CAQH ProView™ - Homepage | CAQH



1428750topCAQH ProView?Extract Guidelinesfor Participating OrganizationsPlease note this is a draft document. Changes may be made to these extract specifications since the CAQH ProView system is still in development. CAQH will distribute the final version of this document as soon as it is available.Contents TOC \o "1-3" \h \z \u 1Introduction PAGEREF _Toc402874293 \h 31.1Overview PAGEREF _Toc402874294 \h 31.2Purpose PAGEREF _Toc402874295 \h 31.3Target Audience PAGEREF _Toc402874296 \h 32Extract Submission PAGEREF _Toc402874297 \h 32.1Using Participating Organization User Interface PAGEREF _Toc402874298 \h 32.2Using Extract Services PAGEREF _Toc402874299 \h 33Extract Retrieval PAGEREF _Toc402874300 \h 44Extract Types PAGEREF _Toc402874301 \h 44.1Standard Extract PAGEREF _Toc402874302 \h 44.2Custom Extract PAGEREF _Toc402874303 \h 45Extract Content PAGEREF _Toc402874304 \h 45.1Extract Qualifying Criteria PAGEREF _Toc402874305 \h 45.2Affiliated / Non-Affiliated Providers PAGEREF _Toc402874306 \h 55.3Delegated Providers PAGEREF _Toc402874307 \h 55.4XML Extract Package Contents PAGEREF _Toc402874308 \h 55.4.1XML Extract File Layout PAGEREF _Toc402874309 \h 65.4.2XML Extract Data Summary Layout PAGEREF _Toc402874310 \h 65.5ASCII Extract Package Contents PAGEREF _Toc402874311 \h 65.5.1ASCII Extract Section names PAGEREF _Toc402874312 \h 75.5.2ASCII Extract Data File Layout PAGEREF _Toc402874313 \h 85.5.3ASCII Extract Data Summary Layout PAGEREF _Toc402874314 \h 85.6Replica/PDF Extract Package Contents PAGEREF _Toc402874315 \h 85.6.1Replica/PDF Extract Data Summary Layout PAGEREF _Toc402874316 \h 96Sanctions Extract PAGEREF _Toc402874317 \h 96.1Sanctions Standard Extract PAGEREF _Toc402874318 \h 96.2Sanctions Custom Extract PAGEREF _Toc402874319 \h 106.3Sanctions Extract Format PAGEREF _Toc402874320 \h 106.4Sanctions Extract Data File Layout PAGEREF _Toc402874321 \h 106.5Sanctions Extract Package Contents PAGEREF _Toc402874322 \h 107Backward Compatibility with Current UPD extract PAGEREF _Toc402874323 \h 108Appendix A – Extract fields for Non-Affiliated and Delegated Providers PAGEREF _Toc402874324 \h 11IntroductionOverviewThe Extract Guideline document is a compliation of instructions and documentation for Participating Organizations to set up and retrieve extracts from the CAQH ProView system (formerly Universal Provider Datasource, UPD). This document will explain multiple types of extract options including standard, custom and sanctions.An extract is a file that contains the latest attested data for every provider associated with a Participating Organization. The data can be requested in various formats (e.g: ASCII, XML and Application Replica PDF). The delivery of the data is based on the schedule set up by the Participating Organization in the system. In addition to provider’s latest self-attested information, CAQH ProView also can provide sanctions data associated with a provider to the Participating Organizations’ through the Sanctions Extract. This option is available for an additional fee. PurposeThis document is intended to serve as a reference for data layout, field definitions, naming standards and all other information pertinent to the dissemination of provider information through various CAQH ProView extracts. Target AudienceThis document is intended for developers, data stewards, operational and technical staff or any other user involved in the exchange of data between CAQH ProView and its Participating Organizations. Extract SubmissionExtract requests can be established in CAQH ProView through the Participating Organization portal or by using the extract web service. Using Participating Organization User InterfaceThe Participating Organization user interface in CAQH ProView will have a screen to schedule extracts. The extract submission screen will let the users define the extract contents, frequency and format. Using Extract ServicesThe Participating Organization can also trigger custom extracts through the Custom Extract Generator Service. Please refer to the CAQH ProView Webservices Specifications document for more details.Extract RetrievalBoth standard and custom extracts can be retrieved from the Participating Organization’s “Outgoing” FTP folder. The naming standards for each type of extract are outlined in the following sections. Extract TypesStandard ExtractStandard Extracts contain the latest attested data for providers who have attested since the last extract run. It also