MLTC Policy 13.08

  • MLTC Policy 13.08: Reporting Out of County Ancillary Providers on the PNDS (PDF, 120KB)

Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 13.08: Reporting Out of County Ancillary Providers on Provider Network Data System (PNDS)

Date of Issuance: March 26, 2013


The Department uses the PNDS to capture provider network information from MLTC plans on a quarterly basis. The purpose of this document is to provide clarification to MLTC plans attempting to submit providers who operate from a single office location and serve multiple counties to the PNDS during quarterly submissions and to provide MLTC plans with a resolution for reporting contracted providers in each county they serve.

The PNDS cannot represent an ancillary provider´s ability to serve multiple counties from a single office location. Typically these providers provide services at a member´s home. Therefore, MLTC plans submitting quarterly provider network data to the PNDS cannot submit multiple county locations for providers who operate only one site location but provide services in multiple counties through the PNDS. This only applies to certain ancillary services. If a provider has a satellite, or branch office, in the counties they serve outside of their main address, plans can still use the satellite/branch addresses to submit to the PNDS in that specific county. Plans can submit the main address of a provider to the PNDS as long as the main address is in the county where service is being provided.

Example 1: A plan has a contract to provide services to members in four boroughs with ABC Home Delivered Meals who has a main operating location in Brooklyn. ABC Home Delivered Meals services Brooklyn, Bronx, Manhattan and Queens from a single location. The plan will only be able to submit ABC Home Delivered Meals to the PNDS as a participating provider in Brooklyn because the PNDS will only recognize coverage for the county of main operating location.

Example 2: A plan has a contract to provide services to members in Dutchess, Ulster and Orange counties with 123 DME who has a main operating location in Dutchess County. 123 DME provides services in Dutchess, Ulster and Orange counties with a satellite branch in each county. A plan will be able to submit the main operating address in Dutchess County and the satellite office addresses in Orange and Ulster counties to the PNDS as participating providers.

This notice only applies to the following ancillary services:

  • DME
  • PERs
  • Home Delivered Meals
  • Licensed Home Care
  • Certified Home Care Hospice
  • Private Duty Nursing
  • Social and Environmental Support Transportation (Non-Emergent) Transportation (Ambulance) Respiratory Therapy

Resolution:

Beginning with the 1st Quarter 2013 provider network submission, all MLTC plans submitting quarterly provider network data for providers that fit the above descriptions must use the 'Out of County Services´ spreadsheet for any of the aforementioned provider specialties who serve multiple counties from a single office location. The main address of the single office location should still be submitted to the PNDS if it is in the county a plan is seeking credit for.

´Out of County Services' Spreadsheet Parameters:

  1. Only one county may be reported in each record (row of spreadsheet). Use multiple records to report the entire service area.
    • Example: DEF Home Health is certified to serve all five boroughs in New York City, for all programs/payors. To report this provider and receive appropriate credit, create and submit five records, one for each borough.
  2. Only one type of service may be reported for each provider per record.
  3. This spreadsheet should be returned at the same time the quarterly submission is made to the PNDS in the timeframe previously described by the Department (no later than three weeks following the end of the quarter) to: MLTCPND@health.state.ny.us.

Should you have any questions regarding this policy plans should contact George Stathidis at 518-474-6965.