DATA DICTIONARY NEW YORK STATE DEPARTMENT OF …

DATA DICTIONARY NEW YORK STATE DEPARTMENT OF HEALTH

Provider Network Data System (PNDS) VERSION 11 (November 2022)

Throughout this document, areas updated from the last version are highlighted.

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DATA DICTIONARY CONTENTS

Provider Network Data System (PNDS)

Table of Contents

I. GENERAL INFORMATION ............................................................................................................................. 3 II. PHYSICIAN AND OTHER PROVIDERS DETAILED RECORD FORMAT ............................................ 6 III. ANCILLARY/SERVICE CENTERS DETAILED RECORD FORMAT................................................... 24 IV. PHYSICIAN AND OTHER PROVIDERS ELEMENT DESCRIPTIONS .............................................. 30 V. ANCILLARY/SERVICE CENTERS ELEMENT DESCRIPTIONS ....................................................... 133 VI. CODES ........................................................................................................................................................ 182

BOROUGH/COUNTY CODES (FIPS) ...................................................................................................... 183 LANGUAGE CODES ................................................................................................................................... 184 PROVIDER AND ANCILLARY/SERVICE SPECIALTY CODES ? NUMERICAL ORDER .............. 188 PROVIDER AND ANCILLARY/SERVICE SPECIALTY CODES ? ALPHABETICAL ORDER........ 201 VII. ATTESTATION.......................................................................................................................................... 215 VIII. PROVIDER & ANCILLARY FILE ERROR CODES ............................................................................ 218 PHYSICIAN AND OTHER PROVIDER ERROR LISTING .................................................................... 219 ANCILLARY/SERVICE CENTER ERROR LISTING .............................................................................. 225 IX. CODING SCHEME SUMMARY REPORTS .......................................................................................... 228 TABLE 1 - CORE LISTING OF REQUIRED PROVIDERS BY PROGRAM TYPE ............................... 229 TABLE 2 - CORE LISTING OF REQUIRED SERVICES BY PROGRAM TYPE................................... 232

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Provider Network Data System

I. GENERAL INFORMATION

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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 pnds.health.. Health Insurers electronically submit provider network data quarterly for the following lines of business: Medicaid; Child Health Plus; 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 PNDS data is used by several different units within the NYS Department of Health. The figure below illustrates the flow of data and the data endpoints.

D. Connection to the Provider Network Data System (PNDS) Connection to the PNDS is through a secure connection at pnds.health.. 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. 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

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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 email 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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