DATA DICTIONARY

Provider Network Data System (PNDS)
VERSION 9 (May 2019)

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DATA DICTIONARY CONTENTS

Provider Network Data System

Table of Contents

  1. GENERAL INFORMATION
  2. PHYSICIAN AND OTHER PROVIDERS DETAILED RECORD FORMAT
  3. ANCILLARY/SERVICE CENTERS DETAILED RECORD FORMAT
  4. PHYSICIAN AND OTHER PROVIDERS ELEMENT DESCRIPTIONS
  5. ANCILLARY/SERVICE CENTERS ELEMENT DESCRIPTIONS
  6. CODES
  7. ATTESTATION
  8. PROVIDER & ANCILLARY FILE ERROR CODES
  9. 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.

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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
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Filler 1 N ALL REC YES Space filled NA
Filler 1 N ALL REC YES Space filled NA
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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
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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
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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
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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
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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:
  1. 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.
  2. Must be left justified.
Example:
  1. 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:
  1. 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.
  2. If in the rare instance a provider does not have a first name, ‘NONAME’ should be entered in the first name data field.
  3. Must be left justified.
Example:
  1. 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:
  1. Must be a valid National Provider Identifier (NPI) number. The NPI is a 10–position numeric identifier (10–digit number).
  2. 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.
  3. 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.
  4. For providers who have not received an NPI, please enter "9999999999". Do not leave blank.
  5. For providers exempt from NPI, you should enter "8888888888" and provide documentation of the exempt status. Do not leave blank.
  6. Site NPI will cause a hard error. Only submit an individual provider NPI in this field.
Example:
  1. Dr. Kehinde participates in Medicaid & HIV SNP and his NPI is 0987654321. Enter "0987654321" in this field.
  2. Dr. Betty participates in Commercial & Child Health Plus and her NPI is 1224445655. Enter "1224445655" in this field.
  3. 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.
  4. 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:
  1. 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.
  2. This is a critical data element. Do not leave blank.
  3. 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.
  4. 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:
  1. 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.
  2. 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.
  3. 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:
  1. 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.
  2. This is a critical data element. Do not leave blank.
  3. 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.
  4. 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.
  5. Fill in "99999999" for providers that are Commercial.
Example:
  1. 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:
  1. None. This is an optional data element for the use of individual managed care plans.
  2. You may leave this data element blank or zero–fill if you do not intend to use.
Example:
  1. 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:
  1. This is a critical data element. Do not leave blank.
  2. 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:
  1. 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.
  2. 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:
  1. This is a critical data element. Do not leave blank.
  2. 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.
  3. 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.
  4. If Not Applicable enter "NA".
Example:
  1. 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:
  1. This is a critical data element. Do not leave blank.
  2. Should never include room or suite number.
  3. Must be left justified.
  4. PO Box is not acceptable as a valid street address. Submitting a PO box in this field will result in a hard error.
Example:
  1. Dr. Josberger is located at 95–27 Western Blvd would be entered as "95–27 Western Boulevard".
  2. Dr. Miller is located at 329 West Seventh Street would be entered as "329 West 7th Street".
  3. Dr. Tanner is located at 1646 Third Street would be entered as "1646 3rd Street".

PHYSICIAN AND OTHER PROVIDERS – DATA DICTIONARY/VERSION 9

_____________________________________________________________________________________________

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:
  1. This is a critical data element. Do not leave blank.
  2. Must be left justified.
Example:
  1. 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".
  2. 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

_____________________________________________________________________________________________

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:
  1. Must be a valid state code.
  2. Should be a valid U.S. Postal Service state code.
    "NY" – New York
    "PA" – Pennsylvania
    "VT" – Vermont
    "CT" – Connecticut
    "NJ" – New Jersey
  3. This is a critical data element. Do not leave blank.
Example:
  1. 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:
  1. Must be a valid NYS county code (FIPS). This is a critical data element. Do not leave blank.
  2. Must be right justified. Zero padding is optional.
Example:
  1. 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

