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{"sheet":"Instructions","index":0,"n_rows":74,"n_cols":3,"rows_kept":74,"cut":false,"hidden":false,"merged":[[15,0,15,2],[73,0,73,1],[71,0,71,2],[12,0,12,2],[13,0,13,2],[14,0,14,2],[0,0,0,3],[1,0,1,3],[2,0,2,3],[3,0,3,3],[4,0,4,3],[10,0,10,3],[8,0,8,3],[5,0,5,3],[6,0,6,3],[7,0,7,3],[9,0,9,3]]}
["Respondent must complete the Network Information tab for the PY2024 initial submission only, keeping in mind the following guidance:"]
["Plans Associated with Network"]
["Network Name: Network name as submitted to Quest"]
["Network ID: ID submitted with each Product ID filing (ex. Product A - PAN001, Product B - PAN002)"]
["Product HIOS ID: Enter the 10-character, HIOS-generated product ID number."]
["Plan HIOS ID: Enter the 14-character, HIOS-generated plan ID number. "]
["Market Type - Identify whether the Plan ID listed in Column B is an Individual or Small Group plan."]
["Network Service Area"]
["County Name - List all of the counties where Products/Plans are marketed that this network services.  Specific Product/Plan Marketing Area is not needed. "]
["Partial County Zip Codes - If the county in Column E is only partially served by this network, list the applicable zip codes."]
["Status - Identify whether this network is currently active in the county in Column E or if an expansion to this county is being requested."]
[]
["Respondent must complete the Data tab for all the provider types/specialties listed in the Lookup tab, keeping in mind the following guidance:"]
["1 row per provider / address / specialty"]
["Provider network should be representative of the current contracted network"]
["Do not delete or add any columns to the Data tab"]
[]
["Required","Data Field Name","Validations/Comments/Examples"]
["Yes","*CarrierName","Cannot be blank"]
["Yes","*NetworkName","Cannot be blank.  Filing name associated to the network being submitted"]
["Yes","*EntityType","Must be \"1\" for individuals and \"2\" for facilities which is determined by the specialty code on Lookup tab columns E and H"]
["Yes","*OrganizationNPI","Must be Type 2 NPI, 10 characters"]
["Yes","*OrganizationName","Cannot be blank.  Name associated with OrgNPI"]
["Yes","*TIN","Must be 9 characters, no puncuation"]
[null,"TINLegalName","Name associated to tax idenitification number"]
["Yes","*IndividualNPI","Must be Type 1 NPI, 10 characters and required when EntityType is \"1\""]
["Yes","*Name","Cannot be blank when EntityType is \"1\""]
[null,"Prefix","Dr, Mr, Mrs, Ms, Prof"]
["Yes","*First","Cannot be blank when EntityType is \"1\""]
[null,"Middle","Middle Name or Initial, if available"]
["Yes","*Last","Cannot be blank when EntityType is \"1\""]
[null,"Suffix","Jr,Sr,II,III"]
[null,"Credentials","MD, DO, DDS, LCSW"]
[null,"Gender","Male=\"M\", Female=\"F\", Unknown - Prefer not to specify=\"U\", Gender X=\"X\""]
[null,"Race","White;Black or African American;American Indian or Alaska Native;Chinese;Filipino;Asian Indian;Prefer not to specify;Vietnamese;Korean;Japanese;Other Asian;Native Hawaiian;Samoan;Other Pacific Islander;Some other race;Prefer not to specify"]
[null,"Ethnicity","Not of Hispanic, Latino, or Spanish origin;Mexican, Mexican Am., Chicano;Puerto Rican;Cuban;Another Hispanic, Latino, or Spanish orig"]
[null,"ProviderLanguages","Full language description based on ISO 639 Code Tables \";\" separated list if multiples."]
