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{"sheet":"Instructions","index":0,"n_rows":62,"n_cols":3,"rows_kept":62,"cut":false,"hidden":false,"merged":[[4,0,4,2],[61,0,61,1],[59,0,59,2],[1,0,1,2],[2,0,2,2],[3,0,3,2]]}
[]
["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)"]
["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"]
[null,"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: 20220505"]

{"sheet":"Data","index":1,"n_rows":2,"n_cols":51,"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","*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":2,"n_rows":54,"n_cols":9,"rows_kept":54,"cut":false,"hidden":false,"merged":[]}
[null,null,"PopulationsTreatedAgeGroup",null,"SpecialtyCode_Provider","SpecialtyDescription_Provider",null,"SpecialtyCode_Facility","SpecialtyDescription_Facility"]
[null,null,"Adult Only",null,"800","Addiction Medicine",null,"040","Acute Care Hospital"]
[null,null,"Children Only",null,"007","Allergy and Immunology",null,"045","Ambulatory Surgery Center"]
[null,null,"All",null,"036","Anesthesiology",null,"P052","Child & Adolescent Inpatient Psychiatric Hospital"]
[null,null,null,null,"198","Audiology",null,"PIBHS","Child & Adolescent Intensive Behavioral Health Services"]
[null,null,null,null,"801","Behavioral Analyst",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,"047","Diagnostic Radiology"]
[null,null,null,null,"P800","Child & Adolescent Addiction Medicine",null,"056","Durable Medical Equipment"]
[null,null,null,null,"P801","Child & Adolescent Behavioral Analyst",null,"055","Home Health"]
[null,null,null,null,"P102","Child & Adolescent Licensed Clinical Social Worker",null,"052","Inpatient Psychiatric Hospital"]
[null,null,null,null,"PMFT","Child & Adolescent Licensed Marriage & Family Therapy",null,"IBHS","Intensive Behavioral Health Services"]
[null,null,null,null,"P107","Child & Adolescent Mental Health Counselor",null,"IOP","Intensive Outpatient Program"]
[null,null,null,null,"P029","Child & Adolescent Psychiatry",null,"050","Occupational Therapy"]
[null,null,null,null,"P103","Child & Adolescent Psychology",null,"054","Orthotics & Prosthetics"]
[null,null,null,null,"010","Chiropractor",null,"044","Outpatient Dialysis"]
[null,null,null,null,"510","Colon and Rectal Surgery",null,"057","Outpatient Infusion/Chemotherapy"]
[null,null,null,null,"011","Dermatology",null,"058","Outpatient Lab"]
[null,null,null,null,"012","Endocrinology",null,"PH","Partial Hospitalization"]
[null,null,null,null,"013","ENT/Otolaryngology",null,"301","Pharmacy"]
[null,null,null,null,"002","Family Practice",null,"049","Physical Therapy"]
[null,null,null,null,"014","Gastroenterology",null,"046","Skilled Nursing Facility"]
[null,null,null,null,"201","General Dentist",null,"051","Speech Therapy"]
[null,null,null,null,"001","General Practice"]
[null,null,null,null,"015","General Surgery"]
[null,null,null,null,"004","Geriatrics"]
[null,null,null,null,"017","Infectious Diseases"]
[null,null,null,null,"003","Internal Medicine"]
[null,null,null,null,"102","Licensed Clinical Social Worker"]
[null,null,null,null,"MFT","Licensed Marriage & Family Therapy"]
[null,null,null,null,"107","Mental Health Counselor"]
[null,null,null,null,"018","Nephrology"]
[null,null,null,null,"019","Neurology"]
[null,null,null,null,"019","Neurology"]
[null,null,null,null,"020","Neurosurgery"]
[null,null,null,null,"016","Obstetrics & Gynecology"]
[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,"202","Orthodontist"]
[null,null,null,null,"025","Orthopedic Surgery"]
[null,null,null,null,"101","Pediatrics"]
[null,null,null,null,"026","Physiatry, Rehabilitative Medicine"]
[null,null,null,null,"027","Plastic Surgery"]
[null,null,null,null,"028","Podiatry"]
[null,null,null,null,"029","Psychiatry"]
[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,"033","Urology"]
[null,null,null,null,"034","Vascular Surgery"]