_____________________________________________________________________________________________

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:
  1. Must be a valid zip code.
  2. Must be right justified. Zero padding optional.
  3. This is a critical data element. Do not leave blank.
Example:
  1. 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

_____________________________________________________________________________________________

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:
  1. Should be a valid Zip Plus Four Code.
  2. Must be right justified. Zero padding is optional.
Example:
  1. 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

_____________________________________________________________________________________________

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:
  1. Must use valid codes:
    • 0 = No
    • 1 = Yes
  2. Do not leave blank. This is a critical data element for all payers.
Example:
  1. 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.
  2. 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

_____________________________________________________________________________________________

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:
  1. 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)
    NOTE: HIV–SNP plans are allowed to use pediatricians that are not HIV Specialists. HIV–SNP PCPs that are HIV Specialists must use primary designation of "3" and the secondary specialty code of HIV Specialist ("303"). If an HIV–PCP Specialist has more than one specialty, another record, with a different specialty, must be entered for that provider.
  2. 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 Director
Office 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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
    Only hours spent routinely scheduled for patient care in the continuity training site may count as providing capacity and are based on 1.0 FTE=40 hours.
  6. 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.
  7. 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.
  8. 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.
  9. Specialty consults must be performed or directly supervised by a MCO credentialed specialist. The specialist may be assisted by a resident or fellow.
  10. 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.
  11. 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.
  12. Nurse practitioners may not act as attending preceptors for resident physicians.
  13. Enrollees must be granted access to the attending physician if they request an appointment with this individual.
Example:
  1. Dr. Smith is a pediatrician. His primary designation would be "1".
  2. Dr. Bones is a full–time Orthopedic Surgeon. His primary designation would be "2" for Specialist.
  3. Sally Brown is a certified midwife. Her primary designation would be "2" for Specialist.
  4. Dr. Lannon is an OB/GYN physician. His primary designation would be a "2" for Specialist.
  5. 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".
  6. 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".
  7. 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".
  8. 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".
  9. 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:
  1. Must be a valid entry. Must be right justified. Zero padding is optional.
  2. Do not leave blank. This is a critical data element for all providers.
  3. 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:
  1. Dr. Smith is a Pediatrician. He received a Medical Degree to practice as a pediatrician. His provider type would be "01" for MD.
  2. 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".
  3. 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".
  4. 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:
  1. Codes must be valid. See Section VI for complete listing of codes.
  2. Do not leave blank. This is a critical data element for all providers.
  3. Zero padding is optional.
Example:
  1. Dr. Shields is a Plastic Surgeon. The primary specialty code to be used is "170".
  2. Dr. Gesten is an Internal Medicine Physician. The code for Internal Medicine is "060."
  3. Dr. Fahrenkopf is an Endodontist. The code for this specialty is "802".
  4. Dr. Dellehunt is a Psychiatrist. Depending upon the practice, the code for this is "191" for Child Psychiatrist or "192" for Adult Psychiatrist.
  5. 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:
  1. If providers do not have a second specialty, enter "999".
  2. Not a critical data element.
  3. Must be right justified. Zero padding is optional.
Example:
  1. See Primary Specialty.
  2. 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:
  1. 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)
  2. This data element is soft edit for all physicians, i.e., provider type of "01" (MD) or "12" (DO).
Example:
  1. 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:
  1. 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)
  2. This data element is currently a soft edit for all physicians, i.e., provider type of "01" (MD) or "12" (DO)
Example:
  1. 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:
  1. 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.
  2. This is a critical data element. Do not leave blank.
  3. Must be a valid professional license number issued by the New York State Department of Education.
  4. Zero padding is optional.
  5. For non–residents, zero–fill the data element.
Example:
  1. 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:
  1. 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.).
    This data element is only applicable to physicians who are not board certified and have not completed a residency program (Primary Board Status = "1"). For all other physicians, code as "9" = Not Applicable.
  2. 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)
  3. 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.)
  4. For Residency Status coded 1–4, the corresponding Board Status should be coded as "1"=not board certified.
Example:
  1. Dr. Rusk is currently in his second year of training as a behavioral pediatrician specialist. His residency status = "2".
  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:
  1. 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.).
    This data element is only applicable to physicians who are not board certified and have not completed a residency program (Primary Board Status = "1"). For all other physicians, code as "9" = Not Applicable.
  2. 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)
  3. 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.)
  4. For Residency Status coded 1–4, the corresponding Board Status should be coded as "1"=not board certified.
Example:
  1. Dr. Rusk is currently in his second year of training as a behavioral pediatrician specialist. His residency status = "2".
  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

_____________________________________________________________________________________________

Definition:

The provider´s gender.