["Yes","*ProviderLicenses","Cannot be blank"]
[null,"MedicaidLicenses","stateabbrev:medicaidlicensenumber"]
[null,"CulturalCompetenceTrainings","\"Y\" or \"N\" if trained"]
[null,"BoardCertifications","Board:Specialty:IssueDate:ExpirationData:Status;Board:Specialty:IssueDate:ExpirationData:Status"]
[null,"PCPStatus","Is the provider a PCP, Specialist or Both? (P, S, B)"]
[null,"Wait Time","What is the wait time for an appointment with this provider (in days) - STRONGLY ENCOURAGED"]
["Yes","*AcceptingNewPatients","Must be either \"Y\" or \"N\" when EntityType is \"1\""]
["Yes","*NumberOfNewPatientsLastYear","Must be zero or greater when EntityType is \"1\""]
[null,"Specialty","Descriptions as listed in column F for EntityType of \"1\" and column I for EntityType of \"2\" on the Lookup tab"]
["Yes","*SpecialtyCode","When EntityType is \"1\", must be a valid code from column E on Lookup tab. When EntityType is \"2\", must be a valid code from column H on Lookup tab. "]
[null,"Taxonomy","NUCC National Taxonomy"]
["Yes","*PopulationsTreatedAgeGroup","Must be valid name from column C on Lookup tab"]
["Yes","*Address","Cannot be blank"]
[null,"Address2","Required if applicable (suite, floor, department)"]
["Yes","*City","Cannot be blank"]
["Yes","*State","Must be 2 characters"]
["Yes","*ZipCode","Must be Service Location ZIP Code or ZIP + 4. No Punctuation. Must be >3 or <10  characters"]
["Yes","*County","Cannot be blank"]
["Yes","*Phone","Must be 10 characters. No punctuation"]
[null,"Fax","10 characters no punctuation"]
[null,"Email","Email address for office, validate in proper email format"]
[null,"GroupAffiliation","Listing of affiliated groups \";\" separated list if multiples"]
[null,"IPAAffiliation","Listing of affiliated IPAs \";\" separated list if multiples"]
[null,"HospitalAffiliation","Name of affiliated hospitals with admitting privledges (if known):\nNo Privilege\nFull\nTemporary\nCourtesy\nProvisional\n(ie: St. Mary's Hospital:Full;St. Vincent Medical Center:Courtesy)"]
[null,"LocationTelehealth","Are telehealth appointments available at this service location?\n\"N\", \"B\", \"O\" (No telehealth, Both telehealth and onsite, Only telehealth)"]
[null,"ProviderTelehealth","Are telehealth appointments available for this individual at service location?\n\"Y\",\"N\""]
[null,"LocationLanguages","Full language description based on ISO 639 Code Tables \";\" separated list if multiples"]
[null,"FrequencyAtLocation","Frequency in which scheduled patients are seen:\npatients_day_in_week\npatients_day_in_month\npatients_infrequently\nsubstitute_for_colleague\npatients_never"]
["Yes","*DirectoryFacing","Is this provider or location listed in the directory?  Must be either \"Y\" or \"N\""]
[null,"ContractStatus","\"E\"=Employed (employee of Health Plan/Health System)\n\"DC\"=Direct Contract (contracted to see members of Health Plan/Health System)\n\"L\"=Leased (contracted through third party vendor/Health Plan/Health System/network administrator)"]
[null,"CredentialingStatus","\"Y\"= Health Plan credentialed\n\"N\"= Not Health Plan credentialed\n\"NA\"= Health Plan credentialing not applicable/not needed\n\"D\"= Delegated credentialing"]
[null,"CredentialingDate","Credentialing expiration date"]
["Yes","PaidClaimIn90Days","Has a claim been paid for the practitioner at this location in the last 90 days \"Y\" or \"N\""]
[]
["Upon completion of populating the template, in cell A1 on data tab, Respondent should see a validation button. Respondent must select the button and confirm all cells pass the validation. If necessary, Respondent must correct any red highlighted cells and rerun the validation until all column headers are green."]
