – Designated AIDS Centers
- This data element can be left blank for all other facilities.
- Must be right justified. Zero padding is optional.
- Your managed care plan has contracted with Bellevue Hospital Center (operating certificate #7002001H). The PFI for this facility is "1438" and should be entered as "001438".
- Your managed care plan has contracted with Beth Israel Medical Center (operating certificate #7002002H). This hospital facility has two locations; if contracted for the services at BOTH locations enter TWO records. One record will have the PFI "001439" and address of the Petrie Campus location at First Ave at 16th Street, NY, NY; the second record will be for the North Division and will have the PFI of "001441" and street address of 170 East End Avenue.
- Your managed care plan has contracted with a consortium of health services licensed under the operating certificate of "1401014H". This includes Buffalo General Hospital with a PFI of "0207", Children´s Hospital of Buffalo with a PFI of "0208" and Columbus Community Healthcare Center with a PFI of "0205". These should be entered as "000207", "000208" and ‘000205". A SEPARATE RECORD should be entered for each of these locations which indicate their unique address, location and PFI.
- The Quest Diagnostics Laboratory is a certified CLIA lab. Their main headquarters are located in New Jersey. Your managed care plan uses three local draw stations in New York State. Enter the local address for each draw station and the approved PFI number for the corresponding operating number of the main site.
- Must be a valid code.
- Right justify all numbers and zero–fill to the left.
- Fill in "99999999" for providers that are Commercial. If the Commercial MEDS ID is not 9–filled, you will receive a critical error (effective Quarter 1, 2009).
- The Eddy Cohoes Rehabilitation Center has a Medicaid Provider Indicator number of "01112234".
- None. This is an optional data element for use by the individual managed care plan.
- You may leave this data element blank or zero–fill if you do not intend to use.
- XYZ managed care plan has contracted with a hospital, Blue County Hospital. The internal computer systems at XYZ Managed Care Plan have coded Blue County Hospital as: "281978HOSP". This code would be entered in the managed care plan´s facility ID for the Blue County Hospital record.
- Codes must be valid:
- 0 = Not a Commercial service center/facility
- 1 = Commercial service center/facility. This facility/location provides care to members of a commercially recognized managed care plan
- Do not leave blank. This is a critical data element for ALL Records.
- Franko Health Care Clinic contracts with the XYZ managed care plan to serve their Commercial members. The data element for Franko Health Care Clinic would be coded with a "1".
- The All Health Outpatient Clinic of St. Hope Hospital serves only individuals receiving public assistance (Medicaid, HIV SNP or CHP). This data element for All Health Clinic would be coded with a "0".
- Codes must be valid:
- 0 = Not a Medicaid managed care service center/facility
- 1 = Medicaid managed care service center. This facility/location provides care to members of a Medicaid recognized managed care plan
- Do not leave blank. This is a critical data element for ALL Records.
- The Pyramid Health Center, contracts with a Commercial HMO that also participates in Medicaid managed care. The center provides direct care to the Medicaid members. This facility would be considered a Medicaid Managed Care Provider and coded as "1" in the Medicaid Provider Indicator Data Element.
- The "Last Stop" Health Center also contracts with a Commercial HMO, but only provides care for members who work for Long Island Railroad, Long Island Shore Company and Long Island Telephone Company. This facility is coded as a "0" because it does not provide care to Medicaid Managed Care members.
- Codes must be valid.
- 0 = Not a Medicare managed care service center/facility.
- 1 = Medicare managed care service center/facility. This facility/location provides care to members of a Medicare recognized managed care plan.
- Do not leave blank. This is a critical data element for ALL Records.
- SoftToe is a physical rehabilitation center that contracts with New Health Managed Care Plan. The center provides care to Medicare members of New Health. The center would be coded as "1" because it provides direct care to Medicare managed care members.
- Codes must be valid:
- 0 = Not a CHP service center/facility.
- 1 = CHP service center/facility. This facility/location provides care to members of a CHP recognized managed care plan.
- Do not leave blank. This is a critical data element for ALL Records.
- Smith Kidney Center provides dialysis care for the All Health Medicaid Managed Care Plan that is also certified to participate in the NYS CHP insurance program. This center provides care to CHP children. The data element for Smith Kidney Center would be coded with a "1".
- Codes must be valid:
- 0 = Not a HARP service center/facility.
- 1 = HARP service center/facility. This facility/location provides care to members of a HARP plan.
- Do not leave blank. This is a critical data element for ALL Records.
- Madison Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the HARP program. This kidney center provides care to HARP adults. This data element for Madison Center would be coded with a "1".
- Codes must be valid:
- 0 = Not a Medicaid Advantage service center/facility.
- 1 = Medicaid Advantage service center/facility. This facility/location provides care to members of a Medicaid Advantage plan.
- Do not leave blank. This is a critical data element for ALL Records.
- Health is Wealth Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the Medicaid Advantage program. This kidney center provides care to Medicaid Advantage adults. This data element for the Health is Wealth Center would be coded with a "1".
- Codes must be valid:
- 0 = Not a Partial CAPS service center/facility.
- 1 = Partial CAPS service center/facility. This facility/location provides care to members of a Partial CAPS plan.
- Do not leave blank. This is a critical data element for ALL Records.
- Applegate Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the Partial CAPS program. This kidney center provides care to Partial CAPS adults. This data element for Applegate Center would be coded with a "1".
- Codes must be valid:
- 0 = Not a MAP service center/facility.
- 1 = MAP service center/facility. This facility/location provides care to members of a MAP plan.
- Do not leave blank. This is a critical data element for ALL Records.
- Bellaire Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the MAP program. This kidney center provides care to MAP adults. This data element for Bellaire Center would be coded with a "1".
- Codes must be valid:
- 0 = Not a PACE service center/facility.
- 1 = PACE service center/facility. This facility/location provides care to members of a PACE plan.
- Do not leave blank. This is a critical data element for ALL Records.
- Madison Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the PACE program. This kidney center provides care to PACE adults. This data element for Madison Center would be coded with a "1".
- Codes must be valid:
- 0 = Not a FIDA service center/facility.
- 1 = FIDA service center/facility. This facility/location provides care to members of a FIDA plan.
- Do not leave blank. This is a critical data element for ALL Records.
- Madison Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the FIDA program. This kidney center provides care to FIDA adults. This data element for Madison Center would be coded with a "1".
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
- Placid Place provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the NYSoH Standard EP. This kidney center provides care to NYSoH Standard EP adults. This data element for Placid Place would be coded with a "1".
- Each facility location must have an indicator for each type of population that they contract to serve.
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
- Placid Place provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the NYSoH EP plus Adult Vision and Dental. This kidney center provides care to NYSoH EP plus Adult Vision and Dental adults. This data element for Placid Place would be coded with a "1".
- Each facility location must have an indicator for each type of population that they contract to serve.
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
- Dr. Blue provides direct care to individuals enrolled in an ABC Health Inc. medical product. The network associated with Commercial Non–MCO Medical Indicator 1 should be coded with a "1"
- This is a critical data element for all providers.
- Must be valid area code number. The following fills will be rejected: all blanks, all zeros, like digits such as "999" and number series, such as "123" or "876".
- The Doctors–R–Us clinic is located in NYC where the area code is 212. Enter "212".
- This is a critical data element for all providers.
- Must be a valid telephone number. The following fills will be rejected: all blanks, all zeros, like digits such as "8888888" and number series, such as "1234567" or "8765432".
- Do not include hyphens.
- Must be 7 digits.
- The Doctors–R–Us has a telephone number of 379–2468. Enter "3792468".
- Codes must be valid. See Appendix for Codes.
- Do not leave blank. This is a critical data element.
- At least one Additional Service must be reported for a hospital; the others may be filled with "000".
For hospitals providing inpatient services, use designated service code "011" for Article 28 hospitals and additional service code "899" for inpatient services. - Service centers/facilities that do not have additional services to be reported beyond the designated service code should be entered as "000".
- Must be right justified. Zero padding is optional.
- The Happy Hospital Center is a certified Article 28 hospital; they are licensed to provide the following services:
- Inpatient Services
- Radiology
- Physical Rehab Therapy
- Occupational Therapy
- Anesthesiology and
- Social Work Services
- Laboratory Services available to both inpatients and outpatients
- Service 1: 899 for inpatient
- Service 2: 200 for radiology
- Service 3: 300 for physical therapy
- Service 4: 301 for occupational therapy
- Service 5: 020 for anesthesiology
- Service 6: 781 for social work
- Service 7: 599 for laboratories
- The Ichabod Crane Health Center is a certified Article 28 clinic; they are licensed to provide the following services:
- Primary medical care center
- Dental
- Birthing
- Diagnostic Radiology
- Service 1: 914 for general medicine
- Service 2: 911 for dental
- The Bush Hospital is certified to provide the following services:
- Hospital Inpatient
- Mental Health Inpatient
- Radiology
- OB/GYN Services
- Codes must be valid.
- Do not leave blank. This is a critical data element for all records.
- Placid Place provides dialysis care for the All Health System that has been certified to participate in the NYSoH Medical QHP network. This kidney center provides care to NYSoH Medical Network adults. This data element for Placid Place would be coded with a "1".
- Each facility location must have an indicator for each type of population that they contract to serve.
- Codes must be valid:
- 0 = Not a SIP–PL service center or facility;
- 1 = SIP–PL service center; provides direct care to enrollees in a SIP–PL program.
- Hamilton Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the SIP–PL program. This kidney center provides care to SIP–PL enrollees. This data element for Hamilton Center would be coded with a "1".
- Codes must be valid:
- 0 = Not a FIDA IDD service center or facility;
- 1 = FIDA IDD service center; provides direct care to enrollees in a FIDA IDD program.
- Do not leave blank. This is a critical data element for all records.
- Madison Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the FIDA IDD program. This kidney center provides care to FIDA IDD enrollees. This data element for Madison Center would be coded with a "1".
- Codes must be valid:
- 0 = Not a HIV SNP service center or facility 1 = HIV SNP service center or facility
- Do not leave blank. This is a critical data element for ALL Records.
- Madison Center provides dialysis care for the All Health Medicaid Managed Care Plan that has been certified to participate in the HIV SNP program. This kidney center provides care to HIV SNP enrollees. This data element for Madison Center would be coded with a "1".
- Must be a valid FIPS county code. See the codes listed in Section VI.
- Must be right justified. Zero padding is optional.
- Code 000 must only be used in servicing county columns and not in the county field.
- Do not leave blank. This is a critical data element. If not applicable, enter "999".
- The All–State Durable Medical Equipment supplier is located in Westchester County and services in all 62 New York State counties as well. The FIPS code for Westchester County is "119" and the code "000" must be entered in servicing county code 1 field.
- The Doctors–R–Us Certified Home Health Agency is located in Queens county, and services the 5 boroughs of New York City. The FIPS code for Queens county (081) should be entered in the borough/county code field, and the FIPS codes for the remaining 4 New York City counties (045, 047, 061, 085) should be entered in servicing county codes 1–4.
- Must be a valid code.
- This is a critical data element and cannot be left blank when reporting the following facilities/services:
- When submitting OASAS services listed above, the OASAS PRU number field must be filled in with valid numbers matching to the OASAS Market Data or "9999999999".
- This filed must be left blank for all other services.
- The edit validation is processed by comparing the submitted OASAS PRU, OASAS Provider Number, and services codes to the NYS OASAS Market Data file.
- Right justify all numbers. Zero–filling is optional.
- The Sunside Counseling Agency is an OASAS Certified Outpatient Chemical Dependency (Clinic) and participates in Medicaid. The OASAS Program Reporting Unit number for this site location is "678" and may be reported as "678" or "0000000678". This same Agency has a satellite location not listed in the OASAS Market Data. This location should be reported with a PRU number of "9999999999".
- New Directions is located at 185 Fulton Ave in Hempstead, NY. This location is not certified by OASAS to offer Residential Substance Abuse Treatment Services. This field should be left blank.
- Must be a valid code.
- This is a critical data element and cannot be left blank when reporting the following facilities/services:
- When submitting OASAS services listed above, the OASAS Provider number field must be filled in with valid numbers matching to the OASAS Market Data or "9999999999".
- This filed must be left blank for all other services.
- The edit validation is processed by comparing the submitted OASAS PRU, OASAS Provider Number, and services codes to the NYS OASAS Market Data file.
- Right justify all numbers. Zero–filling is optional.
- HHH Health is an OASAS Certified Outpatient Chemical Dependency (Clinic) and participates in Medicaid. The OASAS Provider Number for this site location is "20" and may be reported as "20" or "0000000020". HHH Health also has a satellite location not listed in the OASAS Market Data. This satellite location should be listed with a Provider Number of "9999999999".
- Inspiring Health Care is located at 48 Madison Ave in Brooklyn, NY. This location is not certified by OASAS to offer Residential Substance Abuse Treatment Services. This field should be left blank.
- Must be a valid code.
- This is a critical data element and cannot be left blank when reporting the following facilities/services:
- When submitting OMH services listed above, the OMH ID field must be filled in with a valid number matching to the OMH Market Data or "9999999999".
- This field should be left blank for all other services.
- The edit validation is processed by comparing the submitted OMH HCBS Number or OMH OPCERT Number, and services codes to the NYS OMH Market Data file.
- Right justify all numbers. Zero–filling is optional.
- Altoona Health Center is OMH Certified to offer Adult BH HCBS Education Support Services and participates in Medicaid. The OMH Home and Community Based Services (HCBS) Number for this site location is "561" and may be reported as "561" or "0000000561".
- The Bronx Health Center is Certified by OMH to offer Continuing Day Treatment and participates with HARP. The OMH License (OPCERT) Number for this location is "224" and may be reported as "224" or "0000000224". The Bronx Health Center also has a satellite location not listed in the OMH Market Data. This satellite location should be reported with an OMH ID number of "9999999999".
- The New House Hospital Center is located at 605 First Ave in New York, NY and is not certified to offer any OMH Services. This field should be left blank.
- Additions by NYSDOH with assistance on Language Family and Country Spoken from: United Neighborhood Houses of New York.
- Full list available <"a href="https://www.loc.gov/standards/iso639-2/php/code_list.php">here.
- Language Codes listed on pages 346–349 reflect the most commonly used codes. All official ISO 639–2 codes may be entered.
- That the provider network information submitted on the Provider Network Data System (PNDS) is a complete, accurate and truthful listing of providers and service centers with whom the managed care organization/health insurer/SNP has executed contracts in effect at the time of the submission, obligating them to provide care and services to those members and in those counties for which operating authority is granted by the New York State Health Department and/or for which the managed care organization/health insurer/SNP is under contract with the State of New York or one of its counties.
- That member assignments information submitted on the Provider Network Data System (PNDS) is a complete, accurate and truthful assignment of primary care providers to managed care organization/health insurer/SNP enrollees.
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: SIP – Panel Status Required For: Provider
Format – Length: A/N–1 Layout Field Location: HR
Version Number\Effective Date: 9.0 – May 2019
_____________________________________________________________________________________________
Definition:
SIP–PL Panel Status refers to the availability of a physician to accept new SIP–PL members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new SIP–PL members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: SIP–PL Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: HS
Version Number\Effective Date: 9.0 – May 2019
_____________________________________________________________________________________________
Definition:
Total number of SIP–PL enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: FIDA IDD Provider Indicator Required For: Practice
Format – Length: A/N–1 Layout Field Location: HT
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
The FIDA IDD Provider Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members in a FIDA IDD program.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: FIDA IDD Panel Status Required For: Practice
Format – Length: A/N–1 Layout Field Location: HU
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
FIDA IDD Panel Status refers to the availability of a physician to accept new FIDA IDD members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new FIDA IDD members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: FIDA IDD Panel Size Required For: Practice
Format – Length: N–4 Layout Field Location: HV
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
Total number of FIDA IDD enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: HARP Panel Status Required For: Practice
Format – Length: N–1 Layout Field Location: HX
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
HARP Panel Status refers to the availability of a physician to accept new HARP members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new HARP members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: HARP Panel Size Required For: Practice
Format – Length: A/N–4 Layout Field Location: HY
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
Total number of HARP enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: HIV SNP Indicator Required For: Practice
Format – Length: A/N–4 Layout Field Location: HZ
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
The HIV SNP Indicator is used to determine if a provider (PCP and/or Specialist) provides care to members of their managed care plan who receive HIV SNP program.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: HIV SNP Panel Status Required For: Practice
Format – Length: N–1 Layout Field Location: HZ
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
HIV SNP Panel Status refers to the availability of a physician to accept new HIV SNP members which may be either an existing member within the managed care plan or a member joining the plan for the first time. An open panel means the provider is able to accept new members. A closed panel indicates that a physician cannot accept new HIV SNP members at the present time. An existing panel indicates that a physician will only accept members currently enrolled in the plan with another provider.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: HIV SNP Panel Size Required For: Practice
Format – Length: A/N–4 Layout Field Location: IA
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
Total number of HIV SNP enrollees assigned to this provider at your managed care plan. This should be specific to provider´s site location.
Edit Applications:
Example:
PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Site National Provider Identifier (NPI) Required For: Identification
Format – Length: A/N–110 Layout Field Location: IB
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
The Site National Provider Identifier (NPI) is a unique identification number for covered health care providers. The Site NPI is the facility NPI and not an individual´s NPI. This field is optional because not all sites have an NPI. The Federal Government mandated the use of only NPI for electronic healthcare transactions. The NPI number is issued under the direction of the Centers for Medicare & Medicaid Services (CMS). For additional information on NPI, visit here
Edit Applications:
Example:
Provider Network Data System
V. ANCILLARY/SERVICE CENTERS ELEMENT DESCRIPTIONS
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Site Name Required For: Location
Format – Length: A/N–50 Layout Field Location: A
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The name of the contracted service center, i.e., the name of the hospital, pharmacy, radiology center, clinic, etc. If you have contracted with a facility that has more than one location, each location must be listed separately.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Room or Suite Number Required For: Location
Format – Length: A/N–20 Layout Field Location: B
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The room or suite number that is associated with the service center´s site name and/or address.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Street Address Required For: Location
Format – Length: A/N–49 Layout Field Location: C
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.2 – Dec 2008
_____________________________________________________________________________________________
Definition:
The street name associated with the service center´s address.
Edit Applications:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Town/City Required For: Location
Format – Length: A/N–30 Layout Field Location: D
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The name of the town or city associated with the service center´s address. The town/city name of the service center is most often designated by the U.S. Postal Service. There should be one record for each service center location.
Edit Applications:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: State Required For: Location
Format – Length: A/N–2 Layout Field Location: E
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The name of the State in which the contracted service center is located.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Borough/County Required For: Location
Format – Length: A/N–3 Layout Field Location: F
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The federal government has identified a code for each county in the United States. The Federal Information Processing Standard (FIPS) code is a five–digit code for each county. We use the last three digits of the FIPS code to distinguish the counties for each provider. FIPS codes are listed on the PNDS page.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Zip Code Required For: Location
Format – Length: A/N–5 Layout Field Location: G
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The zip code associated with the service center´s mailing address. The zip code is assigned by the United States Postal Service. There should be one record for each service center location. Zip codes are listed on the PNDS page.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Zip Plus Four Required For: Location
Format – Length: A/N–4 Layout Field Location: H
Version Number\Effective Date: 1 – Dec. 1996
_____________________________________________________________________________________________
Definition:
The zip–plus–four code associated with the service center´s mailing address.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Designated Service Required For: Service
Format – Length: A/N–3 Layout Field Location: I
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 3.0 – Nov. 1998
_____________________________________________________________________________________________
Definition:
The designated service is the major health service that you have contracted for and that will be provided to your enrollees by the service center.
Edit Application:
Example:
NOTE: If the hospital has other services that are not listed in the Additional Service Segment that you need to report, you must fill out another record with that appropriate designated service code, i.e., General Hospital has a nutrition program that you have contracted with; you have to enter the same hospital name, address, etc., with the designated service code for the Nutrition Program "909" (you should zero–fill all the elements in the Additional Service Segment).
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Number of Providers at Service Center Required For: Service
Format – Length: N–5 Layout Field Location: J
Version Number\Effective Date: 2.0 – Oct. 1997 Revision Date: 5.0 – Nov. 2000
_____________________________________________________________________________________________
Definition:
This data element refers only to the professional caregivers at the contracted ancillary/service facilities listed below and to the provider types listed in the provider file:
General Medical Clinics
Behavioral Health Facilities
Mental Health Facilities Chemical Dependency
This data element is used to indicate the number of licensed/certified practitioners who work in the service center that you have contracted with (i.e., radiology group, mental health facility, etc.) and who may be listed on your provider file or provider directory. Only provider types listed on the provider files should be included.
