Version: 1.8
Date: January 7, 2021
Introduction
This document defines the file format for the electronic transfer of provider demographic data between a specific PLAN (or their designee) and Performance Health Technology (PH TECH) required to configure PH TECH’s claims administration platform or other data services.
File Format and Naming
Files should be delivered in one of the following formats
- Pipe delimited text file with headers
- Text Qualified CSV - with headers
File naming convention should be the following depending on file format above:
- Clientnm_providerdemographics_yyyymmdd.txt
- Clientnm_providerdemographics_yyyymmdd.csv
File Delivery
File drop locations if using PH TECH SFTP server:
- Test Files : /home/entities/other/client name/to phtech/providerdata/testing
- Production Files : /home/entities/other/client name/to phtech/providerdata/
For more information regarding using PH TECH SFTP please see: SFTP Data Transfer
Data Schema
Column |
Field Name |
Field Type |
Field Length |
Claims Administration |
Provider Directory Required |
CMS Interop Required |
Description |
1 |
Provider_Last_Name |
varchar |
50 |
Yes |
Yes |
Yes |
Provider's last name |
2 |
Provider_First_Name |
varchar |
35 |
Yes |
Yes |
Yes |
Provider's first name |
3 |
Provider_Middle_Name |
varchar |
1 |
No |
Optional |
Optional |
The first initial of the provider's middle name |
4 |
Provider_Suffix |
varchar |
15 |
No |
No |
Optional |
The suffix that would indicate providers MD, DO |
5 |
Provider_Gender |
varchar |
1 |
Optional |
Yes |
Yes |
Gender of the provider, M = male or |
6 |
Provider_DOB |
date |
8 |
No |
No |
Optional |
Provider's date of birth. MMDDYYYY |
7 |
Provider_Category |
varchar |
50 |
No |
No |
Optional |
Type of provider Plan may use to categorize groups of provider types * See Appendix for available values below . This will post a warning in the post load report file if not supplied. |
8 |
Address_Designation |
varchar |
10 |
Yes |
Yes |
Yes |
Indicates if the office listed is the primary working office of the provider. A provider can only have one primary office. |
9 |
Effective_Date_of_Office_Designation |
date |
8 |
No |
No |
No |
Date the provider began work at the practice office MMDDYYYY |
10 |
Termination_Date_of_Office_Designation |
date |
8 |
No |
No |
No |
Date the provider left the practice office MMDDYYYY or blank if still active |
11 |
Practice_Name |
varchar |
100 |
Yes |
Yes |
Yes |
Name of the practice office |
12 |
Practice_Address_1 |
varchar |
55 |
Optional |
Yes |
Yes |
First Address line for the practice |
13 |
Practice_Address_2 |
varchar |
55 |
No |
No |
Optional |
Second Address line for the practice |
14 |
Practice_City |
varchar |
35 |
Optional |
Yes |
Yes |
City of the practice office |
15 |
Practice_State |
varchar |
2 |
Optional |
Yes |
Yes |
State abbreviation of the practice office |
16 |
Practice_Zip |
varchar |
10 |
Optional |
Yes |
Yes |
Zip code for the practice office; #####- #### |
17 |
Practice_Phone |
varchar |
13 |
Optional |
Yes |
Yes |
Phone number for the practice office ###-###-####. This will post a warning in the post load report file if not supplied. |
18 |
Practice_Fax |
varchar |
13 |
No |
No |
Optional |
Fax number for the practice office; ###-###-####. This will post a warning in the post load report file if not supplied. |
19 |
Provider_Tax_ID_SSN |
varchar |
9 |
No |
No |
No |
SSN or TAX ID for the provider. If PH TECH is completing provider enrollments this is required. |
20 |
Provider_IS_PCP |
varchar |
1 |
Yes |
Yes |
Optional |
Indicates if the provider is a PCP. Yes = Y No = N or blank. Utilized for member assignments and claims adjudication. |
21 |
Provider_License_Number |
varchar |
35 |
No |
No |
Optional |
State license number for the provider. If PH TECH is completing provider enrollments this is required. |
22 |
Provider_NPI_Number |
varchar |
10 |
Yes |
Yes |
Yes |
Provider's registered National Provider ID |
23 |
Provider_Taxonomy_Code |
varchar |
35 |
Yes |
Yes |
Yes |
Provider's taxonomy code. Note - The Taxonomy code is required for claims submittal to OHA. If this value is unknown to the PLAN there are two options: 1) Obtain the value from OHA if the provider is already enrolled 2) Utilize NPPES if they are not enrolled with OHA. |
24 |
Primary_Taxonomy |
varchar |
1 |
Yes |
Yes |
Yes |
Indicates the taxonomy code provided is the primary taxonomy for the provider |
25 |
Provider_Network |
varchar |
50 |
No |
No |
No |
Name of the network that a provider can provide services in |
26 |
Network_Effective_Date |
date |
8 |
No |
No |
No |
Date the provider became effective on the network. MMDDYYYY |
27 |
Network_Termination_Date |
date |
8 |
No |
No |
No |
Date the provider became terminated from the network. MMDDYYYY or blank if still active. |
28 |
Billing_Provider_Name |
varchar |
100 |
Yes |
Yes |
No |
Name of the billing provider (provider group/network) for the provider |
29 |
Billing_Provider_Doing_Business_As_Name |
varchar |
100 |
No |
No |
No |
If the billing provider has a different name printed on a check than what is actually printed on the bill |