[]
["Version: 20240101"]

{"sheet":"Network Information","index":1,"n_rows":6,"n_cols":7,"rows_kept":6,"cut":false,"hidden":false,"merged":[[4,0,4,2],[4,4,4,6],[0,1,0,2],[1,1,1,2]]}
["Network Name:"]
["Network ID:"]
["Do any plans utilizing this network offer adult dental benefits? (Yes/No)"]
[]
["Plans Associated with Network",null,null,null,"Network Service Area"]
["Product HIOS ID","Plan HIOS ID","Market Type (Individual or Small Group)",null,"County Name","Partial County Zip Codes If Applicable","Status (Active or Expansion)"]

{"sheet":"Data","index":2,"n_rows":2,"n_cols":52,"rows_kept":2,"cut":false,"hidden":false,"merged":[[0,2,0,11]]}
[null,null,"Please correct any red highlighted cells and rerun validation. All column headers with an * are required and need to be green before submitting data."]
["*CarrierName","*NetworkName","*EntityType","*OrganizationNPI","*OrganizationName","*TIN","TINLegalName","*IndividualNPI","*Name","Prefix","*First","Middle","*Last","Suffix","Credentials","Gender","Race","Ethnicity","ProviderLanguages","*ProviderLicenses","MedicaidLicenses","CulturalCompetenceTrainings","BoardCertifications","PCPStatus","Wait Time","*AcceptingNewPatients","*NumberOfNewPatientsLastYear","Specialty","*SpecialtyCode","Taxonomy","PopulationsTreatedAgeGroup","*Address","Address2","*City","*State","*ZipCode","*County","*Phone","Fax","Email","GroupAffiliation","IPAAffiliation","HospitalAffiliation","LocationTelehealth","ProviderTelehealth","LocationLanguages","FrequencyAtLocation","*DirectoryFacing","ContractStatus","CredentialingStatus","CredentialingDate","PaidClaimIn90Days"]

{"sheet":"Lookup","index":3,"n_rows":66,"n_cols":9,"rows_kept":66,"cut":false,"hidden":false,"merged":[]}
[null,null,"PopulationsTreatedAgeGroup",null,"SpecialtyCode_Provider","SpecialtyDescription_Provider",null,"SpecialtyCode_Facility","SpecialtyDescription_Facility"]
[null,null,"Adult Only",null,"106","Addiction (Substance Use Disorder) Counselor",null,"040","Acute Inpatient Hospitals (Must have 24/7 Emergency services)"]
[null,null,"Children Only",null,"800","Addiction Medicine Physician",null,"AMB","Ambulance"]
[null,null,"All",null,"007","Allergy and Immunology",null,"198","Audiology"]
[null,null,null,null,"036","Anesthesiology",null,"042","Cardiac Catheterization Services"]
[null,null,null,null,"198","Audiology",null,"041","Cardiac Surgery Program"]
[null,null,null,null,"801","Behavioral Analyst",null,"PIBHS","Child & Adolescent Intensive Behavioral Health Services"]
[null,null,null,null,"108","Behavioral Health - Advanced Practice Registered Nurse",null,"PIOP","Child & Adolescent Intensive Outpatient Program"]
[null,null,null,null,"008","Cardiology",null,"PPH","Child & Adolescent Partial Hospitalization"]
[null,null,null,null,"035","Cardiothoracic Surgery",null,"P076","Children's Residential Treatment Facility (Mental Illness; Psychiatric)"]
[null,null,null,null,"P800","Child & Adolescent Addiction Medicine",null,"P072","Children's Substance Abuse Rehabilitation Facility"]
[null,null,null,null,"P801","Child & Adolescent Behavioral Analyst",null,"043","Critical Care Services - Intensive Care Units (ICU)"]
[null,null,null,null,"P102","Child & Adolescent Licensed Clinical Social Worker",null,"047","Diagnostic Radiology (Free-standing; hospital outpatient; ambulatory health facilities with Dx Radiology)"]
[null,null,null,null,"P105","Child & Adolescent Licensed Marriage & Family Therapy",null,"056","Durable Medical Equipment"]
[null,null,null,null,"P107","Child & Adolescent Mental Health Counselor",null,"055","Home Health"]