If the providers are not listed individually on the provider file you may be asked to submit a list of them annually to the Bureau of Managed Care Certification and Surveillance.
You do not need to report the number of providers for hospitals.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: National Provider Identification (NPI) Required For: Service
Format – Length: A/N–10 Layout Field Location: K
Version Number\Effective Date: 6.5 – Feb. 2010
_____________________________________________________________________________________________
Definition:
The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The Federal Government mandated the use of only NPI for electronic healthcare transactions. The NPI number is issued under the direction of the Centers for Medicare & Medicaid Services (CMS). Unless exempt from NPI, all managed care plans must report the NPI of all their participating providers during the quarterly or annual Provider Network Data submission. For additional information on NPI, visit here.
Edit Applications:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: License/Facility Operating Certificate Required For: Service
Format – Length: A/N–8 Layout Field Location: L
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
The Facility Operating Certificate number (OPCERT) is the code used to identify an Article 28, 36 or 40 facility location and is assigned as part of their license or certificate of operation.
These facilities are: hospitals, diagnostic & treatment centers (clinics), long term home health care programs (LTHHCPs) residential health care facilities (nursing homes), certified home health care agencies (CHHAs) and hospice facilities. Often a large facility has only one operating certificate, but more than one location. (The permanent facility indicator, PFI, number is used to identify the location of the facility and remains the same even if the facility changes ownership.)
Edit Applications:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Permanent Facility Identifier (PFI) Required For: Service
Format – Length: A/N–6 Layout Field Location: M
Version Number\Effective Date: 3 – Nov. 1998 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
The Permanent Facility Identifier (PFI) is the code used to identify an Article 28, 36 or 40 facility location. It remains the same even if the facility changes ownership. These facilities are: hospitals, diagnostic & treatment centers (clinics), long term home health care programs (LTHHCPs) residential health care facilities (nursing homes), certified home health care agencies (CHHAs) and hospice facilities. Often a large facility has only one operating certificate but more than one location and PFI.
Edit Applications:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Medicaid Provider Identification Number Required For: Service
Format – Length: A/N–8 Layout Field Location: N
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 9.0 – May 2019
_____________________________________________________________________________________________
Definition:
Each service center that provides services to the Medicaid population has been assigned a Medicaid Provider Number. This number is used for billing purposes under the Medicaid fee–for– service system and is used for identification of services provided under managed care with the Medicaid Encounter Data System.
Edit Application:
Example:
NOTE: Not all service centers may have a Medicaid Provider Identification Number. You should refer to the MMIS file in the Reference Downloads section of the PNDS portal to search for a service center´s MMIS ID.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Managed Care Plan´s Facility ID Required For: Service
Format – Length: A/N–20 Layout Field Location: O
Version Number\Effective Date: 4.0 – Oct. 1999 Revision Date: 8– Jul. 2017
_____________________________________________________________________________________________
Definition:
The Managed Care Plan Facility ID refers to the internal coding of the facility or service center used by the managed care plan. This data element is for matching the internal computer systems used by a managed care plan with the codes/reports printed on the PNDS site. If your managed care plan does not have an internal coding scheme, you DO NOT have to create one for this data element.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Commercial Provider Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: P
Version Number\Effective Date: 5.0 – Nov 2000
_____________________________________________________________________________________________
Definition:
The Commercial Provider Indicator is used to determine if a service center or facility serves Commercial members of the managed care plan.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of member they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Medicaid Provider Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: Q
Version Number\Effective Date: 5.0 – Nov 2000
_____________________________________________________________________________________________
Definition:
The Medicaid Provider Indicator is used to determine if a service center or facility serves Medicaid managed care enrollees.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of member they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Medicare Provider Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: R
Version Number\Effective Date: 5.0 – Nov 2000
_____________________________________________________________________________________________
Definition:
The Medicare Provider Indicator is used to determine if a service center or facility provides care to members receiving Medicare.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of member that they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Child Health Plus Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: S
Version Number\Effective Date: 5.0 – Nov 2000
_____________________________________________________________________________________________
Definition:
The Child Health Plus Provider Indicator is used to determine if a service center or facility provides care to members receiving Child Health Plus (CHP).
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of member that they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: HARP Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: T
Version Number\Effective Date: 6.9 – July 2015
_____________________________________________________________________________________________
Definition:
The HARP Provider Indicator is used to determine if a service center or facility provides care to HARP members.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of that they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Medicaid Advantage Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: U
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
The Medicaid Advantage Provider Indicator is used to determine if a service center or facility provides care to Medicaid Advantage members.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of that they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Partial CAPS Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: V
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
The Partial CAPS Provider Indicator is used to determine if a service center or facility provides care to Partial CAPS members.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of that they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: MAP Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: W
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
The MAP Provider Indicator is used to determine if a service center or facility provides care to MAP members.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of that they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: PACE Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: X
Version Number\Effective Date: 6.5 – October 2011
_____________________________________________________________________________________________
Definition:
The PACE Provider Indicator is used to determine if a service center or facility provides care to PACE members.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of that they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: FIDA Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: Y
Version Number\Effective Date: 6.8 ‖ October 2011
_____________________________________________________________________________________________
Definition:
The FIDA Provider Indicator is used to determine if a service center or facility provides care to FIDA members.
Edit Application:
Example:
NOTE: Each facility location must have an indicator for each type of that they contract to serve.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: MAP Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: Z
Version Number\Effective Date: 6.9 – May 2015
_____________________________________________________________________________________________
Definition:
The NYSoH Standard Essential Health Plan (EP) Indicator is used to determine if a service center or facility provides care to NYSoH Standard EP members.
Edit Applications:
Codes:
0 = Not a NYSoH Standard EP service center/facility;
1 = NYSoH Standard EP service center/facility. This facility/location provides care to members of a NYSoH Standard EP.
Example:
Notes:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: NYSoH EP Plus Adult Vision and Dental Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: AA
Version Number\Effective Date: 6.9 – May 2015
_____________________________________________________________________________________________
Definition:
The NYSoH EP plus Adult Vision and Dental Indicator is used to determine if a service center or facility provides care to NYSoH EP plus Adult Vision and Dental members.
Edit Applications:
Codes:
0 = Not a NYSoH EP plus Adult Vision and Dental service center/facility;
1 = NYSoH EP plus Adult Vision and Dental service center/facility. This facility/location provides care to members of a NYSoH EP plus Adult Vision and Dental.
Example:
Notes:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Commercial Non–MCO Medical Ind 1–8 Required For: Provider
Format – Length: A/N–1 Layout Field Location: AB, BQ–BW
Version Number\Effective Date: 1 – Sep. 2016 Revision Date: 9 – May 2019
_____________________________________________________________________________________________
Definition:
Commercial Non–MCO Medical Indicators 1–8 are used to determine if a specific product is a non–government, non–managed care product (medical only).
Edit Applications:
Codes:
0 = Not a Not a Commercial Non–MCO (vision only);
1 = Commercial Non–MCO Vision product.
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Area Code Required For: Service
Format – Length: A/N–3 Layout Field Location: AD
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 5 – Nov. 2000
_____________________________________________________________________________________________
Definition:
The telephone area code for the facility/service center.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Phone Number Required For: Service
Format – Length: A/N–7 Layout Field Location: AE
Version Number\Effective Date: 1 – Dec. 1996 Revision Date: 6.0 – Dec. 2001
_____________________________________________________________________________________________
Definition:
The telephone number for the facility/service center.
Edit Application:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Service 1 – 25 Required For: Additional Services
Format – Length: A/N–3 Layout Field Location: AF–BD
Version Number\Effective Date: 5 – Nov. 2000 Revision Date: Oct. 2002
_____________________________________________________________________________________________
Definition:
The service or services contracted to be provided at the location.
Edit Application:
Example:
The Outcomes Health Plan contracts for all of the hospital´s services. This facility would be coded as "011" in the designated service data element; seven of the twenty–five service codes should be coded (all twenty–five are searched for codes); here, the Service 1–Service 7 data elements would have the following codes:
The remaining Service 8–Service 25 data elements would be left blank or "000" filled for this record.
The Y2 Managed Care Plan contracts with the Health Center for only the primary care and dental services. This facility would be coded as "321" in the designated service data element; two of the twenty–five service codes should be coded (all twenty–five are searched for codes); here, the Service 1–Service 2 data elements would have the following codes:
Your plan does not contract for birthing and diagnostic radiology services. Those services should not be included in the submission.
The Green Managed Care Plan contracts with Bush Hospital only for the Mental Health Inpatient Services. This facility would be coded as "011" in the designated service data element and "616" in one of the Service 1–Service 25 data elements. The remaining service data elements would be blank or "000" filled.
NOTE: Do not repeat records for the same location. Put as many services on one record as possible. If you have contracted for more than 25 services, and need to submit them on the PNDS, then you must submit a separate record.
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: NYSoH Medical Network Indicators 1–9 Required For: Service
Format – Length: A/N–1 Layout Field Location: BE–BM
Version Number\Effective Date: 6.6 – Apr. 2013 Revision Date: May 2019
_____________________________________________________________________________________________
Definition:
The NYSoH Medical Network Indicators 1–9 are used to determine if a service center or facility provides care to NYSoH Medical Network members.
Edit Applications:
Codes:
0 = Not a NYSoH Medical Network service center/facility;
1 = NYSoH Medical Network service center/facility. This facility/location provides care to members of a NYSoH Medical QHP network.
Example:
Notes:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Specialized I/DD Plans – Provider Led (SIP–PL) Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: CO
Version Number\Effective Date: 9.0 – May 2019 Revision Date: May 2019
_____________________________________________________________________________________________
Definition:
The SIP–PL Indicator is used to determine if a service center or facility provides care to members in a SIP–PL program.
Edit Applications:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: FIDA IDD Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: CP
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
The FIDA IDD Indicator is used to determine if a service center or facility provides care to members in a FIDA IDD program.
Edit Applications:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: HIV SNP Indicator Required For: Service
Format – Length: A/N–1 Layout Field Location: CQ
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
The HIV SNP Indicator is used to determine if a service center or facility provides care to members of their managed care plan who receive HIV SNP program.
Edit Applications:
Example:
ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: Servicing County Codes (1–5) Required For: Location
Format – Length: A/N–3 Layout Field Location: CR–CV
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
The federal government has identified a code for each county in the United States. The Federal Information Processing Standard (FIPS) code is a five–digit code for each county. We use the last three digits of the FIPS code to distinguish the counties for each provider. FIPS codes are listed in Section VI: Codes.
These are fields for reporting additional servicing counties, on top of the county code submitted with the physical site address. An all–county code can be used to indicate this site/organization services all 62 New York State counties. All 62 Counties code= 000.
Servicing County Codes (1–5) only apply to the following designated services:
Service | Designated service code | Additional service code |
---|---|---|
Certified Home Health (CHHA) | 665 | |
Licensed Home Health Care (LHHA) | 668 | |
Consumer Directed Personal Care (CDPC) | 914 | 675, 676 |
Durable Medical Equipment (DME) | 307, 969 | |
Harm Reduction Services/SEP | 613 | |
Home Delivered/Congregate Meals | 667 | |
Hospice Care | 669 | |
Licensed and/or Certified Home Health – Occupational Therapy (OT), Physical Therapy (PT) and Speech Therapy (ST) services | 665, 668 | 300, 301, 302 |
Licensed and/or Certified Home Health – Personal Care Assistance (LHHA/CHHA, HHA/PCA) | 665, 668 | 672, 673 |
Licensed and/or Certified Home Health – Home Based Medical Social Services | 665, 668 | 781 |
Medical Laboratories | 011, 321, 599 | 599 |
Non–Emergent Transportation | 671, 740 | |
Nutrition | 011, 321, 914 | 909 |
Personal Emergency Response (PERS) | 615 | |
Private Duty Nursing | 680 | |
Respiratory Therapy | 011, 321, 914 | 674 |
Social & Environmental Support | 661 |
Edit Application:
Example:
NOTE: Do not repeat records for the same location. Put as many counties on one record as possible. If you have contracted for more than 5 servicing counties, and need to submit them on the PNDS, then you must submit a separate record.
ANCILLARY/SERVICE CENTERS– DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: OASAS PRU Required For: Service
Format – Length: A/N–10 Layout Field Location: CW
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
This field refers to the Office of Alcoholism and Substance Abuse Services (OASAS) Program Reporting Unit (PRU) number for plans reporting OASAS facilities/services. This data element is collected for the purpose of matching to the OASAS Market Data. The OASAS Market Data consists of all OASAS Certified Service Providers that can be counted towards network adequacy for Medicaid, HARP, HIV/SNP, FIDA, FIDA–IDD, and SIP–PL.
This field should be used by any plan reporting the OASAS services listed in the Edit Application. If your plan is not reporting OASAS facilities/services, you may leave this data element blank.
Edit Applications:
Service | Designated Service Code* | Additional Service Code |
---|---|---|
Inpatient Chemical Dependency (ASA Inpatient) | 011, 017, 018 | 7 |
Medically Managed Detox Services | 011, 017, 018 | 13 |
Medically Supervised Detox Services(Inpatient or Outpatient) | 011, 017, 018, 749 | 309, 357, 989 |
Opioid Treatment Program | 011, 321, 749 | 751, 922 |
Outpatient Chemical Dependency (Clinic) | 011, 321, 914 | 749, 984, 986 |
Outpatient Chemical Dependency (Outpatient Rehabilitation) | 011, 321, 914 | 987 |
Residential Substance Abuse Treatment Services | 011, 017, 018, 749 | 15, 16 |
*Designated Service Codes 011 and 321 are also licensed by DOH and are required to enter valid OPCERT/PFI information in the OPCERT and PFI fields.
Example:
ANCILLARY/SERVICE CENTERS– DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: OASAS Provider Number Required For: Service
Format – Length: A/N–10 Layout Field Location: CX
Version Number\Effective Date: 8.0 – February 2018
_____________________________________________________________________________________________
Definition:
This field refers to the OASAS Provider Number for plans reporting OASAS facilities/services. This data element is collected for the purpose of matching to the OASAS Market Data. The OASAS Market Data consists of all OASAS Certified Service Providers that can be counted towards network adequacy for Medicaid, HARP, HIV/SNP, FIDA, FIDA–IDD, and SIP–PL.
This field should be used by any plan reporting the OASAS services listed in the Edit Application. If your plan is not reporting OASAS facilities/services, you may leave this data element blank.
Edit Applications:
Service | Designated Service Code* | Additional Service Code |
---|---|---|
Inpatient Chemical Dependency (ASA Inpatient) | 011, 017, 018 | 7 |
Medically Managed Detox Services | 011, 017, 018 | 13 |
Medically Supervised Detox Services(Inpatient or Outpatient) | 011, 017, 018, 749 | 309, 357, 989 |
Opioid Treatment Program | 011, 321, 749 | 751, 922 |
Outpatient Chemical Dependency (Clinic) | 011, 321, 914 | 749, 984, 986 |
Outpatient Chemical Dependency (Outpatient Rehabilitation) | 011, 321, 914 | 987 |
Residential Substance Abuse Treatment Services | 011, 017, 018, 749 | 15, 16 |
*Designated Service Codes 011 and 321 are also licensed by DOH and are required to enter valid OPCERT/PFI information in the OPCERT and PFI fields.
Example:
ANCILLARY/SERVICE CENTERS– DATA DICTIONARY/VERSION 9
_____________________________________________________________________________________________
Data Element Name: OMH ID Required For: Service
Format – Length: A/N–10 Layout Field Location: CY
Version Number\Effective Date: 8.2 – October 2018
_____________________________________________________________________________________________
Definition:
This field refers to the Office of Mental Health (OMH) Home and Community Based Services (HCBS) Number or OMH License (OPCERT) Number for plans reporting OMH facilities/services. This data element is collected for the purpose of matching to the OMH Market Data. The OMH Market Data consists of all OMH Certified Service Providers that can be counted towards network adequacy for Medicaid, HARP, HIV/SNP, and SIP–PL.
This field should be used by any plan reporting the OMH services listed in the Edit Application. If your plan is not reporting OMH services, you may leave this data element blank. Plans reporting OMH Home and Community Based Services (HCBS) should use this field to report the OMH HCBS ID. This field should be used to report the OMH License (OPCERT) Number for all other OMH Services.
Edit Applications:
Service | Designated Service Code* | Additional Service Code |
---|---|---|
Adult BH HCBS Community Psychiatric Supports and Treatment (CPST) | 839 | 0 |
Adult BH HCBS Education Support Services | 862 | 0 |
Adult BH HCBS Family Support & Training | 855 | 0 |
Adult BH HCBS Habilitation | 854 | 0 |
Adult BH HCBS Intensive Crisis Respite | 857 | 0 |
Adult BH HCBS Intensive Supportive Employment | 860 | 0 |
Adult BH HCBS Ongoing Supported Employment | 861 | 0 |
Adult BH HCBS Peer Support | 837 | 0 |
Adult BH HCBS Pre– Vocational Services | 858 | 0 |
Adult BH HCBS Psychosocial Rehabilitation (PSR) | 836 | 0 |
Adult BH HCBS Short Term Crisis Respite | 856 | 0 |
Adult BH HCBS Transitional Employment | 859 | 0 |
Assertive Community Treatment (ACT) | 816 | 0 |
Children´s Community Psychiatric Support & Treatment | 022 | 0 |
Children´s Crisis Intervention | 023 | 0 |
Children´s Family Peer Support Services | 036 | 0 |
Children´s HCBS Caregiver Family Support and Services | 037 | 0 |
Children´s HCBS Community Habilitation | 038 | 0 |
Children´s HCBS Community Self Advocacy Training and Support | 039 | 0 |
Children´s HCBS Crisis Respite | 044 | 0 |
Children´s HCBS Day Habilitation | 045 | 0 |
Children´s HCBS Palliative Care Bereavement Services | 046 | 0 |
Children´s HCBS Palliative Care Expressive Therapy | 047 | 0 |
Children´s HCBS Palliative Care Massage Therapy | 048 | 0 |
Children´s HCBS Palliative Care Pain and Symptom Management | 049 | 0 |
Children´s HCBS Planned Respite | 051 | 0 |
Children´s HCBS Pre– Vocational Services | 052 | 0 |
Children´s HCBS Supported Employment | 053 | 0 |
Children´s Other Licensed Practitioner | 054 | 0 |
Children´s Psychosocial Rehabilitation | 077 | 0 |
Comprehensive Psychiatric Emergency Program (CPEP) | 992 | 0 |
Continuing Day Treatment | 312, 317 | 0 |
Inpatient Mental Health | 011, 017, 018 | 616 |
Outpatient Mental Health Clinic | 011, 017, 018, 321, 914, 375 | 375, 974 |
Outpatient Mental Health Clinic – Children & adolescents under 21 | 011, 017, 018, 321, 914, 375 | 008, 021 |
Outpatient Mental Health Clinic—State Operated | 971 | 971 |
Partial Hospitalization | 313, 318 | 0 |
Personalized Recovery Oriented Services | 829 | 0 |
Youth Peer Support Services | 078 | 0 |
*Designated Service Codes 011 and 321 are also licensed by DOH and are required to enter valid OPCERT/PFI information in the OPCERT and PFI fields.