Edit Applications:
  1. Should use valid codes:
    • 1=Male
    • 2=Female
  2. This is a critical data element. You may NOT leave this blank.
Example:
  1. Dr. Panagiotis Psalidas is male. Enter "1" in the data field for gender.
  2. 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:
  1. 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).
  2. For non–PCPs, "9 fill" the data element, for Not Applicable (99.99).
  3. For PCP Nurse Practitioners, enter (99.99).
  4. Must be right justified. Zero padding is optional.
Example:
  1. 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".
  2. 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".
  3. 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:
  1. 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:
  1. 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".
  2. 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:
  1. Codes must be valid:
    • 0 = Not a Medicaid Provider
    • 1 = Medicaid Provider; provides direct care to Medicaid members
  2. Do not leave blank. This is a critical data element for ALL Records.
Example:
  1. 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.
  2. 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:
  1. Codes must be valid:
    • 0 = Not a Medicare Provider
    • 1 = Medicare Provider; provides direct care to Medicare members
  2. Do not leave blank. This is a critical data element for ALL Records.
Example:
  1. 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.
  2. 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:
  1. Codes must be valid:
    • 0 = Not a Child Health Plus Provider
    • 1 = Child Health Plus Provider; provides direct care to CHP members
  2. Do not leave blank. This is a critical data element for ALL Records.
Example:
  1. 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

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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:
  1. Codes must be valid:
    • 0 = Not a HARP Provider;
    • 1 = HARP Provider; provides direct care to enrollees in a HARP program.
  2. Do not leave blank. This is a critical data element for all records.
Example:
  1. 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:
  1. Codes must be valid:
    • 0 = Not a Medicaid Advantage Provider
    • 1 = Medicaid Advantage Provider; provides direct care to enrollees in a Medicaid Advantage program
  2. Do not leave blank. This is a critical data element for all records.
Example:
  1. 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

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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

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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:
  1. Codes must be valid:
    • 0 = Not a Partial CAPS Provider
    • 1 = Partial CAPS Provider; provides direct care to enrollees in a Partial CAPS program
  2. Do not leave blank. This is a critical data element for all records.
Example:
  1. 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

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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:
  1. Codes must be valid:
    • 0 = Not a MAP Provider;
    • 1 = MAP Provider; provides direct care to enrollees in a MAP program.
  2. Do not leave blank. This is a critical data element for all records.
Example:
  1. 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:
  1. Codes must be valid:
    • 0 = Not a PACE Provider;
    • 1 = PACE Provider; provides direct care to enrollees in a PACE program.
  2. Do not leave blank. This is a critical data element for all records.
Example:
  1. 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

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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:
  1. Codes must be valid:
    • 0 = Not a FIDA Provider;
    • 1 = FIDA Provider; provides direct care to enrollees in a FIDA program.
  2. Do not leave blank. This is a critical data element for all records.
Example:
  1. 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

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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

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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:
  1. Codes must be valid.
  2. 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:
  1. Dr. Blue provides direct care to individuals enrolled in a NYSOH Standard EP. This data element would be coded with a "1".
Notes:
  1. 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:
  1. Codes must be valid.
  2. 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:
  1. 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:
  1. 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

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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:
  1. Codes must be valid.
  2. 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:
  1. 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:
  1. Codes must be valid.
  2. 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:
  1. 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:
  1. Codes must be valid.
  2. 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:
  1. 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

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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

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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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL PCPs.
Example:
  1. 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

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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

