Name: | Medical Providers File Submission |
---|---|
State: | Oregon |
Definition: | Not Provided |
Version | September 27, 2011 - v2011.1.1 |
Data Element ID | Data Element | Description | Type | Format | Length |
---|---|---|---|---|---|
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Provider ID | Identifier for the provider as assigned by the reporting entity | Text | 30 | |
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Provider Tax ID | Tax ID of the provider (example: 1234567890) | Text | 9 | |
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Provider first name | First name of the provider (example: John); null if provider is an organization entity | Text | 25 | |
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Provider middle initial | Middle initial of the provider (example: M); null if provider is an organization entity | Text | 1 | |
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Provider last name | Last name of the provider or organization entity name | Text | 100 | |
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Provider specialty | Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 11.0 (effective January 1, 2011) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). | Text | 10 | |
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Provider second specialty | Required if available. Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 11.0 (effective January 1, 2011) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). | Text | 10 | |
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Provider third specialty | Required if available. Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 11.0 (effective January 1, 2011) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). | Text | 10 | |
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Provider street address1 | First line of physical address of practice. Example: 123 Main Street | Text | 50 | |
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Provider street address2 | Required if available. Second line of physical address of practice. Example: Bldg A, Suite 100 | Text | 50 | |
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Provider city | Physical address of practice. Example: Grants Pass | Text | 30 | |
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Provider state | Physical address of practice. Example: OR | Text | 2 | |
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Provider ZIP | Physical address of practice. Examples: 97209-1234 or 97209 | Text | 10 | |
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Provider DEA number | Required if available. | Text | 12 | |
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Provider NPI | NPI of the provider (example: 1234567890) | Text | 10 | |
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Provider state license number | Prefix with two-character state of licensure. Example: ORLL12345 | Text | 15 | |
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Provider Medicaid number | Required (if available) for participants in Q-Corp initiative. | Text | 12 | |
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Provider CMS UPIN | Required (if available) for participants in Q-Corp initiative. | Text | 12 | |
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Provider DOB | Required for participants in Q-Corp initiative. | Date | 8 | |
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Provider is PCP | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider is OBGYN | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider is Mental Health | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider is Eye Care Provider | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider is Dentist | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider is Nephrologist | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider is Chem. Dep | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider is Nurse Practitioner | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider is Phys Assist | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 | |
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Provider can prescribe Rx | Required for HEDIS processing for participants in Q- Corp initiative. | Text | 1 |
Data Element ID | Data Element | Code | Value |
---|---|---|---|
QC021 | Provider is PCP | N | |
Y | |||
QC022 | Provider is OBGYN | N | |
Y | |||
QC023 | Provider is Mental Health | N | |
Y | |||
QC024 | Provider is Eye Care Provider | N | |
Y | |||
QC025 | Provider is Dentist | N | |
Y | |||
QC026 | Provider is Nephrologist | N | |
Y | |||
QC027 | Provider is Chem. Dep | N | |
Y | |||
QC028 | Provider is Nurse Practitioner | N | |
Y | |||
QC029 | Provider is Phys Assist | N | |
Y | |||
QC030 | Provider can prescribe Rx | N | |
Y |