includes a file that highlights the changes since the last attestation and a list of data elements that changed value along with their previous and current values. Participating Organizations can create a standard extract by selecting the format of extract, extract frequency, and the sections required in each extract. They can also choose to include supporting documentation with their extracts. Supporting documentation will be a separate zip file that contains all the supporting documentation associated with all providers in the extract. The naming convention for these files will allow the Participating Organization to distinguish the supporting documents for each provider. Standard extracts can be scheduled to run immediately, at a later time, or on a recurring schedule.Custom ExtractCustom extracts include the latest attested data for a provider, but allow Participating Organizations to customize the sections required in each extract. Custom extracts also let users filter data by Plan Provider IDs or CAQH Provider IDs. In CAQH ProView, custom extracts can also be scheduled to run immediately, at a later time, or on a recurring schedule. Extract ContentExtract Qualifying CriteriaThe following criteria must be satisfied for a provider to be included in the extract:Provider has attested and completed their profile/application (including supporting documentation) or re-attested with no changes.Provider in active status in the Participating Organizations roster.Provider has authorized the Participating Organization to access their data.Affiliated / Non-Affiliated ProvidersBased on a provider’s “Affiliation Flag” in the roster file, a Participating Organization can receive both affiliated and non-affiliated providers in their extracts. However, only certain fields will be populated for non-affiliated providers. The list of fields populated for non-affiliated providers are listed in Appendix A.Delegated ProvidersBased on a provider’s “Delegation Flag” in the roster file, a Participating Organization can receive delegated providers in their extracts as well. The list of fields populated for delegated providers are listed in Appendix A.XML Extract Package ContentsThe contents of the XML extract is as follows: FileName: <POID>_<ExtractSubmitTimestamp>_XML.zip (POID is an identifier assigned by UPD for all its Participating Organizations)XML Extract Zip file will contain the following:Separate XML files for each provider in the extract (Filename: <ProviderID>_<ProviderAttestID>.xml)One Extract Index File (Filename: ExtractIndex.xml)One Data Summary File (Filename: DataSummary.txt)One Provider Attachment Index file (Filename:ProviderAttachment.txt)One ZIP file per provider with supporting documents (if requested) (Filename: <ProviderID>_Attachments.zip) All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)Note: For large volume extracts that includes supporting documents, the supporting documents will be delivered as a separate file Filename: <POID>_<ExtractSubmitTimestamp>_XML_Attachments.zipThe separate file will contain the following:One Provider Attachment Index file (Filename:ProviderAttachment.txt)All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)XML Extract File Layout XML Extract Data Summary Layout ASCII Extract Package ContentsThe contents of the ASCII extract is as follows: FileName: <POID>_<ExtractSubmitTimestamp>_ASCII.zip (POID is an identifier assigned by UPD for all its Participating Organizations)ASCII Extract Zip file will contain the following:One file for each provider section (Filename: Provider<SectionName>.text) See layout for sections.One Data Summary File (Filename: DataSummary.txt)One Provider Attachment Index file (Filename:ProviderAttachment.txt)One ZIP file per provider with supporting documents (if requested) (Filename: <ProviderID>_Attachments.zip) All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)Note: For large volume extracts that includes supporting documents, the supporting documents will delivered as a separate file Filename: <POID>_<ExtractSubmitTimestamp>_ASCII_Attachments.zipThe separate file will contain the following:One Provider Attachment Index file (Filename:ProviderAttachment.txt)All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)ASCII Extract Section names