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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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL Medicaid and HIV SNP PCPs and OB/GYNs.
Example:
  1. 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.
  2. 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

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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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL PCPs.
Example:
  1. 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

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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

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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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL PCPs.
Example:
  1. 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

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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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL PCPs.
Example:
  1. 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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL PCPs.
Example:
  1. 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

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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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL PCPs.
Example:
  1. 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

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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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL PCPs.
Example:
  1. 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

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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:
  1. 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
  2. Do not leave blank. This is a critical data element for ALL PCPs.
Example:
  1. 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

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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:
  1. Codes must be valid.
  2. 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:
  1. 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

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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:
  1. Codes must be valid.
  2. 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:
  1. 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:
  1. Must be a valid entry. Do not leave blank.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP/Dentistry Specialists or "Not Applicable" enter "9999".
Example:
  1. 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".
  2. 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".
  3. 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.
  4. 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:
  1. Must be a valid entry. Zero–fill to the left.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Example:
  1. Dr. O´Conner has approximately 800 Medicaid members assigned to him. His Medicaid panel size would be 800, entered as "0800".
  2. 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").
  3. 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.
  4. Dr. Kosek has 300 Medicaid members and 200 HIV SNP members assigned to her. Her Medicaid panel size would be 500. Enter as "0500".
  5. 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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs.
  3. For Non–PCP or "Not Applicable" enter "9999".
Example:
  1. 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".
  2. 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

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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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Example:
  1. 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".
  2. 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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Example:
  1. 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".
  2. 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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Example:
  1. 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".
  2. 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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Example:
  1. 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".
  2. 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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Example:
  1. 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".
  2. 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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Example:
  1. 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".
  2. 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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Examples:
  1. 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".
  2. 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:
  1. Must be a valid entry.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Examples:
  1. 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".
  2. 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

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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 area code for the provider´s office fax.

Edit Application:
  1. This is an optional data element for all providers.
  2. 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:
  1. Dr. Brown´s office is located in NYC where the area code is 212. Enter "212" into this field.
  2. 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:
  1. This is an optional data element for all providers.
  2. 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".
  3. Do not include hyphens.
  4. Must be 7 digits.
Example:
  1. 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:
  1. 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".
  2. 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.
  3. 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.
  4. Enter an "Out of State" Hospital Operating Number as "99999999".
  5. For PCPs (or other providers) who have no inpatient care, enter an "99999999" in the Hospital Operating number.
Example:
  1. 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:
  1. 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).
  2. 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.
  3. Enter an "Out of State" Hospital PFI as "999999".
  4. For PCPs (or other providers) who have no inpatient care, enter "999999" in the Hospital PFI number.
  5. Must be right justified. Zero padding is optional.
Example:
  1. Dr. McPhillips works at an Article 28 comprehensive clinic, Soundview Health Center, Bronx, New York. He is affiliated with three area hospitals;
  2. Our Lady of Mercy Medical Center at 233rd Street, Bronx, Operating Certificate #7000005H and PFI number 1168;
  3. Our Lady of Mercy Medical Center at 1870 Pelham Parkway, South Bronx (same OPCERT) and PFI 1181, and
  4. 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:
  1. 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".
  2. This data element is required for PCPs only. The PCPs must work at the designated facility.
  3. For everyone other than a PCP, you should "9" fill the data element ("99999999").
  4. For PCPs located at private office settings this data element is not required. You should "9" fill the data element.
  5. For PCPs that are working in an out of state facility, you should "8" fill the data element.
Example:
  1. 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.
  2. Dr. McDevitt has a private office. The data element is "9" filled.
  3. 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:
  1. 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.)
  2. This data element is critical for PCPs only. The PCPs must work at the designated facility.
  3. For everyone other than a PCP, you should "9" fill the data element ("999999").
  4. For PCPs located at private office settings this data element is not required. You should "9" fill the data element ("999999").
  5. For PCPs that are working in an out of state facility, "8" fill the data element ("888888").
Example:
  1. 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.
  2. Dr. McDevitt has a private office. The data element is "9" filled.
  3. 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:
  1. Must use a valid entry (between 001 and 168 hours).
  2. This is a critical data element for Medicaid, HIV SNP and Child Health Plus PCPs; DO NOT leave blank or zero–fill.
  3. Zero–fill for non–PCP and Commercial only providers.
Example:
  1. 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".
  2. 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.
  3. 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:
  1. 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)
  2. DO NOT leave blank. This is a critical data element for Medicaid, HIV SNP and Child Health Plus PCPs.
Example:
  1. 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.
  2. 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:
  1. Do not leave blank. This is a critical data element.
  2. Codes must be valid. Language code must be found in the PNDS dictionary. See Language Codes in Section VI.
  3. 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.
  4. For Non–PCPs you may enter the appropriate language code or "999" fill for Not Applicable. Do not leave blank.
Example:
  1. 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:
  1. This is a critical edit data element for all providers.
  2. 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:
  1. 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