30 |
Facility |
varchar |
1 |
No |
No |
No |
Used in authorization management to specify a facility where work should be completed. If the billing provider location should be considered as a facility that patients are referred to then this value should be Y. The default value is N. |
31 |
Billing_Provider_NPI_Number |
varchar |
10 |
Yes |
Yes |
No |
The National Provider ID for the billing provider |
32 |
Billing_Provider_Taxonomy |
varchar |
35 |
No |
No |
No |
The primary taxonomy for the billing provider |
33 |
Billing_Provider_Tax_ID |
varchar |
9 |
Yes |
Yes |
No |
The Tax ID for the billing provider |
34 |
Billing_Provider_Phone |
varchar |
13 |
Yes |
Yes |
No |
The primary phone number for the billing provider; ###-###-#### |
35 |
Billing_Provider_Fax |
varchar |
13 |
No |
No |
No |
The primary fax number for the billing provider; ###-###-#### |
36 |
Billing_Provider_Physical_Street_Address_1 |
varchar |
55 |
Yes |
Yes |
No |
The first line physical address location of the billing provider. This has to be a physical address, PO Boxes are not allowed. |
37 |
Billing_Provider_Physical_Street_Address_2 |
varchar |
55 |
No |
No |
No |
The second line physical address location of the billing provider |
38 |
Billing_Provider_Physical_City |
varchar |
35 |
Yes |
Yes |
No |
The physical city of the billing provider |
39 |
Billing_Provider_Physical_State |
varchar |
2 |
Yes |
Yes |
No |
The physical state of the billing provider |
40 |
Billing_Provider_Physical_Zip |
varchar |
15 |
Yes |
Yes |
No |
The physical zip code of the billing provider; #####-#### |
41 |
Pay_To_Street_Address_1 |
varchar |
55 |
No |
No |
No |
The first line mailing address for the billing provider |
42 |
Pay_To_Street_Address_2 |
varchar |
55 |
No |
No |
No |
The second line mailing address for the billing provider |
43 |
Pay_To_City |
varchar |
35 |
No |
No |
No |
The mailing city for the billing provider |
44 |
Pay_To_State |
varchar |
2 |
No |
No |
No |
The mailing state for the billing provider |
45 |
Pay_To_Zip |
varchar |
15 |
No |
No |
No |
The mailing zip code for the billing provider; #####-#### |
46 |
Panel_Open |
varchar |
1 |
Optional |
Yes |
Yes |
For Provider Directory use and is ONLY applicable for PCP. “Y” indicates that the provider is accepting new patients. “N” indicates that the provider is NOT accepting new patients. Default = “Y”. For compliance, it is very important that this data be as accurate as possible. |
47 |
Include_in_Directory |
varchar |
1 |
Optional |
Yes |
No |
For Provider Directory use. “Y” indicates that the provider is to be included in the directory. “N” indicates that the provider is NOT to be included in the directory. Default = “Y”. |
48 |
Directory_Specialty |
varchar |
100 |
Optional |
Yes |
No |
For Provider Directory use. This is a friendly description that would be understood by a typical member. This is not intended to be populated with a taxonomy code description captured previously. |
49 |
Language_1 |
varchar |
100 |
Optional |
Yes |
Optional |
For Provider Directory use. This is the primary language of the provider as it will appear in the Provider Directory. |
50 |
Language_2 |
varchar |
100 |
No |
No |
Optional |
For Provider Directory use. This is the secondary language of the provider as it will appear in the Provider Directory. |
51 |
Internal_Provider_ID |
varchar |
50 |
No |
No |
Optional |
Optional identifier that is unique to the provider from the originating system that can be used for tracking and identification of that provider for downstream processes. |
52 |
Facility_Type |
varchar |
100 |
No |
No |
Optional |
For Provider Directory use. This is for identifying the specific type of facility that a practice office is e.g. Hospital. |
53 |
Non_Par_OnCall_Start |
date |
8 |
Optional |
No |
No |
Indicates the start date that a provider is valid but non participating in the plan. Usually this is while contracting is pending. |
54 |
Non_Par_OnCall_End |
date |
8 |
Optional |
No |
No |
Indicates the end date that a provider is valid but non participating in the plan. Usually this is while contracting is pending. |
55 |
Practice_Office_URL |
varchar |
255 |
No |
No |
Optional |
For Provider Directory use. Practice office website url if applicable |
56 |
Practice_Office_Accessibility |
varchar |
1 |
Optional |
Yes |
Yes |
For Provider Directory use. Whether the provider's office/facility has accommodations for people with physical disabilities, including offices, exam room(s) and equipment. (Y=Yes, N=No) |
57 |
Age_Restriction |
varchar |
20 |
Optional |
Yes |
Yes |
For Provider Directory use. Are there any age restrictions for this provider at this location (Adults Only, Pediatrics Only etc) |
58 |
Cultural_Competency_Certification |
varchar |
1 |
Optional |
Yes |
Yes |
For Provider Directory use. Has the provider completed the Cultural Competency Certification course. (Y=Yes, N=No) |
Note: Fields marked Optional will be loaded if they are received on a record but not required.
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