Example:
Provider Network Data System
IV. CODES
BOROUGH/COUNTY CODES
LANGUAGE CODES
PROVIDER AND ANCILLARY SERVICE CODES
MANAGED CARE PROVIDER NETWORK DATA SYSTEM
BOROUGH/COUNTY CODES (FIPS)
Albany | 001 | Orange | 071 |
Allegany | 003 | Orleans | 073 |
Broome | 007 | Oswego | 075 |
Cattaraugus | 009 | Otsego | 077 |
Cayuga | 011 | Putnam | 079 |
Chautauqua | 013 | Rensselaer | 083 |
Chemung | 015 | Rockland | 087 |
Chenango | 017 | St. Lawrence | 089 |
Clinton | 019 | Saratoga | 091 |
Columbia | 021 | Schenectady | 093 |
Cortland | 023 | Schoharie | 095 |
Delaware | 025 | Schuyler | 097 |
Dutchess | 027 | Seneca | 099 |
Erie | 029 | Steuben | 101 |
Essex | 031 | Suffolk | 103 |
Franklin | 033 | Sullivan | 105 |
Fulton | 035 | Tioga | 107 |
Genesee | 037 | Tompkins | 109 |
Greene | 039 | Ulster | 111 |
Hamilton | 041 | Warren | 113 |
Herkimer | 043 | Washington | 115 |
Jefferson | 045 | Wayne | 117 |
Lewis | 049 | Westchester | 119 |
Livingston | 051 | Wyoming | 121 |
Madison | 053 | Yates | 123 |
Monroe | 055 | ||
Montgomery | 057 | NYC | |
Nassau | 059 | Bronx | 005 |
Niagara | 063 | Kings | 047 |
Oneida | 065 | New York | 061 |
Onondaga | 067 | Queens | 081 |
Ontario | 069 | Richmond | 085 |
Out of State | 088 | ||
All 62 Counties | 000 |
LANGUAGE CODES
LANGUAGE NAME | CODE | LANGUAGE FAMILY |
---|---|---|
Abkhazian | ABK | Northwest–Caucasian |
Afan (Oromo) | ORM | Hamitic |
Afar | AAR | Hamitic |
Afrikaans | AFR | Germanic |
Albanian | ALB | Indo–European |
Amharic | AMH | Semitic |
Arabic | ARA | Semitic |
Armenian | ARM | Indo–European |
Assamese | ASM | Indian |
Australian Languages | AUS | Australian–Aboriginal |
Aymara | AYM | Amerindian |
Azerbaijani | AZE | Turkic/Altaic |
Balinese | BAN | Malayo–Polynesian |
Bashkir | BAK | Turkic/Altaic |
Basque | BAQ | Basque |
Bengali;bangla | BEN | Indian |
Bhutani/Dzongkha | DZO | Asian/Pacific Islander |
Bihari | BIH | Indian |
Bislama | BIS | (not given) |
Breton | BRE | Celtic |
Bosnian | BOS | Indo–European |
Bulgarian | BUL | Slavic |
Burmese | BUR | Asian/Pacific Islander |
Belarusian | BEL | Slavic |
Cambodian/Central Khmer | KHM | Asian/Pacific Islander |
Catalan | CAT | Romance |
Chinese | CHI | Asian/Pacific Islander |
Corsican | COS | Romance |
Croatian | HRV | Slavic |
Czech | CZE | Slavic |
Danish | DAN | Germanic |
Dutch | DUT | Germanic |
English | ENG | Germanic |
Esperanto | EPO | International |
Estonian | EST | Finno–Ugric |
Faroese | FAO | Germanic |
Fiji | FIJ | Oceanic/Indonesian |
Finnish | FIN | Finno–Ugric |
French | FRE | Romance |
Frisian Northern | FRR | Germanic |
Frisian Eastern | FRS | Germanic |
Frisian Western | FRY | Germanic |
Galician | GLG | Romance |
German | GER | Germanic |
Greek | GRE | Latin/Greek |
Georgian | GEO | Ibero–Caucasian |
Greenlandic | KAL | Eskimo |
Guarani | GRN | Amerindian |
Gujarati | GUJ | Indian |
*Haitian–Creole | HAT | (not given) |
Hausa | HAU | Hausa (African) |
Hawaiian | HAW | Polynesian |
Hebrew | HEB | Semitic |
Hindi | HIN | Indian |
Hungarian | HUN | Finno–Ugric |
Icelandic | ICE | Germanic |
Indonesian | IND | Oceanic/Indonesian |
Interlingua | INA | International |
Interlingue | ILE | International |
Inupiaq | IPK | Eskimo |
Irish | GLE | Celtic |
Italian | ITA | Romance |
Japanese | JPN | Asian/Pacific Islander |
Javanese | JAV | Oceanic/Indonesian |
Kannada | KAN | Dravidian |
Kanuri | KAU | Asian/Pacific Islander |
Kashmiri | KAS | Indian |
Kazakh | KAZ | Turkic/Altaic |
Kinyarwanda | KIN | Bantu (African) |
Kirghiz | KIR | Turkic/Altaic |
Korean | KOR | Asian/Pacific Islander |
Kurdish | KUR | Iranian |
Lao | LAO | Asian/Pacific Islander |
Latin | LAT | Latin/Greek |
Latvian;lettish | LAV | Baltic |
Lingala | LIN | Bantu (African) |
Lithuanian | LIT | Baltic |
Macedonian | MAC | Slavic |
Malagasy | MLG | Oceanic/Indonesian |
Malay | MAY | Oceanic/Indonesian |
Malayalam | MAL | Dravidian |
Maltese | MLT | Semitic |
Maori | MAO | Oceanic/Indonesian |
Marathi | MAR | Indian |
Mongolian | MON | (not given) |
Nauru | NAU | (not given) |
Nepali | NEP | Indian |
Norwegian | NOR | Germanic |
Occitan | OCI | Romance |
Oriya | ORI | Indian |
Pashto;pushto | PUS | Iranian |
Persian | PER | Iranian |
Philippine Languages | PHI | Malayo–Polynesian |
Polish | POL | Slavic |
Portuguese | POR | Romance |
Punjabi | PAN | Indian |
Quechua | QUE | Amerindian |
Rhaeto–romansh | ROH | Romance |
Romanian | RUM | Romance |
Rundi | RUN | Bantu (African) |
Russian | RUS | Slavic |
Samoan | SMO | Oceanic/Indonesian |
Sango | SAG | Bantu (African) |
Sanskrit | SAN | Indian |
Scots | SCO | Celtic |
Serbian | SRP | Slavic |
Sotho | SOT | Bantu (African) |
Tswana | TSN | Bantu (African) |
Shona | SNA | Bantu (African) |
*Sign–Language | SGN | (not given) |
Sindhi | SND | Indian |
Singhalese | SIN | Indian |
Swati | SSW | Bantu (African) |
Slovak | SLO | Slavic |
Slovenian | SLV | Slavic |
Somali | SOM | Hamitic |
Spanish | SPA | Romance |
Sundanese | SUN | Oceanic/Indonesian |
Swahili | SWA | Bantu (African) |
Swedish | SWE | Germanic |
Swiss German | GSW | Germanic |
Tagalog/Filipino | TGL | Oceanic/Indonesian |
Tajik | TGK | Iranian |
Tamil | TAM | Dravidian |
Tatar | TAT | Turkic/Altaic |
Telugu | TEL | Dravidian |
Thai | THA | Asian/Pacific Islander |
Tibetan | TIB | Asian/Pacific Islander |
Tigrinya | TIR | Semitic |
Tonga | TON | Oceanic/Indonesian |
Tsonga | TSO | Bantu (Africa) |
Turkish | TUR | Turkic/Altaic |
Turkmen | TUK | Turkic/Altaic |
Twi | TWI | Akan (African) |
Ukrainian | UKR | Slavic |
Urdu | URD | Indian |
Uzbek | UZB | Turkic/Altaic |
Vietnamese | VIE | Asian/Pacific Islander |
Volapuk | VOL | International aux. |
Welsh | WEL | Celtic |
Wolof | WOL | Wolof (African) |
Xhosa | XHO | Bantu (African) |
Yiddish | YID | Germanic |
Yoruba | YOR | Yoruba (African) |
Zulu | ZUL | Bantu (African) |
Language Code Source: ISO 639–2
PROVIDER AND ANCILLARY/SERVICE SPECIALTY CODES – NUMERICAL ORDER
Code | Provider Specialty/Service Description |
---|---|
002 | NEUROMUSCULOSKELETAL MEDICINE & OMM |
003 | HCBS SELF DIRECTION (SUPPORT BROKERAGE) |
004 | VEHICLE MODIFICATION |
005 | STATE OPERATED CLINIC |
006 | DAY TREATMENT (OPWDD) |
007 | ALCOHOLISM/SUBSTANCE ABUSE INPATIENT |
008 | CHILDREN´S MH OUTPATIENT (NON–RESIDENTIAL) |
009 | FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY |
010 | ALLERGY AND IMMUNOLOGY |
011 | GENERAL HOSPITAL (ARTICLE 28) |
012 | ADVANCED HEART FAILURE & TRANSPLANT CARDIOLOGY |
013 | MEDICALLY MANAGED DETOXIFICATION |
014 | ICF/IID FACILITIES |
015 | RESIDENTIAL SUBSTANCE ABUSE TREATMENT SERVICES (STABILIZATION) |
016 | RESIDENTIAL SUBSTANCE ABUSE TREATMENT SERVICES (REHABILITATION) |
017 | OMH PSYCH CTR/OASAS ASA INPATIENT |
018 | PRIVATE PSYCH & ASA INPATIENT |
019 | SUPPORTED EMPLOYMENT |
020 | ANESTHESIOLOGY |
021 | CHILDREN´S MENTAL HEALTH CLINIC TREATMENT |
022 | CHILDREN´S COMMUNITY PSYCHIATRIC SUPPORT & TREATMENT |
023 | CHILDREN´S CRISIS INTERVENTION |
024 | OASAS DIAG AND TREATMENT DSRIP INTEGRATED SERVICES |
025 | OASAS DIAG AND TREATMENT MMTP DSRIP FREESTAND |
026 | OASAS HOSPITAL–BASED OUTPATIENT DSRIP |
027 | OASAS HOSPITAL–BASED OUTPATIENT MMTP DSRIP |
028 | APPLIED BEHAVORIAL ANALYSIS PROVIDERS |
029 | SLEEP CENTERS |
030 | COLON AND RECTAL SURGERY |
032 | HOME INFUSION VENDORS |
033 | SLEEP MEDICINE PHYSICIANS |
034 | STATE OPERATED FACILITY |
035 | LITHOTRIPSY CENTERS |
036 | CHILDREN´S FAMILY PEER SUPPORT SERVICES |
037 | CHILDREN´S HCBS CAREGIVER FAMILY SUPPORT AND SERVICES |
038 | CHILDREN´S HCBS COMMUNITY HABILITATION |
039 | CHILDREN´S HCBS COMMUNITY SELF ADVOCACY TRAINING AND SUPPORT |
040 | DERMATOLOGY |
041 | DERMATOPATHOLOGY |
042 | FISCAL INTERMEDIARY (OPWDD) |
043 | DAY HABILITATION |
044 | CHILDREN´S HCBS CRISIS RESPITE |
045 | CHILDREN´S HCBS DAY HABILITATION |
046 | CHILDREN´S HCBS PALLIATIVE CARE BEREAVEMENT SERVICES |
047 | CHILDREN´S HCBS PALLIATIVE CARE EXPRESSIVE THERAPY |
048 | CHILDREN´S HCBS PALLIATIVE CARE MASSAGE THERAPY |
049 | CHILDREN´S HCBS PALLIATIVE CARE PAIN AND SYMPTOM MANAGEMENT |
050 | FAMILY PRACTICE |
051 | CHILDREN´S HCBS PLANNED RESPITE |
052 | CHILDREN´S HCBS PRE–VOCATIONAL SERVICES |
053 | CHILDREN´S HCBS SUPPORTED EMPLOYMENT |
054 | CHILDREN´S OTHER LICENSED PRACTITIONER |
055 | ADOLESCENT MEDICINE: FAMILY MEDICINE |
056 | ADOLESCENT MEDICINE: PEDIATRICS |
057 | BEHAVIORAL PEDIATRICS |
058 | INTERNAL MEDICINE AND PEDIATRICS |
059 | PEDIATRIC RHEUMATOLOGY |
060 | INTERNAL MEDICINE |
061 | PEDIATRIC INFECTIOUS DISEASE |
062 | CARDIOVASCULAR DISEASE |
063 | ENDOCRINOLOGY AND METABOLISM |
064 | GASTROENTEROLOGY |
065 | HEMATOLOGY – INTERNAL MED |
066 | INFECTIOUS DISEASES |
067 | NEPHROLOGY |
068 | PULMONARY DISEASES |
069 | RHEUMATOLOGY |
070 | NEUROLOGICAL SURGERY |
071 | SPINAL CORD INJURY MEDICINE |
072 | PEDIATRIC NEUROSURGERY |
073 | PEDIATRIC DERMATOLOGY |
074 | MEDICAL TOXICOLOGY |
075 | UNDERSEA & HYPERBARIC MEDICINE |
076 | PEDIATRIC REHABILITATION |
077 | CHILDREN´S PSYCHOSOCIAL REHABILITATION |
078 | YOUTH PEER SUPPORT SERVICES |
079 | SCHOOL BASED HEALTH CENTERS |
080 | NUCLEAR MEDICINE |
081 | MEDICAL NUCLEAR PHYSICS |
083 | NEUROMUSCULAR MEDICINE |
084 | NEURORADIOLOGY |
085 | NEUROTOLOGY |
089 | OBSTETRICS AND GYNECOLOGY |
092 | MATERNAL AND FETAL MEDICINE |
093 | REPRODUCTIVE ENDOCRINOLOGY |
095 | CERTIFIED DIABETES EDUCATOR |
100 | OPHTHALMOLOGY |
101 | PEDIATRIC OPHTHALMOLOGY |
102 | CERTIFIED ASTHMA EDUCATOR |
110 | ORTHOPEDIC SURGERY |
111 | HAND SURGERY – ORTHOPEDIC SURGERY |
112 | HAND SURGERY – PLASTIC SURGERY |
113 | HAND SURGERY – SURGERY |
114 | PLASTIC SURGERY WITH THE HEAD & NECK |
120 | OTOLARYNGOLOGY |
121 | PEDIATRIC OTOLARYNGOLOGY |
127 | CLIA REGISTRATION/COMPLIANCE/ACCREDITATION |
128 | CLIA WAIVER |
129 | CLIA PHYSICIAN PERFORMED MICROSCOPY PROCEDURE |
130 | CLIA WAIVER/REGISTRATION |
131 | BLOOD BANKING |
135 | CLINICAL PATHOLOGY |
136 | FORENSIC PATHOLOGY |
137 | HEMATOLOGY – PSC PATH |
138 | CHEMICAL PATHOLOGY |
139 | MEDICAL MICROBIOLOGY |
140 | PATHOLOGY WITH MOLECULAR GENETIC SPEC |
141 | NEUROPATHOLOGY |
142 | ANATOMIC PATHOLOGY |
143 | DERMATOPATHOLOGY – PSC PATH |
144 | TRANSPLANT HEPATOLOGY |
145 | PEDIATRIC TRANSPLANT HEPATOLOGY |
146 | ANATOMIC AND CLINICAL PATHOLOGY |
147 | PEDIATRIC PATHOLOGY |
148 | RADIOISOTOPIC PATHOLOGY |
149 | PEDIATRIC EMERGENCY MEDICINE |
150 | PEDIATRICS |
151 | PEDIATRIC CARDIOLOGY |
152 | PEDIATRIC HEMATOLOGY – ONCOLOGY |
153 | PEDIATRIC SURGERY |
154 | PEDIATRIC NEPHROLOGY |
155 | PEDIATRIC NEONATAL – PERINATAL MEDICINE |
156 | PEDIATRIC ENDOCRINOLOGY |
157 | PEDIATRIC PULMONOLOGY |
158 | PREFERRED PHYSICIANS AND CHILDREN PROG |
159 | MEDICAID OBSTETRICAL & MATERNAL SVC PROG |
160 | PHYSICAL MEDICINE & REHABILITATION |
161 | PEDIATRIC CRITICAL CARE |
162 | OSTEOPATHIC MANIPULATIVE MEDICINE |
163 | PEDIATRIC GASTROENTEROLOGY |
164 | CRITICAL CARE MED – ANESTHESIOLOGIST |
165 | CRITICAL CARE MEDICINE – INTERNAL |
166 | CRITICAL CARE MEDICINE – OBSTETRICS |
167 | CRITICAL CARE MEDICINE – SURGERY |
169 | MEDICAID OBSTERICAL & MATERNAL SERVICES PRGM (MOMS): HEALTH SUPPORTIVE SERVICES |
170 | PLASTIC SURGERY |
171 | CLINICAL MOLECULAR GENETICS |
180 | CLINICAL BIOCHEMICAL GENETICS |
181 | AEROSPACE |
182 | GENERAL PREVENTIVE MEDICINE |
183 | OCCUPATIONAL MEDICINE |
184 | PUBLIC HEALTH – PREVENTIVE MEDICINE |
185 | AEROSPACE MEDICINE |
186 | T.B. DIRECTLY OBSERVED THERAPY/PHYSICIAN |
187 | MEDICAL GENETICS |
188 | CLINICAL GENETICS |
189 | MOLECULAR GENETIC PATHOLOGY |
190 | PAIN MANAGEMENT–PSYCHIATRY & NEUROLOGY |
191 | CHILD PSYCHIATRY |
192 | PSYCHIATRY |
193 | CHILD NEUROLOGY |
194 | NEUROLOGY |
195 | PSYCHIATRY & NEUROLOGY |
196 | CLOZAPINE CASE MANAGER – PSYCH |
197 | GERIATRIC PSYCHIATRY |
198 | ADDICTION PSYCHIATRY |
199 | NERODEVELOPMENTAL DISABILITIES |
200 | RADIOLOGY |
201 | DIAGNOSTIC RADIOLOGY |
202 | DIAGNOSTIC ROENTGENOLOGY |
205 | THERAPEUTIC RADIOLOGY |
206 | RADIOLOGICAL PHYSICS |
207 | THERAPEUTIC RADIOLOGICAL PHYSICS |
208 | DIAGNOSTIC RADIOLOGICAL PHYSICS |
210 | GENERAL SURGERY |
211 | HOSPITALIST |
220 | THORACIC SURGERY |
230 | UROLOGY |
231 | PEDIATRIC UROLOGY |
240 | VASCULAR NEUROLOGY |
241 | ONCOLOGY |
242 | GYNECOLOGIC ONCOLOGY |
243 | VASCULAR MEDICINE |
244 | RADIOLOGIST ONCOLOGY |
245 | PEDIATRIC RADIOLOGY |
246 | VASCULAR&INTERVENTIONAL RADIOLOGY |
247 | MANAGED CARE – PHYSICIAN ENHANCED FEE |
248 | MANAGED CARE – DENTAL ENHANCED FEE |
249 | HIV PRIMARY CARE SERVICES |
250 | EMERGENCY MEDICINE |
252 | PRIMARY CARE INITIATIVE IN UNDERSERVED AREAS |
253 | SPECIALSTS PRIMARY CARE INIT – UNDERSRVD AREA |
254 | SPECIALISTS IN PHYSICIANS CASE MGMT PROGRAM |
270 | CHILD HEALTH ASSURANCE PROGRAM |
281 | CLINICAL SOCIAL WORKER |
282 | CERTIFIED DRUG & ALCOHOL COUNSELOR |
283 | COUNSELOR |
290 | ACUPUNCTURIST |
300 | PHYSICAL THERAPY |
301 | OCCUPATIONAL THERAPY |
302 | SPEECH THERAPY |
303 | AIDS/HIV SERVICES |
304 | MEDICAL REHAB |
305 | PEDIATRIC SPECIALTY – ALL EXCEPT PRIMARY CARE |
306 | SCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM |
307 | DURABLE MEDICAL EQUIPMENT |
308 | HIV PRIMARY CARE SERVICES – CLINIC SPECIALTY |
309 | MEDICALLY SUPERVISED SUBSTANCE ABUSE |
310 | OMH ADULT CLINIC (STATE OPR) |
311 | OMH CHILD CLINIC (STATE OPR) |
312 | OMH CONTINUING DAY TRTMT (STATE OPR) |
313 | OMH PARTIAL HOSPITALIZATION (STATE OPR) |
314 | OMH INTEN PSYCH REHAB TRTMT (STATE OPR) |
315 | OMH ADULT CLINIC |
316 | OMH CHILD CLINIC |
317 | OMH CONTINUING DAY TREATMENT |
318 | OMH PARTIAL HOSPITALIZATION |
319 | OMH INTENSIVE PSYCH REHAB TREATMENT |
320 | CLOZAPINE CASE MANAGER – CLINIC |
321 | COMPREHENSIVE SPECIALTY CLINIC SERVICES |
322 | OMH COMPREHENSIVE OUTPATIENT PROGRAM (COPS) CLINIC |
323 | OMH COMP OUTPAT PROG (COPS) CONTINUING DAY TRTMT |
324 | PRE–SCHOOL SUPPORTIVE HEALTH CARE |
325 | EARLY INTERVENTION |
326 | OMH/CR ADULT (VOLUNTARY) |