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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:
  1. This is a critical edit data element for all providers.
  2. 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".
  3. Do not include hyphens.
  4. Must be 7 digits.
Example:
  1. 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

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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:
  1. This is a critical data element for all providers.
  2. Must be a valid email address.
  3. If the provider does not have an email address, or the email address is unknown, leave blank.
  4. Must be left–justified.
Example:
  1. Dr. Kay´s office email address is skay@hospcare.org. Enter "skay@hospcare.org" in this field.
  2. 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

_____________________________________________________________________________________________

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:
  1. This is a critical data element for all providers.
  2. Must be a valid FEIN.
  3. Must be right justified. Zero padding is optional.
Example:
  1. Dr. Ray´s Federal Employer Identification Number is 548331872. Enter "548331872" in this field.
  2. Dr. Patterson´s Federal Employer Identification Number is 244111451. Enter "244111451" in this field.
  3. 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.
  4. 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

_____________________________________________________________________________________________

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:
  1. Codes must be valid.
  2. 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:
  1. This data element would be coded with a "1".
Notes:
  1. 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).
  2. 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

_____________________________________________________________________________________________

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

_____________________________________________________________________________________________

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:
  1. Codes must be valid.
  2. 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:
  1. Dr. Blue provides direct care to individuals enrolled in a NYSoH Dental QHP. This data element would be coded with a "1".
Notes:
  1. 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).
  2. 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

_____________________________________________________________________________________________

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

_____________________________________________________________________________________________

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:
  1. Codes must be valid.
  2. 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:
  1. 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

_____________________________________________________________________________________________

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

_____________________________________________________________________________________________

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:
  1. Codes must be valid.
  2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
  3. For Non–PCP or Not Applicable enter "9999".
Examples:
  1. 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".
  2. 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

_____________________________________________________________________________________________

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

_____________________________________________________________________________________________

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:
  1. Codes must be valid:
    • 0 = Not a SIP–PL Provider;
    • 1 = SIP–PL Provider; provides direct care to enrollees in a SIP–PL program.
    2. Example:
    1. Dr. Hart provides direct care to individuals enrolled in a SIP–PL program. This data element would be coded with a "1".

    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:
    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
    2. Do not leave blank. This is a critical data element for ALL PCPs.
    Example:
    1. 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.

    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:
    1. Must be a valid entry.
    2. Do not leave blank. This is a critical data element for ALL PCPs.
    3. For Non–PCP or Not Applicable enter "9999".
    Example:
    1. 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".

    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:
    1. Codes must be valid:
      • 0 = Not a FIDA IDD Provider;
      • 1 = FIDA IDD Provider; provides direct care to enrollees in a FIDA IDD program.
    2. Do not leave blank. This is a critical data element for all records.
    Example:
    1. Dr. Hart provides direct care to individuals enrolled in a FIDA IDD program. This data element would be coded with a "1".

    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:
    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
    2. Do not leave blank. This is a critical data element for ALL PCPs.
    Example:
  2. 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.

    3. 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:
    1. Must be a valid entry.
    2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
    3. For Non–PCP or Not Applicable enter "9999".
    Example:
    1. 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".
    2. 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".