[null,null,null,null,"P029","Child & Adolescent Psychiatry",null,"052","Inpatient Psychiatry (Free-standing inpatient behavioral health facility and behavioral health beds within an Acute Care Hospital)"]
[null,null,null,null,"P103","Child & Adolescent Psychology",null,"IBHS","Intensive Behavioral Health Services"]
[null,null,null,null,"010","Chiropractor",null,"IOP","Intensive Outpatient Program"]
[null,null,null,null,"510","Colon and Rectal Surgery",null,"048","Mammography"]
[null,null,null,null,"107","Counselor (Mental Health and Professional)",null,"076","Mental Health Residential Treatment Facility (Mental Illness; Psychiatric)"]
[null,null,null,null,"204","Dental - Endodontist",null,"050","Occupational Therapy"]
[null,null,null,null,"201","Dental - General",null,"054","Orthotics & Prosthetics"]
[null,null,null,null,"202","Dental - Orthodontist",null,"044","Outpatient Dialysis"]
[null,null,null,null,"203","Dental - Periodontist",null,"057","Outpatient Infusion/Chemotherapy"]
[null,null,null,null,"206","Dental - Prosthodontist",null,"058","Outpatient Lab"]
[null,null,null,null,"011","Dermatology",null,"PH","Partial Hospitalization"]
[null,null,null,null,"037","Emergency Medicine",null,"301","Pharmacy"]
[null,null,null,null,"012","Endocrinology",null,"049","Physical Therapy"]
[null,null,null,null,"013","ENT/Otolaryngology",null,"046","Skilled Nursing Facility"]
[null,null,null,null,"002","Family Practice",null,"051","Speech Therapy"]
[null,null,null,null,"014","Gastroenterology",null,"072","Substance Abuse Rehabilitation Facility (Hospital unit and residential treatment facility)"]
[null,null,null,null,"001","General Practice",null,"045","Surgical Services (Ambulatory Surgical Centers and Outpatient Hospital)"]
[null,null,null,null,"015","General Surgery",null,"080","Urgent Care"]
[null,null,null,null,"004","Geriatrics",null,"801","Behavioral Analyst"]
[null,null,null,null,"016","Gynecology (OB/GYN)",null,"P801","Child & Adolescent Behavioral Analyst"]
[null,null,null,null,"017","Infectious Diseases"]
[null,null,null,null,"003","Internal Medicine"]
[null,null,null,null,"105","Marriage and Family Therapist"]
[null,null,null,null,"018","Nephrology"]
[null,null,null,null,"019","Neurology"]
[null,null,null,null,"020","Neurosurgery"]
[null,null,null,null,"050","Occupational Therapy"]
[null,null,null,null,"021","Oncology - Medical & Surgical"]
[null,null,null,null,"022","Oncology - Radiation"]
[null,null,null,null,"023","Ophthalmology"]
[null,null,null,null,"200","Optometry"]
[null,null,null,null,"024","Oral & Maxillofacial Surgery"]
[null,null,null,null,"025","Orthopedic Surgery"]
[null,null,null,null,"P201","- Pediatric Dental"]
[null,null,null,null,"026","Physical Medicine & Rehabilitation"]
[null,null,null,null,"049","Physical Therapy"]
[null,null,null,null,"027","Plastic Surgery"]
[null,null,null,null,"028","Podiatry"]
[null,null,null,null,"006","Primary Care - Advanced Registered Nurse Practitioner"]
[null,null,null,null,"101","Primary Care - Pediatric"]
[null,null,null,null,"005","Primary Care - Physician Assistant"]
[null,null,null,null,"029","Psychiatry"]
[null,null,null,null,"103","Psychology"]
[null,null,null,null,"030","Pulmonology"]
[null,null,null,null,"031","Rheumatology"]
[null,null,null,null,"102","Social Worker"]
[null,null,null,null,"051","Speech Therapy"]
[null,null,null,null,"033","Urology"]
[null,null,null,null,"034","Vascular Surgery"]
[null,null,null,null,"IBHS","Intensive Behavioral Health Services"]
[null,null,null,null,"PIBHS","Child & Adolescent Intensive Behavioral Health Services"]