327 | OMH/CR CHILDREN (VOLUNTARY) |
328 | OMH FAMILY BASED TREATMENT |
329 | OMH/CR ADULT (STATE OPR) |
330 | OMH/CR CHILDREN (STATE OPR) |
331 | OMH TEACHING FAMILY HOME |
332 | OMR/DD CR (STATE OPR) |
350 | PPCP ASSOCIATED DENTAL CLINIC – ORAL SURGERY |
351 | PPCP ASSOCIATED DENTAL CLINIC – GENERAL DENTISTRY |
352 | PPCP ASSOCIATED COPS |
353 | PPCP ASSOCIATED OMH CLINICS |
354 | PPCP ASSOCIATED PSYCHIATRY, GENERAL |
355 | AIDS DAY HEALTH CARE SERVICES |
356 | HOME & COMMUNITY BASED SERVICE (HCBS) WAIVER |
357 | OUTPATIENT CHEMICAL DEPENDENCE WITHDRAWL |
358 | TBI SERVICES |
359 | RISPERDAL CONSTA ADMINISTRATION |
360 | ADDICTION MEDICINE |
361 | INTENSIVE BEHAVIORAL SERVICE |
362 | PATHWAYS TO EMPLOYMENT |
365 | MH RESIDENTIAL (NON–INPATIENT) |
370 | PREVOCATIONAL SERVICES |
371 | CASE MANAGEMENT |
372 | START PROGRAM |
373 | RESIDENTIAL HABILITATION –FAMILY CARE |
375 | MH OUTPATIENT (NON–RESIDENTIAL) |
376 | MENTAL HEALTH PRACTITIONER |
400 | MICROBIOLOGY |
401 | FQ OUT–OF–STATE (NON–CMMA) |
402 | FQ PRIMARY |
403 | FQ SECONDARY |
404 | FQ AUTHORIZED |
405 | FEDERALLY QUALIFIED HEALTH CENTER (FQHC) |
406 | PRESUMPTIVE ELIGIBILITY |
407 | TRIBAL HEALTH CENTERS |
408 | DESIGNATED AIDS CENTERS |
410 | BACTERIOLOGY |
411 | BACTERIOLOGY – GENERAL |
412 | BACTERIOLOGY – LIMITED |
413 | BACTERIOLOGY – AEROBES ONLY |
414 | BACTERIOLOGY – NEISSERIA GONORRHOEAE SCREENG |
415 | BACTEROLOGY – GC SMEARS ONLY |
416 | BACTERIOLOGY–RESTRICTED (DENTAL) |
419 | MYCOBACTERIOLOGY – SMEARS AND CULTURE |
420 | MYCOBACTERIOLOGY – GENERAL |
421 | MYCOBACTERIOLOGY – LIMITED |
422 | MYCOBACTERIOLOGY – SMEARS ONLY |
423 | DIAGNOSTIC IMMUNOLOGY – COMPREHENSIVE |
424 | DIAGNOSTIC IMMUNOLOGY – OTHER |
427 | DIAGNOSTIC IMMUNOLOGY – GENERAL/LIMITED |
429 | DIAGNOSTIC IMMUNOLOGY – SPECIAL |
430 | HUMAN IMMUNODEFICIENCY VIRUS – RESTRICTED A |
431 | HUMAN IMMUNODEFICIENCY VIRUS – RESTRICTED B |
432 | HUMAN IMMUNODEFICIENCY VIRUS – COMPREHENSIVE |
433 | SEROLOGY – ROUTINE |
434 | SEROLOGY – LIMITED |
435 | CELLULAR IMMUNOLOGY – LIMITED I |
436 | CELLULAR IMMUNOLOGY – LIMITED II |
437 | SEROLGY – OTHER |
438 | CELLULAR IMMUNOLOGY – GENERAL |
439 | CELLULAR IMMUNOLOGY – LIMITED III |
440 | VIROLOGY – GENERAL I OR GENERAL II |
441 | VIROLOGY – LIMITED |
442 | VIROLOGY – RESTRICTED |
450 | MYCOLOGY – GENERAL |
451 | MYCOLOGY – LIMITED (YEAST ONLY) |
460 | PARASITOLOGY |
461 | PARASITOLOGY – STOOL |
462 | PARASITOLOGY – OTHER |
463 | PARASITOLOGY – BLOOD |
470 | URINE PREGNANCY TESTING |
480 | HEMATOLOGY |
481 | HEMATOLOGY – COMPREHENSIVE |
482 | HEMATOLOGY – GENERAL |
483 | HEMATOLOGY – COAGULATION ONLY |
484 | HEMATOLOGY – LIMITED |
485 | HEMATOLOGY – OTHER |
486 | CYTOHEMATOLOGY – LIMITED/DIAGNOSTIC |
490 | IMMUNOHEMATOLOGY |
491 | BLOOD SERVICES – DIAGNOSTIC IMMUNOHEMATOLOGY |
492 | IMMUNOHEMATOLOGY SPC 492 |
493 | IMMUNOHEMATOLOGY SPC 493 |
510 | CLINICAL CHEMISTRY – GENERAL |
511 | CLINICAL CHEMISTRY – LIMITED |
512 | TOXICOLOGY – ERYTHROCYTE PROTOPORPHYRIN–HEMAT |
513 | TOXICOLOGY – ERYTHROCYTE PROTOPORPHYRIN–EXTRCT |
514 | TOXICOLOGY – DRUG ANALYSIS–QUAL (OR FORENSIC) |
515 | TOXICOLOGY – BLOOD LEAD |
516 | ENDOCRINOLOGY |
517 | CHEMLIMIT |
518 | QUALITATIVE TOXICOLOGY – REHABILITATION PROGS |
519 | CHEM RESERV |
520 | CHEM ALL |
521 | BLOOD PH AND GASES |
522 | CHEM IMD |
523 | THERAPEUTIC SUBSTANCE MONITORING/QUAN TOXICOL |
524 | URINALYSIS |
530 | PATHOLOGY SPC 530 |
531 | HISTOPATHOLOGY – GENERAL/ORAL/DERMATOPATHALGY |
532 | PATHOLOGY SPC 532 |
533 | PATHOLOGY SPC 533 |
540 | CYTOPATHOLOGY |
550 | ONCOFETAL ANTIGEN – GENERAL |
551 | ONCOFETAL ANTIGEN – LIMITED |
552 | ONCOFETAL ANTIGEN – GENERAL, SERA ONLY |
553 | ONCOFETAL ANTIGEN – GENL, AMNIOTIC FLUID ONLY |
560 | GENETIC TESTING |
561 | BLOOD TRANSFUSION COLLECTION |
562 | BLOOD TRANSFUSION |
570 | MISCELLANEOUS |
571 | CYTOGENETICS – GENERAL |
572 | CYTOGENETICS – LIMITED |
573 | CYTOGENETICS – HEMATOLOGICAL DISORDERS |
574 | MISCELLANEOUS HIS |
575 | MISCELLANEOUS LIMITED HIS |
576 | MISCELLANEOUS MISCELLANEOUS |
579 | NURSE: MEDICALLY FRAGILE CHILDREN |
580 | HISTOCOMPATIBILITY – LIMITED |
585 | MISCELLANEOUS CLINIC CHEM |
590 | MISCELLANEOUS SPECIALTY TEST |
599 | LABORATORY |
600 | SPORTS MEDICINE – EMERGENCY |
601 | SPORTS MEDICINE – FAMILY MEDICINE |
602 | SPORTS MEDICINE – INTERNAL |
603 | SPORTS MEDICINE – PEDIATRICS |
604 | SPORTS MEDICINE – ORTHOPEDIC |
611 | RESIDENTIAL HABILITATION –SUPERVISED IRA/CR |
612 | RESIDENTIAL HABILITATION –SUPPORTIVE IRA/CR |
613 | HARM REDUCTION SERVICES/SEP |
614 | ASSISTED LIVING SERVICE |
615 | PERSONAL EMERGENCY RESPONSE SYSTEM |
616 | MENTAL HEALTH INPATIENT |
620 | GERIATRICS – FAMILY MEDICINE |
621 | GERIATRICS – INTERNAL |
630 | PAIN MANAGEMENT |
640 | AUDIOLOGIST |
650 | GENERAL VASCULARY SURGERY |
651 | CARDIO–THORACIC |
652 | INTERVENTION CARDIOLOGY |
653 | CLINICAL CARDIAC ELECTROPHYSIOLOGY |
655 | AIDS SKILLED NURSING FACILITY |
656 | HEAD INJURY/TBI INJURY SNF |
657 | BEHAVIORAL HEALTH INTERVENTION SKILLED NURSING FACILITY (NEURO) |
658 | PEDIATRIC SKILLED NURSING FACILITY |
659 | VENT SKILLED NURSING FACILITY |
660 | INSTITUTIONAL LTC |
661 | SOCIAL AND ENVIRONMENTAL SUPPORTS |
662 | SOCIAL DAY CARE |
663 | NURSING HOME CARE SHORT TERM REHAB |
664 | ADULT DAY HEALTH CARE |
665 | NON INSTITUTIONAL LTC |
666 | ASSISTED LIVING PROGRAM |
667 | HOME DELIVERED MEALS/CONGREGATE MEALS |
668 | HOME CARE – HOME HEALTH AIDE |
669 | HOSPICE CARE |
670 | AMBULANCE |
671 | OTHER TRANSPORTATION (NON–EMERGENT) |
672 | PARALEVEL1 PARAPROFESSIONAL SERVICES: LEVEL 1 HMMAKER/HOUSKP |
673 | PARALEVEL2 PARAPROFESSIONAL SERVICES: LEVEL 2 PERSONAL CARE |
674 | RESPIRATORY THERAPY |
675 | CONSUMER DIRECTED PERSONAL CARE: LEVEL 1 |
676 | CONSUMER DIRECTED PERSONAL CARE: LEVEL 2 |
680 | NURSING |
711 | PRESCRIPTION FOOTWEAR |
714 | LOW VISION SPECIALIST |
715 | OPTICIAN/CONTACT LENS PRIVILGE |
716 | OPTOMETRIST/DIAGNOSTIC PHARMACEUTICALS |
730 | INBORN METABOLIC DISEASE CENTER |
738 | PORTABLE X–RAY COMPANIES |
739 | INDEPENDENT PHYSIOLOGICAL LABS |
740 | REGIONAL PERINATAL TRANSPORTATION PROVIDER |
741 | TRANSPLANT SURGERY |
749 | ASA GENERAL OUTPATIENT |
750 | METHADONE MAINTENANCE (PHYSICIAN) |
751 | METHADONE MAINTENANCE PREFERRED PROVIDER |
752 | COMMUNITY HABILITATION |
754 | ASA MEDICALLY MONITORED WITHDRAWAL |
755 | DOULA |
760 | PHARMACY |
762 | HOME CARE SERVICES AGENCY LIMITED LICENSE |
775 | ALL SPECIALITIES |
776 | GENERAL PRACTICE ONLY – NO SPEC |
777 | ALL PHYSICIAN |
778 | PODIATRIST |
779 | NURSE PRAC |
780 | CLINICAL PSYCHLG |
781 | SOCIAL WKRS |
782 | NURSE MIDWIVES |
790 | RESPITE |
791 | S/HMO (ELDERPLAN) |
798 | LONG–TERM HOME HEALTH |
799 | NO SPECIALTY REQUIRED |
800 | GENERAL DENTIST |
801 | ORTHODONTURE |
802 | ENDODONTIST |
803 | ORAL PATHOLOGIST |
804 | PEDODONTIST |
805 | PROSTHODONTIST |
806 | PERIODONTIST |
807 | PUBLIC HEALTH |
808 | ORAL SURGEON |
809 | DENTAL ANESTHESIOLOGIST |
810 | PARENTERAL CONSCIOUS SEDATION |
811 | MAXILLOFACIAL SURGERY |
815 | DENTIST – FAMILY |
816 | ASSERTIVE COMMUNITY TREATMENT |
817 | ASSISTIVE TECHNOLOGY |
818 | COMMUNITY INTEGRATION COUNSELING |
819 | COMMUNITY TRANSITIONAL SERVICE PROVIDER |
820 | ENVIRONMENTAL MODIFICATIONS SERVICES |
821 | FREESTANDING BIRTH CENTER |
822 | INDEPENDENT LIVING SKILLS TRAINING PROVIDER |
823 | URGENT CARE |
824 | MOBILE MENTAL HEALTH TREATMENT PROVIDER/CRISIS INTERVENTION |
825 | MOVING ASSISTANCE PROVIDER |
826 | PALLIATIVE CARE PROVIDER |
827 | PEER DELIVERED SERVICES |
828 | PEER MENTORING PROVIDER |
829 | PERSONALIZED RECOVERY ORIENTED SERVICES |
830 | POSITIVE BEHAVIORAL INTERVENTIONS AND SUPPORTS |
831 | SOCIAL DAY CARE TRANSPORTATION |
832 | STRUCTURED DAY PROGRAM |
833 | TELEHEALTH |
834 | HOME AND COMMUNITY SUPPORT SERVICES |
835 | PROVIDER TRAVEL |
836 | PSYCHOSOCIAL REHAB |
837 | PEER SUPPORT |
838 | OMH OTHER LICENSED PRACTITIONERS |
839 | COMMUNITY PSYCHIATRIC SUPPORTS AND TREATMENT |
851 | OTHER VISION CARE |
852 | PCCM ENHANCEMENT |
853 | PCCM QUALITY ENHANCEMENT |
854 | HABILITATION SUPPORT SERVICES |
855 | FAMILY SUPPORT AND TRAINING |
856 | SHORT–TERM CRISIS RESPITE |
857 | INTENSIVE CRISIS RESPITE |
858 | PRE–VOCATIONAL SERVICES |
859 | TRANSITIONAL EMPLOYMENT |
860 | INTENSIVE SUPPORTIVE EMPLOYMENT |
861 | ONGOING SUPPORTED EMPLOYMENT |
862 | EDUCATION SUPPORT SERVICES |
899 | HOSPITAL INPATIENT |
900 | HMO CO–PAYMENT |
901 | EMERGENCY ROOM |
902 | ENDOCRINE |
903 | DIABETES |
904 | OBSTETRICS |
905 | GYNECOLOGY |
906 | FAMILY PLANNING |
907 | ABORTION |
908 | CHILD HEALTH ASSURANCE PROGRAM (CHAP) |
909 | NUTRITION |
910 | ORAL SURGERY – CLINIC SPECIALTY |
911 | GENERAL DENTISTRY – CLINIC SPECIALTY |
912 | ORTHODONTICS – CLINIC SPECIALTY |
913 | HEMODIALYSIS |
914 | GENERAL MEDICINE – CLINIC SPECIALTY |
915 | ALLERGY |
916 | ARTHRITIS |
917 | RHEUMATOLOGY – CLINIC SPECIALTY |
918 | PODIATRIST CENTER |
919 | EYE/VISION CENTER |
920 | PHYSICAL THERAPY – CLINIC SPECIALTY |
921 | SPEECH THERAPY– CLINIC SPECIALTY |
922 | METHADONE MAINTENANCE TREATMENT PROGRAM |
923 | OCCUPATIONAL THERAPY– CLINIC SPECIALTY |
924 | REHABILITATION MEDICINE– CLINIC SPECIALTY |
925 | HYPERTENSION – CLINIC SPECIALTY |
926 | HEMATOLOGY– CLINIC SPECIALTY |
927 | CARDIOLOGY |
928 | CARDIOVASCULAR– CLINIC SPECIALTY |
929 | PULMONARY–CLINIC SPECIALTY |
930 | GASTROENTEROLOGY – CLINIC SPECIALTY |
931 | NEUROLOGY– CLINIC SPECIALTY |
932 | NEUROSURGERY– CLINIC SPECIALTY |
933 | CANCER DETECTION |
934 | ONCOLOGY – THERAPY (RADIATION OR CHEMO) |
935 | EAR, NOSE & THROAT– CLINIC SPECIALTY |
936 | PEDIATRIC GENERAL MEDICINE– CLINIC SPECIALTY |
937 | PEDIATRIC ALLERGY– CLINIC SPECIALTY |
938 | PEDIATRIC NEUROLOGY– CLINIC SPECIALTY |
939 | PEDIATRIC HEMATOLOGY– CLINIC SPECIALTY |
940 | PEDIATRIC CARDIAC – CLINIC SPECIALTY |
941 | PEDIATRIC RENAL– CLINIC SPECIALTY |
942 | PEDIATRIC PULMONARY– CLINIC SPECIALTY |
943 | PEDIATRIC ORTHOPEDIC– CLINIC SPECIALTY |
944 | PEDIATRIC ENDOCRINE – CLINIC SPECIALTY |
945 | PSYCHIATRY – INDIVIDUAL |
946 | PSYCHIATRY – GROUP |
947 | PSYCHIATRY – HALF DAY CARE |
948 | PSYCHIATRY – FULL DAY CARE |
949 | ALCOHOLISM TREATMENT PROGRAM |
950 | ORTHOPEDIC– CLINIC SPECIALTY |
951 | SURGICAL, MINOR |
952 | SURGICAL, GENERAL |
953 | UROLOGY – CLINIC SPECIALTY |
954 | NEPHROLOGY – CLINIC SPECIALTY |
955 | GENITO–URINARY– CLINIC SPECIALTY |
956 | DERMATOLOGY – CLINIC SPECIALTY |
957 | CONTRACT CARRIER |
958 | OPHTHALMOLOGY – CLINIC SPECIALTY |
959 | OUTPAT CHEM DEPENDENCY PROG FOR YOUTH |
960 | PEDIATRIC DERMATOLOGY – CLINIC SPECIALTY |
961 | PEDIATRIC DIABETES– CLINIC SPECIALTY |
962 | PEDIATRIC SURGERY – CLINIC SPECIALTY |
963 | CHILD PSYCHIATRY – CLINIC SPECIALTY |
964 | PSYCHIATRY–GENERAL– CLINIC SPECIALTY |
965 | TUBERCULOSIS– CLINIC SPECIALTY |
966 | INFECTIOUS DISEASES – CLINIC SPECIALTY |
967 | SPEECH & HEARING– CLINIC SPECIALTY |
968 | AMPUTEE CENTER |
969 | HOSP DME/ORTHOTIC/PROSTH APPLNC VENDOR |
970 | NURSING HOME HOSPITAL DAYCARE (NO CLAIM) |
971 | MH CLINIC TREATMENT (STATE OPR) |
972 | MH DAY TREATMENT (STATE OPR) |
973 | MH CONTINUING TREATMENT (STATE OPR) |
974 | MENTAL HEALTH CLINIC TREATMENT |
975 | MENTAL HEALTH DAY TREATMENT |
976 | MENTAL HEALTH CONTINUING TREATMENT |
977 | MR/DD CLINIC TREATMENT (STATE OPR) |
978 | PREFERRED PRIMARY CARE CLINIC |
979 | MR/DD CLINIC TREATMENT |
980 | T.B. DIRECTLY OBSERVED THERAPY/CLINIC |
981 | DIAG AND RESEARCH CLINIC MR (STATE OPR) |
982 | APNEA CENTER |
983 | SPECIALTY CLINIC – MR |
984 | ALCOHOLISM CLINIC TREATMENT (STATE OPR) |
985 | ALCOHOLISM DAY REHAB (STATE OPR) |
986 | ALCOHOLISM CLINIC TREATMENT |
987 | ALCOHOLISM DAY REHABILIATION |
988 | COMPREHENSIVE ALCOHOLISM CARE |
989 | MEDICALLY SUPERVISED WITHDRAWAL–OUTPATIENT |
990 | COMP PHYSICAL EXAM (SCHOOL HEALTH PROJ) |
991 | ROUTINE VISIT (SCHOOL HEALTH PROJECT) |
992 | OMH COMPREHENSIVE PSYCHIATRIC EMERGENCY PROG |
993 | HOSP–BASED/FREESTANDING AMBULAT SURGERY |
994 | BLOOD PRODUCTS (ORDERED AMBULATORY) |
995 | GENETIC COUNSELING (ORDERED AMBULATORY) |
996 | HEARING SERVICES (ORDERED AMBULATORY) |
997 | OPERATING ROOM (ORDERED AMBULATORY) |
998 | RADIOLOGY (ORDERED AMBULATORY) |
999 | OTHER |
PROVIDER AND ANCILLARY/SERVICE SPECIALTY CODES – ALPHABETICAL ORDER
Code | Provider Specialty/Service Description |
---|---|
907 | ABORTION |
290 | ACUPUNCTURIST |
360 | ADDICTION MEDICINE |
198 | ADDICTION PSYCHIATRY |
055 | ADOLESCENT MEDICINE: FAMILY MEDICINE |
056 | ADOLESCENT MEDICINE: PEDIATRICS |
664 | ADULT DAY HEALTH CARE |
012 | ADVANCED HEART FAILURE & TRANSPLANT CARDIOLOGY |
181 | AEROSPACE |
185 | AEROSPACE MEDICINE |
355 | AIDS DAY HEALTH CARE SERVICES |
655 | AIDS SKILLED NURSING FACILITY |
303 | AIDS/HIV SERVICES |
986 | ALCOHOLISM CLINIC TREATMENT |
984 | ALCOHOLISM CLINIC TREATMENT (STATE OPR) |
985 | ALCOHOLISM DAY REHAB (STATE OPR) |
987 | ALCOHOLISM DAY REHABILIATION |
949 | ALCOHOLISM TREATMENT PROGRAM |
007 | ALCOHOLISM/SUBSTANCE ABUSE INPATIENT |
777 | ALL PHYSICIAN |
775 | ALL SPECIALITIES |
915 | ALLERGY |
010 | ALLERGY AND IMMUNOLOGY |
670 | AMBULANCE |
968 | AMPUTEE CENTER |
146 | ANATOMIC AND CLINICAL PATHOLOGY |
142 | ANATOMIC PATHOLOGY |
020 | ANESTHESIOLOGY |
982 | APNEA CENTER |
028 | APPLIED BEHAVORIAL ANALYSIS PROVIDERS |
916 | ARTHRITIS |
749 | ASA GENERAL OUTPATIENT |
754 | ASA MEDICALLY MONITORED WITHDRAWAL |
816 | ASSERTIVE COMMUNITY TREATMENT |
666 | ASSISTED LIVING PROGRAM |
614 | ASSISTED LIVING SERVICE |
817 | ASSISTIVE TECHNOLOGY |
640 | AUDIOLOGIST |
410 | BACTERIOLOGY |
413 | BACTERIOLOGY – AEROBES ONLY |
411 | BACTERIOLOGY – GENERAL |
412 | BACTERIOLOGY – LIMITED |
414 | BACTERIOLOGY – NEISSERIA GONORRHOEAE SCREENG |
416 | BACTERIOLOGY–RESTRICTED (DENTAL) |
415 | BACTEROLOGY – GC SMEARS ONLY |
657 | BEHAVIORAL HEALTH INTERVENTION SKILLED NURSING FACILITY (NEURO) |
057 | BEHAVIORAL PEDIATRICS |
131 | BLOOD BANKING |
521 | BLOOD PH AND GASES |