    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:
    1. 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
    2. Do not leave blank. This is a critical data element for ALL PCPs.
    Example:
    1. 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.

    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:
    1. Must be a valid entry.
    2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
    3. For Non–PCP or Not Applicable enter "9999".
    Example:
    1. 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".
    2. 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".

    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:
    1. Codes must be valid:
      • 0 = Not in HIV SNP
      • 1 = HIV SNP provider
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. Dr. Hart provides direct care to individuals enrolled in a HIV SNP program. This data element would be coded with a "1".

    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:
    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
    2. Do not leave blank. This is a critical data element for ALL PCPs.
    Example:
    1. 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.

    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:
    1. Must be a valid entry.
    2. Do not leave blank. This is a critical data element for ALL PCPs and General Dentists.
    3. For Non–PCP or Not Applicable enter "9999".
    Example:
    1. 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".
    2. 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".

    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:
    1. Must be a valid National Provider Identifier (NPI) number. The NPI is a 10–position numeric identifier (10–digit number).
    2. This is a critical data element. Do not leave blank. If not applicable, enter "9999999999".
    3. DO NOT enter a provider´s individual NPI in this field, it will result in a hard error.
    Example:
    1. Dr. Kehinde participates in Medicaid & HIV SNP and his site´s NPI is 0987654321. Enter "0987654321" in this field.
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    Provider Network Data System

    V. ANCILLARY/SERVICE CENTERS ELEMENT DESCRIPTIONS

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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:
    1. Must be a valid entry. Left justify.
    2. Do not leave blank. This is a critical data element. This element must be completed for the record to be accepted.
    Example:
    1. 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

    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:
    1. 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.
    2. If Not Applicable enter "NA".
    Example:
    1. The radiology center is located in Suite 100 of the Professional Office Center. Enter "Suite 100" or "Room 100".

    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:
    1. Must be a valid entry.
    2. Do not leave blank. This is a critical data element.
    3. Do not include room or suite number. Use the Room or Suite Number element for these.
    Example:
    1. The Service Center located at 95–27 Western Blvd would be entered as "95–27 Western Boulevard".
    2. The Service Center located at 329 West Seventh Street would be entered as "329 West 7th Street".
    3. The Service Center located at 1646 Third Street would be entered as "1646 3rd Street".

    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:
    1. Must be a valid entry.
    2. Do not leave blank. This is a critical element.
    Example:
    1. The ABC Service Center is located in Syracuse, NY. The town/city should be entered as "Syracuse".

    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:
    1. Must be a valid US Postal Service State code:
      • Example:
        "NY" = New York;
        "PA" = Pennsylvania;
        "VT" = Vermont;
        "CT" = Connecticut;
        "NJ" = New Jersey.
    2. Do not leave blank. This is a critical data element.
    Example:
    1. The Doctors–R–Us Clinic is located in the State of New York. Enter "NY" for the State.

    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:
    1. Must be a valid FIPS county code. See the codes listed in Section VI.
    2. Do not leave blank. This is a critical data element.
    3. 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.
    4. Must be right justified. Zero padding is optional.
    Example:
    1. The Doctors–R–Us clinic is located in Columbia County. The FIPS code for Columbia County is "021".

    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:
    1. Must be a valid zip code.
    2. Do not leave blank. This is a critical data element.
    3. Must be right justified. Zero padding is optional.
    Example:
    1. Doctors–R–Us have a zip code of "14308". This should be entered in the zip code field.
    2. 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.
    3. Remsen Pharmacy is located at 8823 Avenue L, Brooklyn, NY 11236. The zip code ‘11236´ should be entered in this field.

    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:
    1. Must be a valid code.
    2. Must be right justified. Zero padding is optional.
    3. This is a critical data element and cannot be left blank when reporting Harm Reduction Services/SEP.
    Example:
    1. Doctors–R–Us has a zip–plus–four code of "1598". This should be entered in the correct position.
    2. 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.

    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:
    1. Must use valid codes. (See Section VI for codes.) Right justify and zero–fill to the left.
    2. Do not leave blank. This is a critical data element.
    Example:
    1. 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.)
    2. 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".