ProviderPersonalInformationProviderOtherNameProviderOtherQuestionsProviderReferenceProviderSpecialtyProviderSubstanceAbuseProviderTimeGapProviderWorkHistoryProviderMedicaidProviderMedicalAssociationProviderMedicalConditionProviderMedicalConditionProviderProviderMedicalLicenseProviderMedicareProviderMilitaryProviderNon-PracticeAddressProviderOtherBusinessInterestProviderOtherInterestProviderInsuranceCoverageProviderLanguageProviderLiabilityActionProviderMalpracticeCaseStatusProviderMalpracticeHistoryProviderDisclosureProviderEducationProviderHospitalAssociateProviderHospitalPrivilegeProviderCDSProviderCertificationProviderCriminalActionProviderDEAProviderDegreePracticeServicePracticeSpecialtyPracticeTaxIDProviderAdverseActionPracticeOtherQuestionsPracticeOtherTaxIDPracticePatientTypePracticePhoneCoveragePracticeHoursPracticeInformationPracticeLanguagePracticeLimitationPracticeOtherAddressPracticeAccessibilityPracticeAssociatePracticeAssociateOtherQuestionsPracticeAssociateSpecialtyPracticeBusinessArrangementPracticeCertificationOwnershipDisclosure (new)EntityOwnershipDetail (new)MedicareMedicaidOwnershipDetail (new)ASCII Extract Data File Layout The extract layout for each data file in an ASCII Extract are as follows:ASCII Extract Data Summary Layout Replica/PDF Extract Package ContentsThe contents of the ASCII extract is as follows: FileName: <POID>_<ExtractSubmitTimestamp>_Replica.zip (POID is an identifier assigned by UPD for all its Participating Organizations)Replica Extract Zip file will contain the following:One Data Summary File (Filename: DataSummary.txt)One document for each replica file (Filename: ReplicaApp_<ProviderID>_<StateCode>.pdf)One ZIP file per provider with supporting documents (if requested) (Filename: <ProviderID>_Attachments.zip) All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)Note: For large volume extracts that includes supporting documents, the supporting documents will delivered as a separate file Filename: <POID>_<ExtractSubmitTimestamp>_Replica_Attachments.zipThe separate file will contain the following:One Provider Attachment Index file (Filename:ProviderAttachment.txt)All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)Replica/PDF Extract Data Summary Layout Sanctions ExtractCAQH SanctionsTrak is a centralized data collection process of querying national and state boards for sanctions data and loading this data to CAQH ProView. Sanctions are matched to unique providers within CAQH ProView. Participating Organizations can request this sanctions data through the CAQH ProView portal.Sanctions Standard ExtractSanctions Standard Extract can be scheduled to run on a recurring basis by the POs. The standard extract will contain additions and updates to sanctions since the last standard extract. When new sanctions are added or updates are made to existing sanctions for a provider, they will be reported on the next scheduled standard extract run for a Participating Organization (if the Participating Organization has purchased the sanctions module of CAQH ProView)Sanctions Custom ExtractSanctions Custom Extracts are ad hoc reports based on the most current Sanction data CAQH ProView has for a provider.The sanctions custom extract will be generated based on the criteria provided by a Participating Organization (if the Participating Organization has purchased the sanctions module of CAQH ProView). Sanctions Extract FormatThe sanctions extract will be delivered in a pipe-delimited text file. In addition, a PDF attachment will be available for each sanction if supplied by the sanction vendor. The PDF file can be linked to the provider in the pipe-delimited text file using the naming convention detailed below. In addition, the provider record in the ASCII file will contain the name of the PDF file that corresponds to the provider’s sanction image.Sanctions Extract Data File LayoutSanctions Extract Package ContentsFileName: <POID>_Sanctions_<ExtractDate>.zipSanctions ASCII extract zip file will contain the following:One text file that contains all the providers in the extract (Filename: SanctionExtract.txt)Sanction Image File for providers who have a sanctions image identified by the “SanctionImageName” field in the ASCII file (Filename: <ProviderID>_<SanctionDate>_<SequenceNumber>.pdf)Backward Compatibility with Current UPD ExtractCAQH will support existing UPD extract formats for a limited time. This will provide additional time for Participating Organizations to transition into the new layout. The existing UPD extract files and layout for ASCII and XML will be honored. Appendix A – Extract fields for Non-Affiliated and Delegated Providers ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download