994 | BLOOD PRODUCTS (ORDERED AMBULATORY) |
491 | BLOOD SERVICES – DIAGNOSTIC IMMUNOHEMATOLOGY |
562 | BLOOD TRANSFUSION |
561 | BLOOD TRANSFUSION COLLECTION |
933 | CANCER DETECTION |
927 | CARDIOLOGY |
651 | CARDIO–THORACIC |
928 | CARDIOVASCULAR– CLINIC SPECIALTY |
062 | CARDIOVASCULAR DISEASE |
371 | CASE MANAGEMENT |
438 | CELLULAR IMMUNOLOGY – GENERAL |
435 | CELLULAR IMMUNOLOGY – LIMITED I |
436 | CELLULAR IMMUNOLOGY – LIMITED II |
439 | CELLULAR IMMUNOLOGY – LIMITED III |
781 | SOCIAL WKRS |
102 | CERTIFIED ASTHMA EDUCATOR |
095 | CERTIFIED DIABETES EDUCATOR |
282 | CERTIFIED DRUG & ALCOHOL COUNSELOR |
520 | CHEM ALL |
522 | CHEM IMD |
519 | CHEM RESERV |
138 | CHEMICAL PATHOLOGY |
517 | CHEMLIMIT |
270 | CHILD HEALTH ASSURANCE PROGRAM |
908 | CHILD HEALTH ASSURANCE PROGRAM (CHAP) |
193 | CHILD NEUROLOGY |
191 | CHILD PSYCHIATRY |
963 | CHILD PSYCHIATRY – CLINIC SPECIALTY |
022 | CHILDREN´S COMMUNITY PSYCHIATRIC SUPPORT & TREATMENT |
023 | CHILDREN´S CRISIS INTERVENTION |
036 | CHILDREN´S FAMILY PEER SUPPORT SERVICES |
037 | CHILDREN´S HCBS CAREGIVER FAMILY SUPPORT AND SERVICES |
038 | CHILDREN´S HCBS COMMUNITY HABILITATION |
039 | CHILDREN´S HCBS COMMUNITY SELF ADVOCACY TRAINING AND SUPPORT |
044 | CHILDREN´S HCBS CRISIS RESPITE |
045 | CHILDREN´S HCBS DAY HABILITATION |
046 | CHILDREN´S HCBS PALLIATIVE CARE BEREAVEMENT SERVICES |
047 | CHILDREN´S HCBS PALLIATIVE CARE EXPRESSIVE THERAPY |
048 | CHILDREN´S HCBS PALLIATIVE CARE MASSAGE THERAPY |
049 | CHILDREN´S HCBS PALLIATIVE CARE PAIN AND SYMPTOM MANAGEMENT |
051 | CHILDREN´S HCBS PLANNED RESPITE |
052 | CHILDREN´S HCBS PRE–VOCATIONAL SERVICES |
053 | CHILDREN´S HCBS SUPPORTED EMPLOYMENT |
021 | CHILDREN´S MENTAL HEALTH CLINIC TREATMENT |
008 | CHILDREN´S MH OUTPATIENT (NON–RESIDENTIAL) |
054 | CHILDREN´S OTHER LICENSED PRACTITIONER |
077 | CHILDREN´S PSYCHOSOCIAL REHABILITATION |
129 | CLIA PHYSICIAN PERFORMED MICROSCOPY PROCEDURE |
127 | CLIA REGISTRATION/COMPLIANCE/ACCREDITATION |
128 | CLIA WAIVER |
130 | CLIA WAIVER/REGISTRATION |
180 | CLINICAL BIOCHEMICAL GENETICS |
653 | CLINICAL CARDIAC ELECTROPHYSIOLOGY |
510 | CLINICAL CHEMISTRY – GENERAL |
511 | CLINICAL CHEMISTRY – LIMITED |
188 | CLINICAL GENETICS |
171 | CLINICAL MOLECULAR GENETICS |
135 | CLINICAL PATHOLOGY |
780 | CLINICAL PSYCHLG |
281 | CLINICAL SOCIAL WORKER |
320 | CLOZAPINE CASE MANAGER – CLINIC |
196 | CLOZAPINE CASE MANAGER – PSYCH |
030 | COLON AND RECTAL SURGERY |
752 | COMMUNITY HABILITATION |
818 | COMMUNITY INTEGRATION COUNSELING |
819 | COMMUNITY TRANSITIONAL SERVICE PROVIDER |
839 | COMMUNITY PSYCHIATRIC SUPPORTS AND TREATMENT |
990 | COMP PHYSICAL EXAM (SCHOOL HEALTH PROJ) |
988 | COMPREHENSIVE ALCOHOLISM CARE |
321 | COMPREHENSIVE SPECIALTY CLINIC SERVICES |
675 | CONSUMER DIRECTED PERSONAL CARE: LEVEL 1 |
676 | CONSUMER DIRECTED PERSONAL CARE: LEVEL 2 |
957 | CONTRACT CARRIER |
283 | COUNSELOR |
164 | CRITICAL CARE MED – ANESTHESIOLOGIST |
165 | CRITICAL CARE MEDICINE – INTERNAL |
166 | CRITICAL CARE MEDICINE – OBSTETRICS |
167 | CRITICAL CARE MEDICINE – SURGERY |
571 | CYTOGENETICS – GENERAL |
573 | CYTOGENETICS – HEMATOLOGICAL DISORDERS |
572 | CYTOGENETICS – LIMITED |
486 | CYTOHEMATOLOGY – LIMITED/DIAGNOSTIC |
540 | CYTOPATHOLOGY |
043 | DAY HABILITATION |
006 | DAY TREATMENT (OPWDD) |
809 | DENTAL ANESTHESIOLOGIST |
815 | DENTIST – FAMILY |
040 | DERMATOLOGY |
956 | DERMATOLOGY – CLINIC SPECIALTY |
041 | DERMATOPATHOLOGY |
143 | DERMATOPATHOLOGY – PSC PATH |
408 | DESIGNATED AIDS CENTERS |
903 | DIABETES |
981 | DIAG AND RESEARCH CLINIC MR (STATE OPR) |
423 | DIAGNOSTIC IMMUNOLOGY – COMPREHENSIVE |
427 | DIAGNOSTIC IMMUNOLOGY – GENERAL/LIMITED |
424 | DIAGNOSTIC IMMUNOLOGY – OTHER |
429 | DIAGNOSTIC IMMUNOLOGY – SPECIAL |
208 | DIAGNOSTIC RADIOLOGICAL PHYSICS |
201 | DIAGNOSTIC RADIOLOGY |
202 | DIAGNOSTIC ROENTGENOLOGY |
755 | DOULA |
307 | DURABLE MEDICAL EQUIPMENT |
935 | EAR, NOSE & THROAT– CLINIC SPECIALTY |
325 | EARLY INTERVENTION |
862 | EDUCATION SUPPORT SERVICES |
250 | EMERGENCY MEDICINE |
901 | EMERGENCY ROOM |
902 | ENDOCRINE |
516 | ENDOCRINOLOGY |
063 | ENDOCRINOLOGY AND METABOLISM |
802 | ENDODONTIST |
820 | ENVIRONMENTAL MODIFICATIONS SERVICES |
919 | EYE/VISION CENTER |
906 | FAMILY PLANNING |
050 | FAMILY PRACTICE |
855 | FAMILY SUPPORT AND TRAINING |
009 | FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY |
042 | FISCAL INTERMEDIARY (OPWDD) |
136 | FORENSIC PATHOLOGY |
404 | FQ AUTHORIZED |
405 | FEDERALLY QUALIFIED HEALTH CENTER (FQHC) |
401 | FQ OUT–OF–STATE (NON–CMMA) |
402 | FQ PRIMARY |
403 | FQ SECONDARY |
821 | FREESTANDING BIRTH CENTER |
064 | GASTROENTEROLOGY |
930 | GASTROENTEROLOGY – CLINIC SPECIALTY |
800 | GENERAL DENTIST |
911 | GENERAL DENTISTRY – CLINIC SPECIALTY |
011 | GENERAL HOSPITAL (ARTICLE 28) |
914 | GENERAL MEDICINE – CLINIC SPECIALTY |
776 | GENERAL PRACTICE ONLY – NO SPEC |
182 | GENERAL PREVENTIVE MEDICINE |
210 | GENERAL SURGERY |
650 | GENERAL VASCULARY SURGERY |
995 | GENETIC COUNSELING (ORDERED AMBULATORY) |
560 | GENETIC TESTING |
955 | GENITO–URINARY– CLINIC SPECIALTY |
197 | GERIATRIC PSYCHIATRY |
620 | GERIATRICS – FAMILY MEDICINE |
621 | GERIATRICS – INTERNAL |
242 | GYNECOLOGIC ONCOLOGY |
905 | GYNECOLOGY |
854 | HABILITATION SUPPORT SERVICES |
111 | HAND SURGERY – ORTHOPEDIC SURGERY |
112 | HAND SURGERY – PLASTIC SURGERY |
113 | HAND SURGERY – SURGERY |
613 | HARM REDUCTION SERVICES/SEP |
656 | HEAD INJURY/TBI INJURY SNF |
996 | HEARING SERVICES (ORDERED AMBULATORY) |
480 | HEMATOLOGY |
483 | HEMATOLOGY – COAGULATION ONLY |
481 | HEMATOLOGY – COMPREHENSIVE |
482 | HEMATOLOGY – GENERAL |
065 | HEMATOLOGY – INTERNAL MED |
484 | HEMATOLOGY – LIMITED |
485 | HEMATOLOGY – OTHER |
137 | HEMATOLOGY – PSC PATH |
926 | HEMATOLOGY– CLINIC SPECIALTY |
913 | HEMODIALYSIS |
580 | HISTOCOMPATIBILITY – LIMITED |
531 | HISTOPATHOLOGY – GENERAL/ORAL/DERMATOPATHALGY |
249 | HIV PRIMARY CARE SERVICES |
308 | HIV PRIMARY CARE SERVICES – CLINIC SPECIALTY |
900 | HMO CO–PAYMENT |
356 | HOME & COMMUNITY BASED SERVICE (HCBS) WAIVER |
834 | HOME AND COMMUNITY SUPPORT SERVICES |
668 | HOME CARE – HOME HEALTH AIDE |
762 | HOME CARE SERVICES AGENCY LIMITED LICENSE |
667 | HOME DELIVERED MEALS/CONGREGATE MEALS |
969 | HOSP DME/ORTHOTIC/PROSTH APPLNC VENDOR |
993 | HOSP–BASED/FREESTANDING AMBULAT SURGERY |
032 | HOME INFUSION VENDORS |
669 | HOSPICE CARE |
899 | HOSPITAL INPATIENT |
211 | HOSPITALIST |
003 | HCBS SELF DIRECTION (SUPPORT BROKERAGE) |
432 | HUMAN IMMUNODEFICIENCY VIRUS – COMPREHENSIVE |
430 | HUMAN IMMUNODEFICIENCY VIRUS – RESTRICTED A |
431 | HUMAN IMMUNODEFICIENCY VIRUS – RESTRICTED B |
925 | HYPERTENSION – CLINIC SPECIALTY |
014 | ICF/IID FACILITIES |
490 | IMMUNOHEMATOLOGY |
492 | IMMUNOHEMATOLOGY SPC 492 |
493 | IMMUNOHEMATOLOGY SPC 493 |
730 | INBORN METABOLIC DISEASE CENTER |
822 | INDEPENDENT LIVING SKILLS TRAINING PROVIDER |
739 | INDEPENDENT PHYSIOLOGICAL LABS |
066 | INFECTIOUS DISEASES |
966 | INFECTIOUS DISEASES – CLINIC SPECIALTY |
660 | INSTITUTIONAL LONG–TERM CARE |
663 | INSTITUTIONAL SHORT–TERM CARE |
361 | INTENSIVE BEHAVIORAL SERVICE |
857 | INTENSIVE CRISIS RESPITE |
860 | INTENSIVE SUPPORTIVE EMPLOYMENT |
060 | INTERNAL MEDICINE |
058 | INTERNAL MEDICINE AND PEDIATRICS |
652 | INTERVENTION CARDIOLOGY |
599 | LABORATORY |
035 | LITHOTRIPSY CENTERS |
798 | LONG–TERM HOME HEALTH |
714 | LOW VISION SPECIALIST |
248 | MANAGED CARE – DENTAL ENHANCED FEE |
247 | MANAGED CARE – PHYSICIAN ENHANCED FEE |
092 | MATERNAL AND FETAL MEDICINE |
811 | MAXILLOFACIAL SURGERY |
169 | MEDICAID OBSTERICAL & MATERNAL SERVICES PRGM (MOMS): HEALTH SUPPORTIVE SERVICES |
159 | MEDICAID OBSTETRICAL & MATERNAL SVC PROG |
187 | MEDICAL GENETICS |
139 | MEDICAL MICROBIOLOGY |
081 | MEDICAL NUCLEAR PHYSICS |
304 | MEDICAL REHAB |
074 | MEDICAL TOXICOLOGY |
013 | MEDICALLY MANAGED DETOXIFICATION |
309 | MEDICALLY SUPERVISED SUBSTANCE ABUSE |
989 | MEDICALLY SUPERVISED WITHDRAWAL–OUTPATIENT |
974 | MENTAL HEALTH CLINIC TREATMENT |
976 | MENTAL HEALTH CONTINUING TREATMENT |
975 | MENTAL HEALTH DAY TREATMENT |
616 | MENTAL HEALTH INPATIENT |
376 | MENTAL HEALTH PRACTITIONER |
750 | METHADONE MAINTENANCE (PHYSICIAN) |
751 | METHADONE MAINTENANCE PREFERRED PROVIDER |
922 | METHADONE MAINTENANCE TREATMENT PROGRAM |
971 | MH CLINIC TREATMENT (STATE OPR) |
973 | MH CONTINUING TREATMENT (STATE OPR) |
972 | MH DAY TREATMENT (STATE OPR) |
375 | MH OUTPATIENT (NON–RESIDENTIAL) |
365 | MH RESIDENTIAL (NON–INPATIENT) |
400 | MICROBIOLOGY |
570 | MISCELLANEOUS |
585 | MISCELLANEOUS CLINIC CHEM |
574 | MISCELLANEOUS HIS |
575 | MISCELLANEOUS LIMITED HIS |
576 | MISCELLANEOUS MISCELLANEOUS |
590 | MISCELLANEOUS SPECIALTY TEST |
824 | MOBILE MENTAL HEALTH TREATMENT PROVIDER/CRISIS INTERVENTION |
189 | MOLECULAR GENETIC PATHOLOGY |
825 | MOVING ASSISTANCE PROVIDER |
979 | MR/DD CLINIC TREATMENT |
977 | MR/DD CLINIC TREATMENT (STATE OPR) |
420 | MYCOBACTERIOLOGY – GENERAL |
421 | MYCOBACTERIOLOGY – LIMITED |
419 | MYCOBACTERIOLOGY – SMEARS AND CULTURE |
422 | MYCOBACTERIOLOGY – SMEARS ONLY |
450 | MYCOLOGY – GENERAL |
451 | MYCOLOGY – LIMITED (YEAST ONLY) |
067 | NEPHROLOGY |
954 | NEPHROLOGY – CLINIC SPECIALTY |
199 | NERODEVELOPMENTAL DISABILITIES |
070 | NEUROLOGICAL SURGERY |
194 | NEUROLOGY |
931 | NEUROLOGY– CLINIC SPECIALTY |
083 | NEUROMUSCULAR MEDICINE |
002 | NEUROMUSCULOSKELETAL MEDICINE & OMM |
141 | NEUROPATHOLOGY |
084 | NEURORADIOLOGY |
932 | NEUROSURGERY– CLINIC SPECIALTY |
085 | NEUROTOLOGY |
799 | NO SPECIALTY REQUIRED |
665 | NON–INSTITUTIONAL LTC |
080 | NUCLEAR MEDICINE |
782 | NURSE MIDWIVES |
779 | NURSE PRAC |
579 | NURSE: MEDICALLY FRAGILE CHILDREN |
680 | NURSING |
970 | NURSING HOME HOSPITAL DAYCARE (NO CLAIM) |
909 | NUTRITION |
024 | OASAS DIAG AND TREATMENT DSRIP INTEGRATED SERVICES |
025 | OASAS DIAG AND TREATMENT MMTP DSRIP FREESTAND |
026 | OASAS HOSPITAL–BASED OUTPATIENT DSRIP |
027 | OASAS HOSPITAL–BASED OUTPATIENT MMTP DSRIP |
904 | OBSTETRICS |
089 | OBSTETRICS AND GYNECOLOGY |
183 | OCCUPATIONAL MEDICINE |
301 | OCCUPATIONAL THERAPY |
923 | OCCUPATIONAL THERAPY– CLINIC SPECIALTY |
315 | OMH ADULT CLINIC |
310 | OMH ADULT CLINIC (STATE OPR) |
316 | OMH CHILD CLINIC |
311 | OMH CHILD CLINIC (STATE OPR) |
323 | OMH COMP OUTPAT PROG (COPS) CONTINUING DAY TRTMT |
322 | OMH COMPREHENSIVE OUTPATIENT PROGRAM (COPS) CLINIC |
992 | OMH COMPREHENSIVE PSYCHIATRIC EMERGENCY PROG |
317 | OMH CONTINUING DAY TREATMENT |
312 | OMH CONTINUING DAY TRTMT (STATE OPR) |
328 | OMH FAMILY BASED TREATMENT |
314 | OMH INTEN PSYCH REHAB TRTMT (STATE OPR) |
319 | OMH INTENSIVE PSYCH REHAB TREATMENT |
838 | OMH OTHER LICENSED PRACTITIONERS |
318 | OMH PARTIAL HOSPITALIZATION |
313 | OMH PARTIAL HOSPITALIZATION (STATE OPR) |
017 | OMH PSYCH CTR/OASAS ASA INPATIENT |
331 | OMH TEACHING FAMILY HOME |
329 | OMH/CR ADULT (STATE OPR) |
326 | OMH/CR ADULT (VOLUNTARY) |
330 | OMH/CR CHILDREN (STATE OPR) |
327 | OMH/CR CHILDREN (VOLUNTARY) |
332 | OMR/DD CR (STATE OPR) |
550 | ONCOFETAL ANTIGEN – GENERAL |
552 | ONCOFETAL ANTIGEN – GENERAL, SERA ONLY |
553 | ONCOFETAL ANTIGEN – GENL, AMNIOTIC FLUID ONLY |
551 | ONCOFETAL ANTIGEN – LIMITED |
241 | ONCOLOGY |
934 | ONCOLOGY – THERAPY (RADIATION OR CHEMO) |
861 | ONGOING SUPPORTED EMPLOYMENT |
997 | OPERATING ROOM (ORDERED AMBULATORY) |
100 | OPHTHALMOLOGY |
958 | OPHTHALMOLOGY – CLINIC SPECIALTY |
716 | OPTOMETRIST/DIAGNOSTIC PHARMEUTICALS |
803 | ORAL PATHOLOGIST |
808 | ORAL SURGEON |
910 | ORAL SURGERY – CLINIC SPECIALTY |
912 | ORTHODONTICS – CLINIC SPECIALTY |
801 | ORTHODONTURE |
950 | ORTHOPEDIC– CLINIC SPECIALTY |
110 | ORTHOPEDIC SURGERY |
162 | OSTEOPATHIC MANIPULATIVE MEDICINE |
999 | OTHER |
671 | OTHER TRANSPORTATION (NON–EMERGENT) |
851 | OTHER VISION CARE |
120 | OTOLARYNGOLOGY |
959 | OUTPAT CHEM DEPENDENCY PROG FOR YOUTH |
357 | OUTPATIENT CHEMICAL DEPENDENCE WITHDRAWL |
630 | PAIN MANAGEMENT |
190 | PAIN MANAGEMENT–PSYCHIATRY & NEUROLOGY |
826 | PALLIATIVE CARE PROVIDER |
672 | PARALEVEL1 PARAPROFESSIONAL SERVICES: LEVEL 1 HMMAKER/HOUSKP |
673 | PARALEVEL2 PARAPROFESSIONAL SERVICES: LEVEL 2 PERSONAL CARE |
460 | PARASITOLOGY |
463 | PARASITOLOGY – BLOOD |
462 | PARASITOLOGY – OTHER |
461 | PARASITOLOGY – STOOL |
810 | PARENTERAL CONSCIOUS SEDATION |
530 | PATHOLOGY SPC 530 |
532 | PATHOLOGY SPC 532 |
533 | PATHOLOGY SPC 533 |
140 | PATHOLOGY WITH MOLECULAR GENETIC SPEC |
362 | PATHWAYS TO EMPLOYMENT |
852 | PCCM ENHANCEMENT |
853 | PCCM QUALITY ENHANCEMENT |
937 | PEDIATRIC ALLERGY– CLINIC SPECIALTY |
940 | PEDIATRIC CARDIAC – CLINIC SPECIALTY |
151 | PEDIATRIC CARDIOLOGY |
161 | PEDIATRIC CRITICAL CARE |
073 | PEDIATRIC DERMATOLOGY |
960 | PEDIATRIC DERMATOLOGY – CLINIC SPECIALTY |
961 | PEDIATRIC DIABETES– CLINIC SPECIALTY |
149 | PEDIATRIC EMERGENCY MEDICINE |
944 | PEDIATRIC ENDOCRINE – CLINIC SPECIALTY |
156 | PEDIATRIC ENDOCRINOLOGY |
163 | PEDIATRIC GASTROENTOLOGY |
936 | PEDIATRIC GENERAL MEDICINE– CLINIC SPECIALTY |
152 | PEDIATRIC HEMATOLOGY – ONCOLOGY |
939 | PEDIATRIC HEMATOLOGY– CLINIC SPECIALTY |
061 | PEDIATRIC INFECTIOUS DISEASE |
155 | PEDIATRIC NEONATAL – PERINATAL MEDICINE |
154 | PEDIATRIC NEPHROLOGY |
938 | PEDIATRIC NEUROLOGY– CLINIC SPECIALTY |
072 | PEDIATRIC NEUROSURGERY |
101 | PEDIATRIC OPHTHALMOLOGY |
943 | PEDIATRIC ORTHOPEDIC– CLINIC SPECIALTY |
121 | PEDIATRIC OTOLARYNGOLOGY |
147 | PEDIATRIC PATHOLOGY |
942 | PEDIATRIC PULMONARY– CLINIC SPECIALTY |
157 | PEDIATRIC PULMONOLOGY |
245 | PEDIATRIC RADIOLOGY |
076 | PEDIATRIC REHABILITATION |
941 | PEDIATRIC RENAL– CLINIC SPECIALTY |
059 | PEDIATRIC RHEUMATOLOGY |
658 | PEDIATRIC SKILLED NURSING FACILITY |
305 | PEDIATRIC SPECIALTY – ALL EXCEPT PRIMARY CARE |
153 | PEDIATRIC SURGERY |
962 | PEDIATRIC SURGERY – CLINIC SPECIALTY |
145 | PEDIATRIC TRANSPLANT HEPATOLOGY |
231 | PEDIATRIC UROLOGY |
150 | PEDIATRICS |