    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:
    1. Must be a valid code. Do not leave blank.
    Example:
    1. 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".
    2. 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".
    3. 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.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    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:
    1. Must be a valid National Provider Identifier (NPI) number. The NPI is a 10–position numeric identifier (10–digit number).
    2. 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.
    3. 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.
    4. For facilities/services exempt from NPI, you should enter "8888888888" and provide documentation of the exempt status.
    5. DO NOT enter a provider´s individual NPI in this field, it will result in a hard error.
    Example:
    1. Albany Medical Center has the National Provider Identifier number of "5426871301". Enter "5426871301" in this field.
    2. Camela Home Care is exempt from NPI, enter "8888888888" in this field and provide documentation of exempt status.
    3. 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.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    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:
    1. Must use valid codes.
    2. 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
    3. This data element can be left blank for all other facilities.
    Example:
    1. The License Number/Facility Operating Certificate for Julia L. Butterfield Memorial Hospital is "3920000H". This should be entered in the correct position.
    2. The registration number of Remsen Pharmacy is "14795". This number should be entered in the License/Facility Operating Certificate field.
    3. 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".
    4. 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.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    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:
    1. Must use valid codes.
    2. 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
    3. This data element can be left blank for all other facilities.
    4. Must be right justified. Zero padding is optional.
    Example:
    1. 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".
    2. 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.
    3. 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.
    4. 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.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    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:
    1. Must be a valid code.
    2. Right justify all numbers and zero–fill to the left.
    3. 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).
    Example:
    1. The Eddy Cohoes Rehabilitation Center has a Medicaid Provider Indicator number of "01112234".

    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

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    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

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    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:
    1. None. This is an optional data element for use by the individual managed care plan.
    2. You may leave this data element blank or zero–fill if you do not intend to use.
    Example:
    1. 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.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    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:
    1. 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
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".
    2. 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".

    NOTE: Each facility location must have an indicator for each type of member they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    Definition:

    The Medicaid Provider Indicator is used to determine if a service center or facility serves Medicaid managed care enrollees.

    Edit Application:
    1. 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
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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.
    2. 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.

    NOTE: Each facility location must have an indicator for each type of member they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    Definition:

    The Medicare Provider Indicator is used to determine if a service center or facility provides care to members receiving Medicare.

    Edit Application:
    1. 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.
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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.

    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

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    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

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    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:
    1. 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.
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".

    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

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    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

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    Definition:

    The HARP Provider Indicator is used to determine if a service center or facility provides care to HARP members.

    Edit Application:
    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.
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".

    NOTE: Each facility location must have an indicator for each type of that they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    Definition:

    The Medicaid Advantage Provider Indicator is used to determine if a service center or facility provides care to Medicaid Advantage members.

    Edit Application:
    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.
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".

    NOTE: Each facility location must have an indicator for each type of that they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    Definition:

    The Partial CAPS Provider Indicator is used to determine if a service center or facility provides care to Partial CAPS members.

    Edit Application:
    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.
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".

    NOTE: Each facility location must have an indicator for each type of that they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    Definition:

    The MAP Provider Indicator is used to determine if a service center or facility provides care to MAP members.

    Edit Application:
    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.
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".

    NOTE: Each facility location must have an indicator for each type of that they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    Definition:

    The PACE Provider Indicator is used to determine if a service center or facility provides care to PACE members.

    Edit Application:
    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.
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".

    NOTE: Each facility location must have an indicator for each type of that they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    Definition:

    The FIDA Provider Indicator is used to determine if a service center or facility provides care to FIDA members.

    Edit Application:
    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.
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".

    NOTE: Each facility location must have an indicator for each type of that they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    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:
    1. Codes must be valid.
    2. Do not leave blank. This is a critical data element for all records.
    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:
    1. 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".
    Notes:
    1. Each facility location must have an indicator for each type of population that they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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:
    1. Codes must be valid.
    2. Do not leave blank. This is a critical data element for all records.
    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:
    1. 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".
    Notes:
    1. Each facility location must have an indicator for each type of population that they contract to serve.