804 | PEDODONTIST |
827 | PEER DELIVERED SERVICES |
828 | PEER MENTORING PROVIDER |
837 | PEER SUPPORT |
806 | PERIODONTIST |
615 | PERSONAL EMERGENCY RESPONSE SYSTEM |
829 | PERSONALIZED RECOVERY ORIENTED SERVICES |
760 | PHARMACY |
160 | PHYSICAL MEDICINE & REHABILITATION |
300 | PHYSICAL THERAPY |
920 | PHYSICAL THERAPY – CLINIC SPECIALTY |
170 | PLASTIC SURGERY |
114 | PLASTIC SURGERY WITH THE HEAD & NECK |
778 | PODIATRIST |
918 | PODIATRIST CENTER |
738 | PORTABLE X–RAY COMPANIES |
830 | POSITIVE BEHAVIORAL INTERVENTIONS AND SUPPORTS |
352 | PPCP ASSOCIATED COPS |
351 | PPCP ASSOCIATED DENTAL CLINIC – GENERAL DENTISTRY |
350 | PPCP ASSOCIATED DENTAL CLINIC – ORAL SURGERY |
353 | PPCP ASSOCIATED OMH CLINICS |
354 | PPCP ASSOCIATED PSYCHIATRY, GENERAL |
158 | PREFERRED PHYSICIANS AND CHILDREN PROG |
978 | PREFERRED PRIMARY CARE CLINIC |
324 | PRE–SCHOOL SUPPORTIVE HEALTH CARE |
406 | PRESUMPTIVE ELIGIBILITY |
711 | PRESCRIPTION FOOTWEAR |
370 | PREVOCATIONAL SERVICES |
252 | PRIMARY CARE INITIATIVE IN UNDERSERVED AREAS |
018 | PRIVATE PSYCH & ASA INPATIENT |
805 | PROSTHODONTIST |
835 | PROVIDER TRAVEL |
836 | PSYCHOSOCIAL REHAB |
192 | PSYCHIATRY |
948 | PSYCHIATRY – FULL DAY CARE |
946 | PSYCHIATRY – GROUP |
947 | PSYCHIATRY – HALF DAY CARE |
945 | PSYCHIATRY – INDIVIDUAL |
195 | PSYCHIATRY & NEUROLOGY |
964 | PSYCHIATRY–GENERAL– CLINIC SPECIALTY |
807 | PUBLIC HEALTH |
184 | PUBLIC HEALTH – PREVENTIVE MEDICINE |
068 | PULMONARY DISEASES |
929 | PULMONARY–CLINIC SPECIALTY |
518 | QUALITATIVE TOXICOLOGY – REHABILITATION PROGS |
148 | RADIOISOTOPIC PATHOLOGY |
206 | RADIOLOGICAL PHYSICS |
244 | RADIOLOGIST ONCOLOGY |
200 | RADIOLOGY |
998 | RADIOLOGY (ORDERED AMBULATORY) |
740 | REGIONAL PERINATAL TRANSPORTATION PROV |
924 | REHABILITATION MEDICINE– CLINIC SPECIALTY |
093 | REPRODUCTIVE ENDOCRINOLOGY |
373 | RESIDENTIAL HABILITATION –FAMILY CARE |
611 | RESIDENTIAL HABILITATION –SUPERVISED IRA/CR |
612 | RESIDENTIAL HABILITATION –SUPPORTIVE IRA/CR |
015 | RESIDENTIAL SUBSTANCE ABUSE TREATMENT SERVICES (STABILIZATION) |
016 | RESIDENTIAL SUBSTANCE ABUSE TREATMENT SERVICES (REHABILITATION) |
674 | RESPIRATORY THERAPY |
790 | RESPITE |
069 | RHEUMATOLOGY |
917 | RHEUMATOLOGY – CLINIC SPECIALTY |
359 | RISPERDAL CONSTA ADMINISTRATION |
991 | ROUTINE VISIT (SCHOOL HEALTH PROJECT) |
791 | S/HMO (ELDERPLAN) |
079 | SCHOOL BASED HEALTH CENTERS |
306 | SCHOOL SUPPORTIVE HEALTH SERVICES PROGRAM |
437 | SEROLGY – OTHER |
434 | SEROLOGY – LIMITED |
433 | SEROLOGY – ROUTINE |
856 | SHORT–TERM CRISIS RESPITE |
029 | SLEEP CENTERS |
033 | SLEEP MEDICINE PHYSICIANS |
661 | SOCIAL AND ENVIRONMENTAL SUPPORTS |
662 | SOCIAL DAY CARE |
831 | SOCIAL DAY CARE TRANSPORTATION |
254 | SPECIALISTS IN PHYSICIANS CASE MGMT PROGRAM |
253 | SPECIALSTS PRIMARY CARE INIT – UNDERSRVD AREA |
983 | SPECIALTY CLINIC – MR |
967 | SPEECH & HEARING– CLINIC SPECIALTY |
302 | SPEECH THERAPY |
921 | SPEECH THERAPY– CLINIC SPECIALTY |
071 | SPINAL CORD INJURY MEDICINE |
600 | SPORTS MEDICINE – EMERGENCY |
601 | SPORTS MEDICINE – FAMILY MEDICINE |
602 | SPORTS MEDICINE – INTERNAL |
604 | SPORTS MEDICINE – ORTHOPEDIC |
603 | SPORTS MEDICINE – PEDIATRICS |
372 | START PROGRAM |
005 | STATE OPERATED CLINIC |
034 | STATE OPERATED FACILITY |
832 | STRUCTURED DAY PROGRAM |
019 | SUPPORTED EMPLOYMENT |
952 | SURGICAL, GENERAL |
951 | SURGICAL, MINOR |
980 | T.B. DIRECTLY OBSERVED THERAPY/CLINIC |
186 | T.B. DIRECTLY OBSERVED THERAPY/PHYSICIAN |
358 | TBI SERVICES |
833 | TELEHEALTH |
207 | THERAPEUTIC RADIOLOGICAL PHYSICS |
205 | THERAPEUTIC RADIOLOGY |
523 | THERAPEUTIC SUBSTANCE MONITORING/QUAN TOXICOL |
220 | THORACIC SURGERY |
515 | TOXICOLOGY – BLOOD LEAD |
514 | TOXICOLOGY – DRUG ANALYSIS–QUAL (OR FORENSIC) |
513 | TOXICOLOGY – ERYTHROCYTE PROTOPORHYRIN–EXTRCT |
512 | TOXICOLOGY – ERYTHROCYTE PROTOPORPHYRIN–HEMAT |
859 | TRANSITIONAL EMPLOYMENT |
144 | TRANSPLANT HEPATOLOGY |
741 | TRANSPLANT SURGERY |
407 | TRIBAL HEALTH CENTERS |
965 | TUBERCULOSIS– CLINIC SPECIALTY |
075 | UNDERSEA & HYPERBARIC MEDICINE |
823 | URGENT CARE |
524 | URINALYSIS |
470 | URINE PREGNANCY TESTING |
230 | UROLOGY |
953 | UROLOGY – CLINIC SPECIALTY |
243 | VASCULAR MEDICINE |
240 | VASCULAR NEUROLOGY |
246 | VASCULAR&INTERVENTIONAL RADIOLOGY |
659 | VENT SKILLED NURSING FACILITY |
004 | VEHICLE MODIFICATION |
440 | VIROLOGY – GENERAL I OR GENERAL II |
441 | VIROLOGY – LIMITED |
442 | VIROLOGY – RESTRICTED |
078 | YOUTH PEER SUPPORT SERVICES |
Provider Network Data System
VII. ATTESTATION
Provider Network Attestation
The document on the following page is to be signed by the Chief Executive Officer (CEO) of the managed care organization/health insurer/Special Needs Program (SNP) and notarized as the formal attestation that the electronic submission of data will represent the total and accurate contracted network for the managed care organization/health insurer/SNP.
All managed care organizations/health insurer/SNP´s must submit an annual Provider Network Attestation form. Please note that a separate attestation form is required for New York State of Health Network and/or SNP networks. Plans should follow up with their plan managers to receive the correct attestation template.
The annual Provider Network attestation form(s) assures the New York State Department of Health and the Center for Medicare and Medicaid Services (CMS) that all CEOs are current and are acknowledging the importance of the provider network submission.
ONLY ONE ATTESTATION IS REQUIRED PER YEAR unless specifically requested by the Office of Health Insurance Programs in conjunction with the review of an acquisition, expansion or new plan application.
DUE DATE: JANUARY 31
Please mail the notarized form to:
Susan Bentley, DirectorNew York State Department of Health
Bureau of Managed Care Certification and Surveillance
Division of Health Plan Contracting and Oversight
Corning Tower
OCP–Room # 1609
Albany, NY 12237
PROVIDER NETWORK ATTESTATION
I, _____________________________, the Chief Executive Officer of ______________________________________________________, hereby attest under the penalty of
(Name of the Managed Care Organization/Health Insurer/SNP)
Perjury to the following:
_______________________________________
Chief Executive Officer
_______________________________________
Date
_______________________________________
Notary Seal and Signature
Provider Network Data System
VIII. PROVIDER & ANCILLARY FILE ERROR CODES
ERROR CODES
PHYSICIAN AND OTHER PROVIDER ERROR LISTING
Message Number | Provider File Error Description |
---|---|
1 | LAST NAME BLANK |
2 | FIRST NAME BLANK |
3 | LICENSE NUMBER BLANK OR NOT VALID |
4 | MEDS ID NOT VALID/BLANK FOR MCAIDPROV |
5 | COMM MEDS ID IS NOT 9 FILLED |
6 | ROOM/SUITE NUMBER BLANK |
7 | STREET ADDRESS BLANK |
8 | TOWN/CITY BLANK |
9 | STATE BLANK OR NOT VALID |
10 | COUNTY CODE NOT A VALID FIPS CODE |
11 | NOT VALID ZIP OR COUNTY CODE |
12 | NOT VALID WHEELCHAIR – ALL PAYERS |
13 | PRIMARY DESIG CODE NOT VALID |
14 | PROVIDER TYPE CODE NOT VALID |
15 | PRIMARY SPEC CODE NOT VALID |
16 | SECONDARY SPEC CODE NOT VALID |
17 | PRIMARY DESIG/SPEC CODE COMBO NOT VALID |
18 | BOARD STATUS NOT VALID |
19 | BOARD STATUS NOT VALID FOR RESID STATUS |
20 | BOARD OR RESID STATUS NOT VALID FOR MD/DO |
21 | BOARD STATUS 2 NOT VALID |
22 | BOARD STATUS 2 NOT VALID FOR RESID STATUS 2 |
23 | BOARD OR RESID STATUS 2 NOT VALID FOR MD |
24 | RESID ATTENDING PHYSICIAN LICENSE # BLANK OR 0 |
25 | RESID STATUS NOT VALID FOR PCP–MD |
26 | RESID STATUS NOT VALID FOR SPECIALIST |
27 | RESID STATUS NOT VALID FOR NON–MD |
28 | RESID STATUS 2 NOT VALID FOR MD OR SPEC |
29 | RESID STATUS 2 NOT VALID FOR NONPCP |
30 | GENDER NOT VALID |
31 | PHYSICIAN EXT NOT VALID FOR PCP–MD/DO |
32 | PHYSICIAN EXT NOT VALID FOR PCP–NP & NONPCP |
33 | COMM PROV IND NOT 0 OR 1 |
34 | MCAID PROV IND NOT 0 OR 1 |
35 | MCARE PROV IND NOT 0 OR 1 |
36 | CHP PROV IND NOT 0 OR 1 |
37 | HARP PROV IND NOT 0 OR 1 |
38 | COMM NON–MCO MEDICAL IND 1 NOT 0 OR 1 |
39 | COMM NON–MCO VISION IND 1 NOT 0 OR 1 |
40 | COMM NON–MCO DENTAL IND 1 NOT 0 OR 1 |
41 | PCP COMM PANL STATUS NOT VALID |
42 | PCP MCAID PANL STATUS NOT VALID |
43 | NONPCP MCAID OB PANL STATUS NOT VALID |
44 | PCP MCARE PANL STATUS NOT VALID |
45 | PCP CHP PANL STATUS NOT VALID |
46 | NONPCP COMM PANL STATUS NOT VALID |
47 | NONPCP MCAID PANL STAT NOT VALID |
48 | NONPCP MCARE PANL STATUS NOT VALID |
49 | NONPCP CHP PANL STATUS NOT VALID |
50 | COMM PANL SZ MISSING FOR PCP |
51 | MCAID PANL SZ MISSING FOR PCP |
52 | MCARE PANL SZ MISSING FOR PCP |
53 | CHP PANL SZ MISSING FOR PCP |
54 | COMM PANL SZ NOT 9 FILL FOR NONPCP |
55 | MCAID PANL SZ NOT 9 FILL FOR NONPCP |
56 | MCARE PANL SZ NOT 9 FILL FOR NONPCP |
57 | CHP PANL SZ NOT 9 FILL FOR NONPCP |
58 | HA#1 OPCERT INVALID 4 PCP–MD/OB–GYN |
59 | HA#2 OPCERT INVALID 4 PCP–MD/OB–GYN |
60 | HA#3 OPCERT INVALID 4 PCP–MD/OB–GYN |
61 | HA#1 PFI NOT VALID FOR PCP |
62 | HA#2 PFI NOT VALID FOR PCP |
63 | HA#3 PFI NOT VALID FOR PCP |
64 | HA#1 PFI & OPCERT DON´T MATCH |
65 | HA#2 PFI & OPCERT DON´T MATCH |
66 | HA#3 PFI & OPCERT DON´T MATCH |
67 | TOTAL OFFICE HOURS NOT VALID FOR PCP |
68 | EVE IND NOT VALID FOR MCAID/CHP PCP |
69 | LANGUAGES MISSING ENGLISH |
70 | AREA CODE BLANK OR NOT VALID |
71 | PHONE NUMBER BLANK OR NOT VALID |
72 | NPI BLANK OR NOT VALID |
73 | MEDICAID ADVANTAGE PROV IND NOT 0 OR 1 |
74 | PARTIAL CAPS PROV IND NOT 0 OR 1 |
75 | MAP PROV IND NOT 0 OR 1 |
76 | PACE PROV IND NOT 0 OR 1 |
77 | PCP MCAID ADVANTAGE PANL STATUS NOT VALID |
78 | PCP PARTIAL CAPS PANL STATUS NOT VALID |
79 | PCP MAP PANL STATUS NOT VALID |
80 | PCP PACE PANL STATUS NOT VALID |
81 | NONPCP MCAID ADVANTAGE PANL STATUS NOT VALID |
82 | NONPCP PARTIAL CAPS PANL STATUS NOT VALID |
83 | NONPCP MAP PANL STATUS NOT VALID |
84 | NONPCP PACE PANL STATUS NOT VALID |
85 | MCAID ADVANTAGE PANL SZ MISSING FOR PCP |
86 | PARTIAL CAPS PANL SZ MISSING FOR PCP |
87 | MAP PANL SZ MISSING FOR PCP |
88 | PACE PANL SZ MISSING FOR PCP |
89 | MCAID ADVANTAGE PANL SZ NOT 9 FILL FOR NONPCP |
90 | PARTIAL CAPS PANL SZ NOT 9 FILL FOR NONPCP |
91 | MAP PANL SZ NOT 9 FILL FOR NONPCP |
92 | PACE PANL SZ NOT 9 FILL FOR NONPCP |
93 | FEIN BLANK OR NOT VALID |
94 | NYSOH MEDICAL NET IND 1 NOT 0 OR 1 |
95 | NYSOH MEDICAL NET IND 2 NOT 0 OR 1 |
96 | NYSOH MEDICAL NET IND 3 NOT 0 OR 1 |
97 | NYSOH MEDICAL NET IND 4 NOT 0 OR 1 |
98 | NYSOH MEDICAL NET IND 5 NOT 0 OR 1 |
99 | NYSOH MEDICAL NET IND 6 NOT 0 OR 1 |
100 | NYSOH MEDICAL NET IND 7 NOT 0 OR 1 |
101 | NYSOH MEDICAL NET IND 8 NOT 0 OR 1 |
102 | NYSOH MEDICAL NET IND 9 NOT 0 OR 1 |
103 | NYSOH DENTAL NET IND 1 NOT 0 OR 1 |
104 | NYSOH DENTAL NET IND 2 NOT 0 OR 1 |
105 | NYSOH DENTAL NET IND 3 NOT 0 OR 1 |
106 | NYSOH DENTAL NET IND 4 NOT 0 OR 1 |
107 | COMM NON–MCO MEDICAL IND 2 NOT 0 OR 1 |
108 | COMM NON–MCO MEDICAL IND 3 NOT 0 OR 1 |
109 | COMM NON–MCO MEDICAL IND 4 NOT 0 OR 1 |
110 | COMM NON–MCO MEDICAL IND 5 NOT 0 OR 1 |
111 | COMM NON–MCO MEDICAL IND 6 NOT 0 OR 1 |
112 | COMM NON–MCO MEDICAL IND 7 NOT 0 OR 1 |
113 | COMM NON–MCO MEDICAL IND 8 NOT 0 OR 1 |
114 | COMM NON–MCO VISION IND 2 NOT 0 OR 1 |
115 | COMM NON–MCO VISION IND 3 NOT 0 OR 1 |
116 | COMM NON–MCO VISION IND 4 NOT 0 OR 1 |
117 | COMM NON–MCO VISION IND 5 NOT 0 OR 1 |
118 | COMM NON–MCO VISION IND 6 NOT 0 OR 1 |
119 | COMM NON–MCO DENTAL IND 2 NOT 0 OR 1 |
120 | COMM NON–MCO DENTAL IND 3 NOT 0 OR 1 |
121 | COMM NON–MCO DENTAL IND 4 NOT 0 OR 1 |
122 | COMM NON–MCO DENTAL IND 5 NOT 0 OR 1 |
123 | PCP NYSOH MED NET 1 PANL STATUS NOT VALID |
124 | PCP NYSOH MED NET 2 PANL STATUS NOT VALID |
125 | PCP NYSOH MED NET 3 PANL STATUS NOT VALID |
126 | PCP NYSOH MED NET 4 PANL STATUS NOT VALID |
127 | PCP NYSOH MED NET 5 PANL STATUS NOT VALID |
128 | PCP NYSOH MED NET 6 PANL STATUS NOT VALID |
129 | PCP NYSOH MED NET 7 PANL STATUS NOT VALID |
130 | PCP NYSOH MED NET 8 PANL STATUS NOT VALID |
131 | PCP NYSOH MED NET 9 PANL STATUS NOT VALID |
132 | NONPCP NYSOH MED NET 1 PANL STATUS NOT VALID |
133 | NONPCP NYSOH MED NET 2 PANL STATUS NOT VALID |
134 | NONPCP NYSOH MED NET 3 PANL STATUS NOT VALID |
135 | NONPCP NYSOH MED NET 4 PANL STATUS NOT VALID |
136 | NONPCP NYSOH MED NET 5 PANL STATUS NOT VALID |
137 | NONPCP NYSOH MED NET 6 PANL STATUS NOT VALID |
138 | NONPCP NYSOH MED NET 7 PANL STATUS NOT VALID |
139 | NONPCP NYSOH MED NET 8 PANL STATUS NOT VALID |
140 | NONPCP NYSOH MED NET 9 PANL STATUS NOT VALID |
141 | NYSOH MED NET 1 PANL SZ MISSING FOR PCP |
142 | NYSOH MED NET 2 PANL SZ MISSING FOR PCP |
143 | NYSOH MED NET 3 PANL SZ MISSING FOR PCP |
144 | NYSOH MED NET 4 PANL SZ MISSING FOR PCP |
145 | NYSOH MED NET 5 PANL SZ MISSING FOR PCP |
146 | NYSOH MED NET 6 PANL SZ MISSING FOR PCP |
147 | NYSOH MED NET 7 PANL SZ MISSING FOR PCP |
148 | NYSOH MED NET 8 PANL SZ MISSING FOR PCP |
149 | NYSOH MED NET 9 PANL SZ MISSING FOR PCP |
150 | NYSOH MED NET 1 PANL SZ NOT 9 FILL FOR NONPCP |
151 | NYSOH MED NET 2 PANL SZ NOT 9 FILL FOR NONPCP |
152 | NYSOH MED NET 3 PANL SZ NOT 9 FILL FOR NONPCP |
153 | NYSOH MED NET 4 PANL SZ NOT 9 FILL FOR NONPCP |
154 | NYSOH MED NET 5 PANL SZ NOT 9 FILL FOR NONPCP |
155 | NYSOH MED NET 6 PANL SZ NOT 9 FILL FOR NONPCP |
156 | NYSOH MED NET 7 PANL SZ NOT 9 FILL FOR NONPCP |
157 | NYSOH MED NET 8 PANL SZ NOT 9 FILL FOR NONPCP |
158 | NYSOH MED NET 9 PANL SZ NOT 9 FILL FOR NONPCP |
160 | SIP INDICATOR NOT 0 OR 1 |
161 | PCP SIP IND PANL STATUS NOT VALID |
162 | NONPCP SIP IND PANL STATUS NOT VALID |
163 | SIP IND PANL SZ MISSING FOR PCP |
164 | SIP IND PANL SZ NOT 9 FILL FOR NONPCP |
319 | NYSOH MUST HAVE AT LEAST 1 NYSOH PRODUCT IND |
320 | FIDA PROV IND NOT 0 OR 1 |
321 | PCP FIDA PANL STATUS NOT VALID |
322 | NONPCP FIDA PANL STATUS NOT VALID |
323 | FIDA PANL SZ MISSING FOR PCP |
324 | FIDA PANL SZ NOT 9 FILL FOR NONPCP |
325 | STANDARD EP PROV IND NOT 0 OR 1 |
326 | EP PLUS ADULT VISION AND DENTAL PROV IND NOT 0 OR 1 |
327 | PCP STANDARD EP PANL STATUS NOT VALID |
328 | PCP EP PLUS ADULT VISION AND DENTAL PANL STATUS NOT VALID |
329 | STANDARD EP PANL SZ MISSING FOR PCP |
330 | STANDARD EP PANL SZ NOT 9 FILL FOR NONPCP |
331 | EP PLUS ADULT VISION AND DENTAL PANL SZ MISSING FOR PCP |
332 | EP PLUS ADULT VISION AND DENTAL PANL SZ NOT 9 FILL FOR NONPCP |
333 | NONPCP STANDARD EP PANL STATUS NOT VALID |
334 | NONPCP EP+ ADULT VISION & DENTAL PANL STATUS NOT VALID |
335 | FIDA IDD IND NOT 0 OR 1 |
336 | PCP FIDA IDD PANL STATUS NOT VALID |
337 | NONPCP FIDA IDD OB PANL STATUS NOT VALID |
338 | NONPCP FIDA IDD PANL STAT NOT VALID |
339 | FIDA IDD PANL SZ MISSING FOR PCP |
340 | FIDA IDD PANL SZ NOT 9 FILL FOR NONPCP |
341 | PCP HARP PANL STATUS NOT VALID |
342 | NONPCP HARP OB PANL STATUS NOT VALID |
343 | NONPCP HARP PANL STAT NOT VALID |
344 | HARP PANL SZ MISSING FOR PCP |
345 | HARP PANL SZ NOT 9 FILL FOR NONPCP |
346 | HIV SNP IND NOT 0 OR 1 |
347 | PCP HIV SNP PANL STATUS NOT VALID |
348 | NONPCP HIV SNP OB PANL STATUS NOT VALID |
349 | NONPCP HIV SNP PANL STAT NOT VALID |
350 | HIV SNP PANL SZ MISSING FOR PCP |
351 | HIV SNP PANL SZ NOT 9 FILL FOR NONPCP |
352 | SITE NPI BLANK OR NOT VALID |
353 | INVALID PROVIDER TYPE FOR PRIMARY DESIGNATION |
354 | ADDRESS UNDEFINED LOCATION |
355 | TOTAL OFFICE HOURS NOT VALID FOR NONPCP |
356 | TOTAL OFFICE HOURS NOT VALID FOR COMMERCIAL ONLY/NON MED–HIV–CHP PCP |
357 | TOTAL OFFICE HOURS ZERO FOR PCP |
358 | MAN CARE PLAN ID NUM FORMAT |
999 | SITE NPI REFERENCE ERROR |
1000 | NPI REFERENCE ERROR |
1001 | SED REFERENCE ERROR |
1002 | MMIS REFERENCE ERROR |
1003 | HFIS REFERENCE ERROR |
1004 | PRODUCT INVALID FOR THE PLAN |
1005 | PRODUCT MISSING FOR THE PLAN/COUNTY/SUBMISSION |
1006 | RECORD FORMAT INVALID |
1007 | ADDRESS VALIDATION FAILURE |
1008 | NAME VALIDATION FAILURE |
1009 | MMIS MLTC REFERENCE ERROR |
1010 | INVALID PRODUCT VALUES FOR NETWORK CHECK |
1011 | VALUES NOT IDENTICAL WITHIN A NETWORK PRODUCT |
1012 | VALUES NOT IDENTICAL FOR ALL NETWORK PRODUCTS |
1016 | MEDS ID NOT FOUND ON REFERENCE DATA |
1017 | MEDS ID NOT ASSOCIATED WITH SUBMITTED NPI |
1339 | UNKOWN LANGUAGE CODE |
1340 | INVALID EMAIL |
1341 | SITE NAME BLANK |
ERROR CODES
ANCILLARY/SERVICE CENTER ERROR LISTING
Message Number | Service File Error Description |
---|---|
1 | SITE NAME BLANK |
2 | ROOM/SUITE NUMBER BLANK |
3 | COUNTY CODE NOT A VALID FIPS CODE |
4 | DESIGNATED SERVICE CODE NOT VALID |
5 | STREET ADDRESS BLANKS |
6 | CITY BLANK |
7 | ZIP OR COUNTY CODE NOT VALID |
8 | MEDICAID PROVIDER NUMBER BLANK |
9 | AREA CODE BLANK OR INVALID |
10 | PHONE NUMBER BLANK OR INVALID |
11 | STATE CODE BLANK OR INVALID |
12 | HOSPITAL OPCERT/PFI COMBO INVALID |
13 | NURSING HOME OPCERT/PFI COMBO INVALID |
14 | HOME CARE OPCERT/PFI COMBO INVALID |
15 | CLINIC OPCERT/PFI COMBO INVALID |
16 | HOSPICE OPCERT/PFI COMBO INVALID |
17 | CLIA OPCERT/PFI COMBO INVALID |
18 | NUMBER OF PROVIDERS AT CENTER NOT VALID |
19 | COMM PROVIDER INDICATOR NOT 0 OR 1 |
20 | MCAID PROVIDER INDICATOR NOT 0 OR 1 |
21 | MCARE PROVIDER INDICATOR NOT 0 OR 1 |
22 | CHP PROVIDER INDICATOR NOT 0 OR 1 |
23 | HARP PROVIDER INDICATOR NOT 0 OR 1 |
24 | COMMERCIAL NON–MCO MEDICAL INDICATOR NOT 0 OR 1 |
25 | COMMERCIAL NON–MCO VISION INDICATOR NOT 0 OR 1 |
26 | COMMERCIAL NON–MCO DENTAL INDICATOR NOT 0 OR 1 |
27 | MISSING ADDITIONAL SERVICES FOR HOSPITAL |
28 | SERVICE #1 CODE NOT VALID |
29 | SERVICE #2 CODE NOT VALID |
30 | SERVICE #3 CODE NOT VALID |
31 | SERVICE #4 CODE NOT VALID |
32 | SERVICE #5 CODE NOT VALID |
33 | SERVICE #6 CODE NOT VALID |
34 | SERVICE #7 CODE NOT VALID |
35 | SERVICE #8 CODE NOT VALID |
36 | SERVICE #9 CODE NOT VALID |
37 | SERVICE #10 CODE NOT VALID |
38 | SERVICE #11 CODE NOT VALID |
39 | SERVICE #12 CODE NOT VALID |
40 | SERVICE #13 CODE NOT VALID |
41 | SERVICE #14 CODE NOT VALID |
42 | SERVICE #15 CODE NOT VALID |
43 | SERVICE #16 CODE NOT VALID |
44 | SERVICE #17 CODE NOT VALID |
45 | SERVICE #18 CODE NOT VALID |
46 | SERVICE #19 CODE NOT VALID |
47 | SERVICE #20 CODE NOT VALID |
48 | SERVICE #21 CODE NOT VALID |
49 | SERVICE #22 CODE NOT VALID |
50 | SERVICE #23 CODE NOT VALID |
51 | SERVICE #24 CODE NOT VALID |
52 | SERVICE #25 CODE NOT VALID |
53 | NPI BLANK OR NOT VALID |
54 | MCAID ADVAN PROVIDER INDICATOR NOT 0 OR 1 |
55 | PARTIAL CAPS PROVIDER INDICATOR NOT 0 OR 1 |
56 | MAP PROVIDER INDICATOR NOT 0 OR 1 |
57 | PACE PROVIDER INDICATOR NOT 0 OR 1 |
58 | NYSOH MEDICAL NET IND 1 NOT 0 OR 1 |
59 | NYSOH MEDICAL NET IND 2 NOT 0 OR 1 |
60 | NYSOH MEDICAL NET IND 3 NOT 0 OR 1 |
61 | NYSOH MEDICAL NET IND 4 NOT 0 OR 1 |
62 | NYSOH MEDICAL NET IND 5 NOT 0 OR 1 |
63 | NYSOH MEDICAL NET IND 6 NOT 0 OR 1 |
64 | NYSOH MEDICAL NET IND 7 NOT 0 OR 1 |
65 | NYSOH MEDICAL NET IND 8 NOT 0 OR 1 |
66 | NYSOH MEDICAL NET IND 9 NOT 0 OR 1 |
67 | COMM NONMCO MEDICAL NET IND 2 NOT 0 OR 1 |
68 | COMM NONMCO MEDICAL NET IND 3 NOT 0 OR 1 |
69 | COMM NONMCO MEDICAL NET IND 4 NOT 0 OR 1 |
70 | COMM NONMCO MEDICAL NET IND 5 NOT 0 OR 1 |
71 | COMM NONMCO MEDICAL NET IND 6 NOT 0 OR 1 |
72 | COMM NONMCO MEDICAL NET IND 7 NOT 0 OR 1 |
73 | COMM NONMCO MEDICAL NET IND 8 NOT 0 OR 1 |
74 | SIP INDICATOR IND 1 NOT 0 OR 1 |
103 | NYSOH MUST HAVE AT LEAST 1 NYSOH PRODUCT IND |
104 | FIDA PROVIDER INDICATOR NOT 0 OR 1 |
105 | STANDARD EP PROVIDER INDICATOR NOT 0 OR 1 |
106 | EP PLUS ADULT VISION AND DENTAL PROV IND NOT 0 OR 1 |
107 | FIDA IDD IND NOT 0 OR 1 |
108 | HIV SNP IND NOT 0 OR 1 |
109 | SERV CNTY CODE 1 NOT A VALID FIPS CODE |
110 | SERV CNTY CODE 2 NOT A VALID FIPS CODE |
111 | SERV CNTY CODE 3 NOT A VALID FIPS CODE |
112 | SERV CNTY CODE 4 NOT A VALID FIPS CODE |
113 | SERV CNTY CODE 5 NOT A VALID FIPS CODE |
114 | SERV CNTY CODE 1 NOT 999 FOR DESER |
115 | SERV CNTY CODE 2 NOT 999 FOR DESER |
116 | SERV CNTY CODE 3 NOT 999 FOR DESER |
117 | SERV CNTY CODE 4 NOT 999 FOR DESER |
118 | SERV CNTY CODE 5 NOT 999 FOR DESER |
119 | OASAS PRU NOT VALID |
120 | OASAS PROVIDER ID NOT VALID |
121 | OMH ID NOT VALID |
122 | ADDRESS UNDEFINED LOCATION |
123 | MAN CARE PLAN FACILITY ID NUM FORMAT |
1000 | NPI REFERENCE ERROR |
1001 | SED REFERENCE ERROR |
1002 | MMIS REFERENCE ERROR |
1003 | HFIS REFERENCE ERROR |
1004 | PRODUCT INVALID FOR THE PLAN |
1005 | PRODUCT MISSING FOR THE PLAN/COUNTY/SUBMISSION |
1006 | RECORD FORMAT INVALID |
1007 | ADDRESS VALIDATION FAILURE |
1008 | NAME VALIDATION FAILURE |
1009 | MMIS MLTC REFERENCE ERROR |
1010 | INVALID PRODUCT VALUES FOR NETWORK CHECK |
1011 | VALUES NOT IDENTICAL WITHIN A NETWORK PRODUCT |
1012 | VALUES NOT IDENTICAL FOR ALL NETWORK PRODUCTS |
1013 | OMH REFERENCE ERROR |
1014 | OASAS REFERENCE ERROR |
1015 | HRS/SEP REFERENCE ERROR |
Provider Network Data System
IX. CODING SCHEME SUMMARY REPORTS
Provider File
Service File
Table 1 – Core Listing of Required Providers by Program Type
Category of Service | Primary Designation | Provider Type | Specialty Codes | Commercial MCO off of the NYSOH | CHP | Medicaid | HIV Special Needs | MAP & MLTC | PACE | Medicaid Advantage | FIDA | NYSOH QHP/EP | NYSOH Dental | HARP | Commercial Non–MCO Medical | Commercial Non–MCO Vision | Commercial Non–MCO Dental | FIDA IDD | SIP–PL |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Primary Care Providers | |||||||||||||||||||
Family Practice | 1, 3 | 01, 2, 12 | 50 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
General Practice | 1, 3 | 01, 2, 12 | 776 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Internal Medicine | 1, 3 | 01, 2, 12 | 60 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
HIV Specialist PCP 1 | 3 | 01, 02, 12 | 050, 060, 776, 066, Secd Spec=303 |
N | N | N | *(SNP– 1) | N | N | N | N | N | N | N | N | N | N | N | N |
Pediatrics | 1, 3 | 01, 02, 12 | 150 | * | * | * | *(SNP– 1) | N | N | N | N | N–EP / *QHP | N | N | * | N | N | N | * |
Obstetrics/Gynecology Care and Support | |||||||||||||||||||
Doula § | 2 | 11 | 755 | N | N | * | N | N | N | N | N | N | N | N | N | N | N | N | * |
Gynecology | 2, 3 | 01, 12 | 905 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Nurse Midwife/Certified Midwife | 2, 3 | 03, 50 | 782 | * | * | * | * | N | N | N | * | * | N | * | * | N | N | * | * |
Obstetrics & Gynecology (OB/GYN) | 2, 3 | 01, 12 | 89 | * | * | * | * | N | N | N | * | * | N | * | * | N | N | * | * |
Behavioral Health Providers | |||||||||||||||||||
Behavior Analysis | 2, 3 | 71, 78 | 28 | * | * | * | * | N | N | N | N | * | N | * | * | N | N | N | * |
Buprenorphine Prescribers | 2, 3 | 01, 02, 12, 23 | 750 | N | N | * | * | N | N | N | N | N | N | * | N | N | N | N | * |
Licensed Social Work | 2 | 4 | 781 | * | * | * | * | * | * | N | * | * | N | * | * | N | N | * | * |
Child Psychiatry | 2, 3 | 01, 12 | 191 | * | * | * | * | N | N | N | N | N–EP / *QHP | N | N | * | N | N | N | * |
Clinical Psychology, Psychology | 2 | 05, 14 | 192, 195, 780 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Psychiatry | 2, 3 | 01, 12 | 192, 195 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Specialist Care Providers | |||||||||||||||||||
Allergy/ Immunology | 2, 3 | 01, 12 | 10 | * | * | * | * | N | N | N | * | * | N | * | * | N | N | * | * |
Cardiology | 2, 3 | 01, 12 | 062, 927 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Chiropractic | 2, 3 | 01, 10, 12 | 162 | * | N | N | N | N | N | N | * | * | N | N | * | N | N | * | N |
Colon Rectal Surgery | 2, 3 | 01, 12 | 30 | * | * | * | * | N | N | N | N | * | N | * | * | N | N | N | * |
Dermatology | 2, 3 | 01, 12 | 40 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Endocrinology & Metabolism | 2, 3 | 01, 12 | 063, 516 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Family Planning | 2, 3 | 01, 12, 23 | 906 | N | N | N | N | N | N | N | * | N | N | N | N | N | N | * | * |
Gastroenterology | 2, 3 | 01, 12 | 64 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
General Surgery | 2, 3 | 01, 12 | 210 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Geriatrics | 2, 3 | 01, 12 | 620, 621 | * | N | N | N | N | * | N | * | * | N | N | * | N | N | N | N |
Neonatal–Perinatal Medicine | 2, 3 | 01, 12 | 155 | * | * | * | * | N | N | N | N | N–EP / *QHP | N | * | * | N | N | N | * |
Nephrology | 2, 3 | 01, 12 | 67 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Neurology | 2, 3 | 01, 12 | 194 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Neurology Surgery | 2, 3 | 01, 12 | 70 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Oncology & Hematology | 2, 3 | 01, 12 | 137, 241 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Ophthalmology | 2, 3 | 01, 12 | 100 | * | * | * | * | N | * | N | * | * | N | * | * | * | N | * | * |
Optometry | 2 | 6 | 714, 716 | * | * | * | * | * | * | * | * | * | N | * | * | * | N | * | * |
Orthopedics | 2, 3 | 01, 12 | 110 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Otolaryngology | 2, 3 | 01, 12 | 120 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Palliative Care | 2, 3 | 1, 2, 11, 12 | 826 | N | N | N | N | N | N | N | * | N | N | N | N | N | N | * | * |
Pediatric Surgery | 2, 3 | 01, 12 | 153 | * | * | * | * | N | N | N | N | N–EP / *QHP | N | N | * | N | N | N | * |
Physical Med & Rehabilitation | 2, 3 | 01, 12 | 160 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Plastic Surgery | 2, 3 | 01, 12 | 170 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Podiatry | 2 | 9 | 778 | * | * | * | * | * | * | * | * | * | N | * | * | N | N | * | * |
Pulmonary Medicine | 2, 3 | 01, 12 | 68 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Rheumatology | 2, 3 | 01, 12 | 69 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Thoracic Surgery | 2, 3 | 01, 12 | 220, 651 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Urology | 2, 3 | 01, 12 | 230 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Non–PCP Nurse Practitioners | |||||||||||||||||||
Non–PCP Nurse Practitioners | 2 | 2 | ALL | *(NP) | *(NP) | *(NP) | *(NP) | N | N | N | N | *(NP) | N | *(NP) | *(NP) | N | N | N | * (NP) |
Dental Care Providers | |||||||||||||||||||
General Dentistry | 2 | 08, 18 | 800, 815 | N | * | * | * | * | * | * | * | * | * | * | * | N | * | * | * |
Oral Surgery | 2 | 08, 18, 19 | 808 | N | * | * | * | * | * | * | * | * | * | * | * | N | * | * | * |
Orthodontics | 2 | 08, 18, 19 | 801 | N | * | * | * | N | N | N | N | * | * | * | * | N | * | * | * |
Pedodontics | 2 | 08, 18, 19 | 804 | N | * | * | * | N | N | N | N | N–EP / *QHP | * | N | * | N | * | N | * |
Crossover Specialties∧ | |||||||||||||||||||
Anesthesiology | 2, 3 | 01, 12 | 20 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Audiology | 2 | 30 | 640 | * | * | * | * | * | * | * | * | * | N | * | * | N | N | * | * |
Dentistry | 2 | 08, 18 | 800, 815 | N | N | N | N | N | N | N | N | N | N | N | * | N | N | N | N |
Infectious Disease | 2, 3 | 01, 12 | 66 | * | * | * | * | N | N | N | * | * | N | * | * | N | N | * | * |
Nutrition | 2 | 40 | 909 | N | N | N | N | * | * | * | * | N | N | N | N | N | N | * | N |
Pathology | 2, 3 | 01, 12 | 135, 138, 142, 146 | * | * | * | * | N | N | N | N | * | N | * | * | N | N | N | * |
Radiology | 2, 3 | 01, 12 | 200, 244 | * | * | * | * | N | * | N | * | * | N | * | * | N | N | * | * |
Therapy: Physical | 2 | 60 | 300 | * | * | * | * | * | * | * | * | * | N | * | * | N | N | * | * |
Therapy: Occupational | 2 | 61 | 301 | * | * | * | * | * | * | * | * | * | N | * | * | N | N | * | * |
Therapy: Speech | 2 | 62, 63 | 302 | * | * | * | * | * | * | * | * | * | N | * | * | N | N | * | * |
Therapy: Respiratory | 2 | 64 | 674 | N | N | N | N | * | * | * | * | N | N | N | N | N | N | * | N |
∧ For Crossover Specialties, adequacy can be met by either providers or sites where services are marked as "*Used for Adequacy Measures" in both Table 1 and Table 2.