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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:
    1. Codes must be valid.
    2. 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:
    1. 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"

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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

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    Definition:

    The telephone area code for the facility/service center.

    Edit Application:
    1. This is a critical data element for all providers.
    2. 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".
    Example:
    1. The Doctors–R–Us clinic is located in NYC where the area code is 212. Enter "212".

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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:
    1. This is a critical data element for all providers.
    2. 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".
    3. Do not include hyphens.
    4. Must be 7 digits.
    Example:
    1. The Doctors–R–Us has a telephone number of 379–2468. Enter "3792468".

    ANCILLARY/SERVICE CENTERS – DATA DICTIONARY/VERSION 9

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    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:
    1. Codes must be valid. See Appendix for Codes.
    2. Do not leave blank. This is a critical data element.
    3. 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.
    4. Service centers/facilities that do not have additional services to be reported beyond the designated service code should be entered as "000".
    5. Must be right justified. Zero padding is optional.
    Example:
    1. 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

    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:

    • 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 remaining Service 8–Service 25 data elements would be left blank or "000" filled for this record.

    1. 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

    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:

    • Service 1:       914           for general medicine
    • Service 2:       911           for dental

    Your plan does not contract for birthing and diagnostic radiology services. Those services should not be included in the submission.

    1. The Bush Hospital is certified to provide the following services:
      • Hospital Inpatient
      • Mental Health Inpatient
      • Radiology
      • OB/GYN Services

    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:
    1. Codes must be valid.
    2. Do not leave blank. This is a critical data element for all records.
    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:
    1. 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".
    Notes:
    1. Each facility location must have an indicator for each type of population that they contract to serve.

    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:
    1. 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.
    Example:
    1. 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".

    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:
    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.
    2. Do not leave blank. This is a critical data element for all records.
    Example:
    1. 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".

    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:
    1. Codes must be valid:
      • 0 = Not a HIV SNP service center or facility 1 = HIV SNP service center or facility
    2. Do not leave blank. This is a critical data element for ALL Records.
    Example:
    1. 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".

    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:
    1. Must be a valid FIPS county code. See the codes listed in Section VI.
    2. Must be right justified. Zero padding is optional.
    3. Code 000 must only be used in servicing county columns and not in the county field.
    4. Do not leave blank. This is a critical data element. If not applicable, enter "999".
    Example:
    1. 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.
    2. 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.

    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:
    1. Must be a valid code.
    2. This is a critical data element and cannot be left blank when reporting the following facilities/services:
    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.

    1. 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".
    2. This filed must be left blank for all other services.
    3. The edit validation is processed by comparing the submitted OASAS PRU, OASAS Provider Number, and services codes to the NYS OASAS Market Data file.
    4. Right justify all numbers. Zero–filling is optional.
    Example:
    1. 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".
    2. 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.

    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:
    1. Must be a valid code.
    2. This is a critical data element and cannot be left blank when reporting the following facilities/services:
    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.

    1. 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".
    2. This filed must be left blank for all other services.
    3. The edit validation is processed by comparing the submitted OASAS PRU, OASAS Provider Number, and services codes to the NYS OASAS Market Data file.
    4. Right justify all numbers. Zero–filling is optional.
    Example:
    1. 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".
    2. 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.

    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:
    1. Must be a valid code.
    2. This is a critical data element and cannot be left blank when reporting the following facilities/services:
    > > > > > > > > > > > > > > > > > > >
    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.

    1. 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".
    2. This field should be left blank for all other services.
    3. 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.
    4. Right justify all numbers. Zero–filling is optional.
    Example:
    1. 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".
    2. 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".
    3. 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.
    |top of section| |top of page|

    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
    • 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.

    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
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    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, Director
    New 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:

    • 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.

    _______________________________________
    Chief Executive Officer


    _______________________________________
    Date


    _______________________________________
    Notary Seal and Signature

    |top of section| |top of page|

    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
    |top of section| |top of page|

    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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