LEGEND:
* – Used for Adequacy Measures
N – Not Used for Adequacy Measures
*(SNP–1) – HIV Special Needs Requires PCPs to be HIV Specialists
*(NP) – Nurse practitioners are required to be in the network as a primary care and/or specialist provider
1 – HIV Specialist PCPs must have a Secondary Specialty of 303 in combination with one of the Specialty Codes listed. See page 56 for more information.
§ – Required only in specific pilot program counties
Table 2 – Core Listing of Required Services by Program Type
Category of Service | Designated Service Codes | Additional Service Codes | Commercial MCO off of the NYSOH | CHP | Medicaid | HIV Special Needs | MAP & MLTC | PACE | Medicaid Advantage | FIDA | NYSOH QHP/EP | HARP | Commercial Non–MCO Medical | Commercial Non–MCO Vision | FIDA IDD | SIP– PL |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ancillary/Tertiary Care Services | ||||||||||||||||
Adult BH HCBS Community Psychiatric Supports and Treatment (CPST) | 839 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Education Support Services | 862 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Family Support & Training | 855 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Habilitation | 854 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Intensive Crisis Respite | 857 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Intensive Supportive Employment | 860 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Ongoing Supported Employment | 861 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Peer Support | 837 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Pre–Vocational Services | 858 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Psychosocial Rehabilitation (PSR) | 836 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult BH HCBS Short Term Crisis Respite/ Short Term Crisis Respite | 856 | N | N | N | * | N | N | N | N | N | * | N | N | * | N | |
Adult BH HCBS Transitional Employment | 859 | N | N | N | * | N | N | N | N | N | * | N | N | N | N | |
Adult Day Health Care | 664 | N | N | * | * | * | * | N | * | N | * | N | N | * | * | |
AIDS Designated Centers | 011, 321 | 408 | N | N | * | * | N | N | N | N | N | * | N | N | N | N |
Article 16 Clinic/ IPSIDD | 979 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Assertive Community Treatment | 816 | N | N | * | * | N | N | N | * | N | * | N | N | * | * | |
Assisted Living Program | 666 | N | N | N | N | N | N | * | N | N | N | N | N | N | N | |
Assisted Living Service | 614 | N | N | N | N | N | N | N | * | N | N | N | N | * | N | |
Assistive Technology Agency / Adaptive Technology | 817 | N | N | *† | *† | *† | *† | N | * | N | *† | N | N | * | *† | |
Certified Home Health (HHA) | 665 | N | * | * | * | * | * | * | * | * | * | N | N | * | * | |
Certified Home Health: Home Based Medical Social Services | 665 | 781 | N | N | N | N | * | N | * | * | N | N | N | N | * | N |
Certified Home Health: Home Based Occupational Therapy | 665 | 301 | N | N | N | N | * | N | * | * | * | N | N | N | * | N |
Certified Home Health: Home Based Physical Therapy | 665 | 300 | N | N | N | N | * | N | * | * | * | N | N | N | * | N |
Certified Home Health: Home Based Speech Therapy | 665 | 302 | N | N | N | N | * | N | * | * | * | N | N | N | * | N |
Certified or Licensed Home Health Care – Personal Care Assistant (HHA/PCA) | 665, 668 | 672, 673 | * | N | * | * | * | * | N | * | *EP / N– QHP | * | N | N | * | * |
Children´s Community Psychiatric Support & Treatment | 022 | N | N | * | * | N | N | N | N | N | N | N | N | N | * | |
Children´s Crisis Intervention | 023 | N | N | * | * | N | N | N | N | N | N | N | N | N | * | |
Children´s Family Peer Support Services | 036 | N | N | * | * | N | N | N | N | N | N | N | N | N | * | |
Children´s HCBS Caregiver Family Support and Services | 037 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Community Habilitation | 038 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Community Self Advocacy Training and Support | 039 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Crisis Respite | 044 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Day Habilitation | 045 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Palliative Care Bereavement Services | 046 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Palliative Care Expressive Therapy | 047 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Palliative Care Massage Therapy | 048 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Palliative Care Pain and Symptom Management | 049 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Planned Respite | 051 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Pre–Vocational Services | 052 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s HCBS Supported Employment | 053 | N | N | * | * | N | N | N | N | N | N | N | N | N | N | |
Children´s Other Licensed Practitioner | 054 | N | N | * | * | N | N | N | N | N | N | N | N | N | * | |
Children´s Psychosocial Rehabilitation | 077 | N | N | * | * | N | N | N | N | N | N | N | N | N | * | |
Community Habilitation | 752 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Community Integration Counseling | 818 | N | N | N | N | N | N | N | * | N | N | N | N | N | N | |
Community Transitional Service | 819 | N | N | *† | *† | *† | *† | N | *† | N | *† | N | N | *† | *† | |
Comprehensive Psychiatric Emergency Program (CPEP) | 992 | N | N | * | * | N | N | N | * | N | * | N | N | N | * | |
Consumer Directed Personal Care (CDPC) | 914 | 675, 676 | N | N | * | * | * | * | N | * | N | * | N | N | * | * |
Continuing Day Treatment | 312, 317 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Day Habilitation | 043 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Day Treatment (OPWDD) | 006 | N | N | N | N | N | N | N | N | N | N | N | N | * | N | |
Dental Services– Article 28 | 011, 321 | 911 | N | * | * | * | N | N | * | * | * | * | N | N | * | * |
Dental Services | 011, 321, 911 | 911 | N | N | N | N | N | N | N | N | N | N | * | N | N | N |
Durable Medical Equipment (DME) | 307, 969 | * | * | * | * | * | * | * | * | * | * | * | N | * | * | |
Environmental Modifications | 820 | N | N | *† | *† | *† | *† | N | * | N | *† | N | N | * | *† | |
Federally Qualified Health Centers (FQHC) | 011, 321 | 405 | N | N | * | * | N | N | N | N | * | * | N | N | N | * |
Fiscal Intermediary | 042 | N | N | N | N | * | * | N | N | N | N | N | N | * | * | |
General Vascular Surgery | 011, 321, 914 | 650 | N | N | N | N | N | N | N | * | N | N | N | N | * | N |
Harm Reduction Services/SEP | 613 | N | N | * | * | N | N | N | N | N | * | N | N | N | * | |
Hemodialysis | 011, 321, 914 | 913 | N | N | N | N | N | N | N | * | N | N | N | N | * | * |
Home & Community Support Services | 834 | N | N | *† | *† | *† | *† | N | * | N | *† | N | N | *† | *† | |
Home Delivered/ Congregate Meals | 667 | N | N | *† | *† | * | * | N | * | N | *† | N | N | *† | *† | |
Hospice Care | 669 | * | * | * | * | N | N | N | N | * | * | * | N | N | * | |
Hospital Based/Freestand ing Surgery | 011, 321, 914 | 993 | N | N | N | N | N | N | N | * | N | N | N | N | * | N |
Independent Living Skills | 822 | N | N | N | N | N | N | N | * | N | N | N | N | N | N | |
Inpatient Chemical Dependency (ASA Inpatient) | 011, 017, 018 | 7 | * | * | * | * | N | N | N | * | * | * | * | N | * | * |
Inpatient Hospital (Medical Inpatient) | 11 | 899 | * | * | * | * | N | * | N | * | * | * | * | N | * | * |
Inpatient Mental Health | 011, 017, 018 | 616 | * | * | * | * | N | N | N | * | * | * | * | N | * | * |
Institutional Long Term Care | 660 | N | N | * | * | * | * | N | * | * | * | N | N | * | * | |
Institutional Long Term Care (Aids Skilled Nursing Facility) | 660 | 655 | N | N | * | * | * | * | N | N | N | * | N | N | N | * |
Institutional Long Term Care (Behavioral Health Intervention Skilled Nursing Facility –Neuro) | 660 | 657 | N | N | * | * | N | N | N | N | N | * | N | N | N | * |
Institutional Long Term Care (HEAD INJURY/TBI INJURY SNF) | 660 | 656 | N | N | * | * | N | N | N | N | N | * | N | N | N | * |
Institutional Long Term Care (Vent Skilled Nursing Facility) | 660 | 659 | N | N | * | * | * | * | N | N | N | * | N | N | N | * |
Institutional Short Term Care | 663 | * | N | * | * | * | * | N | N | * | * | * | N | N | * | |
Intensive Behavioral Services | 361 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Licensed Home Health Care | 668 | N | N | N | N | * | * | N | N | * | N | N | N | N | N | |
Licensed Home Health Care: Home Based Medical Social Services | 668 | 781 | N | N | N | N | * | * | N | N | N | N | N | N | N | N |
Licensed Home Health Care: Home Based Occupational Therapy | 668 | 301 | N | N | N | N | * | * | N | N | * | N | N | N | N | N |
Licensed Home Health Care: Home Based Physical Therapy | 668 | 300 | N | N | N | N | * | * | N | N | * | N | N | N | N | N |
Licensed Home Health Care: Home Based Speech Therapy | 668 | 302 | N | N | N | N | * | * | N | N | * | N | N | N | N | N |
Medical Laboratories | 011, 321, 599 | 599 | * | * | * | * | N | * | N | * | * | * | * | N | * | * |
Medically Managed Detox Services | 011, 017, 018 | 13 | * | * | * | * | N | N | N | N | * | * | * | N | N | * |
Medically Supervised Detox Services (Inpatient or Outpatient) | 011, 017, 018, 749 | 309, 357, 989 | * | * | * | * | N | N | N | N | * | * | * | N | N | * |
Mobile Mental Health Treatment | 824 | N | N | * | * | N | N | N | * | N | * | N | N | * | * | |
Models of Care @ AIDS Center | 011, 321 | 355 | N | N | N | * | N | N | N | * | N | N | N | N | N | * |
Moving Assistance | 825 | N | N | *† | *† | *† | *† | N | * | N | *† | N | N | *† | *† | |
Non–Emergent Transportation | 671, 740 | N | N | N | N | * | * | * | * | N | N | N | N | * | N | |
NYS OMH Licensed CRs | 326, 327, 329, 330 | N | N | N | N | N | N | N | * | N | N | N | N | N | * | |
Oncology – Therapy (Radiation or Chemo) | 011, 321, 914 | 934 | N | N | N | N | N | N | N | * | N | N | N | N | * | * |
Opioid Treatment Program | 011, 321, 749 | 922, 751 | N | N | * | * | N | N | N | N | N | * | N | N | * | * |
Outpatient Chemical Dependency – Clinic | 011, 321, 914 | 749, 984, 986 | * | * | * | * | N | N | N | * | * | * | * | N | * | * |
Outpatient Chemical Dependency – Outpatient Rehabilitation | 011, 321, 914 | 987 | * | * | * | * | N | N | N | * | * | * | * | N | * | * |
Outpatient Mental Health Clinic | 011, 017, 018, 321, 914, 375 | 375, 974 | * | * | * | * | N | N | N | * | * | * | * | N | * | * |
Outpatient Mental Health Clinic – Children & adolescents under 21 | 011, 017, 018, 321, 914, 375 | 008, 021 | N | N | * | * | N | N | N | N | N | N | N | N | N | * |
Outpatient Mental Health Clinic—State Operated | 971 | 971 | N | N | * | * | N | N | N | N | N | * | N | N | N | * |
Partial Hospitalization | 313, 318 | * | N | * | * | N | N | N | * | * | * | * | N | * | * | |
Peer Delivered Services | 827 | N | N | N | N | N | N | N | * | N | * | N | N | N | N | |
Pathways to Employment | 362 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Peer Mentoring | 828 | N | N | N | N | N | N | N | * | N | N | N | N | N | N | |
Personal Emergency Response (PERS) | 615 | N | N | * | * | * | * | * | * | N | * | N | N | * | * | |
Personalized Recovery Oriented Services | 829 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Personalized Recovery Oriented Services, Continuing Day Treatment | 829, 312, 317 | N | N | * | * | N | N | N | * | N | * | N | N | N | N | |
Pharmacy | 011, 321, 760 | 760 | * | * | * | * | N | * | N | * | * | * | * | N | * | * |
Positive Behavioral Interventions & Support | 830 | N | N | N | N | N | N | N | * | N | N | N | N | N | N | |
Presumptive Eligible | 011, 321 | 406 | N | N | * | * | N | N | N | N | N | * | N | N | N | * |
Prevocational Services | 370 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Private Duty Nursing | 680 | N | N | N | N | * | * | * | * | N | N | N | N | * | * | |
Residential Habilitation | 373,611,612 | N | N | N | N | N | N | N | N | N | N | N | N | N | * | |
Residential Substance Abuse Treatment Services | 011, 017, 018, 749 | 015, 016 | * | * | * | * | N | N | N | N | N | * | N | N | N | * |
Respite | 790 | N | N | N | N | N | N | N | N | N | N | N | N | N | * | |
Social & Environmental Support | 661 | N | N | N | N | * | * | N | * | N | N | N | N | N | N | |
S ocial Day Care | 662 | N | N | N | N | * | * | N | * | N | N | N | N | N | N | |
Social Day Care Transportation | 831 | N | N | N | N | N | N | N | * | N | N | N | N | N | N | |
START Program | 372 | N | N | N | N | N | N | N | N | N | N | N | N | * | N | |
Structured Day Programs | 832 | N | N | N | N | N | N | N | * | N | N | N | N | N | N | |
Support Brokerage | 003 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Supported Employment | 860, 861 | N | N | N | N | N | N | N | N | N | N | N | N | * | * | |
Telehealth | 833 | N | N | N | N | * | * | N | * | N | N | N | N | * | N | |
Transplant Surgery | 011, 321, 914 | 741 | N | N | N | N | N | N | N | * | N | N | N | N | * | N |
Transportation (Ambulance Service) | 670 | N | N | N | N | N | * | N | * | N | N | N | N | * | N | |
Tribal Health Centers | 011, 321 | 407 | N | N | N | N | N | N | N | N | * | N | N | N | N | N |
Urgent Care Centers | 823 | N | N | N | N | N | N | N | * | * | N | N | N | * | * | |
Vehicle Modification | 004 | N | N | *† | *† | *† | *† | N | *† | N | *† | N | N | N | *† | |
Youth Peer Support Services | 078 | N | N | * | * | N | N | N | N | N | N | N | N | N | * | |
Crossover Specialties∧ | ||||||||||||||||
Anesthesiology Services | 011, 321, 914 | 20 | * | * | * | * | N | * | N | * | * | * | * | N | * | * |
Audiology Services | 011, 321, 914 | 640 | * | * | * | * | * | * | * | * | * | * | * | N | * | * |
Dentistry | 011, 321,911 | 911 | N | N | N | N | N | N | N | N | N | N | * | N | N | N |
Infectious Disease | 011, 321, 914 | 966 | * | * | * | * | N | N | N | * | * | * | * | N | * | * |
Nutrition | 011, 321, 914 | 909 | N | N | N | N | * | * | N | N | N | N | N | N | N | N |
Pathology Services | 011, 321, 914 | 135 | * | * | * | * | N | N | N | N | * | * | * | N | N | * |
Radiology Services | 011, 321, 914 | 200 | * | * | * | * | N | * | N | * | * | * | * | N | * | * |
Therapy: Occupational | 011, 321, 914 | 301 | * | * | * | * | * | * | * | * | * | * | * | N | * | * |
Therapy: Physical | 011, 321, 914 | 300 | * | * | * | * | * | * | * | * | * | * | * | N | * | * |
Therapy: Speech/ Language | 011, 321, 914 | 302 | * | * | * | * | * | * | * | * | * | * | * | N | * | * |
Therapy: Respiratory | 011, 321, 914 | 674 | N | N | N | N | * | * | * | * | N | N | N | N | * | N |
† For Crossover Specialties, adequacy can be met by either providers or sites where services are marked as "*– Used for Adequacy Measures" in both Table 1 and Table 2
LEGEND:
* – Used for Adequacy Measures
N – Not Used for Adequacy Measures
† – CFCO services for these products will not be measured for adequacy until 2020
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