Provider Upload Request

Provider Upload Request

This document explains how to submit and process Provider Upload Requests. Currently, the provider upload process can be used for the following actions:

1) Adding a new provider to NCTracks. For example, a provider’s NPI doesn’t exist in NCTracks and needs to be added.

2) Adding or reactivating health plans. For example, a provider’s NPI exists in NCTracks, but doesn’t have any enrollment in the DMH health plans. Or a provider’s NPI exists in NCTracks but the enrollment in the DMH health plans has been terminated.

The process will add active segments in the DMH health plans specified on the record for the date ranges specified on the record

Creating a Request File

Request files should list the providers and/or clinicians to be included in the provider upload file. These files should be uploaded to the Provider_Upload_Request FTP folder in a pipe-delimited text file.

Provider ID

The first segment in the piped-string is the provider ID, which is required in all cases and should only contain values from the prv_id column in tb_providers. To include all the providers a clinician is associated with and the corresponding sites, a -1 can be placed in the provider ID segment. One caveat with this is the provider upload format only allows ten locations per NPI. This is a limitation of using fixed width strings to represent hierarchical data.

Column 1 / 1234|#|#|@|# / Used for the provider ID (prv_id). This cannot be blank, but can have a value of -1. When a valid prv_id, then all Provider info, locations and taxonomies will be sent on the file from the string. When -1 is in the prv_id, but contains a valid clin_id then only clinician information will be sent on the file from the string and becomes a Clinician Only string.

Clinician ID

The second segment is optional and represents the clinician ID. This segment should only contain values from the clin_id column in tb_clinicians.

Column 2 / #|6789|#|@|# / Used for the clinician ID (clin_id). When this contains a valid clin_id, all providers and it's sites the clinician is mapped to (Provider Associations)[tb_clins_to_providers] will be sent on the file. If the clin_id is left blank, but has a valid prv_id then the string becomes a Provider Only string.

NPI

The third segment is mandatory and should only contain valid NPIs.

Column 3 / #|#|1234567890|@|# / The NPI number set here is what will be used as the Provider NPI on the Provider file. For "Clinician Providers" the NPI is set to the clinicians NPI from Clinician Maintenance automatically regardless of what NPI number is identified in the request file.

Record Type

The fourth segment is not mandatory. When this field is blank on the request file, the traditional logic to determine if the record is an 'A' for new provider or 'U' for a provider update. This can also be used to manually determine a record type: designate the record type as a 'T' for New Taxonomy or 'L' for a new Location.

Column 4 / #|#|#|T|# / Values 'A', 'U', 'T' or 'L' can be used here to identify a (A) New Provider, (U) Update Provider, (T) New Taxonomy, (L) New Location.

Notes on record type usage: 'A' or 'U' is determined by the last insert date. If the clinician or provider was created in the system within the last 60 days, the record type will default to ‘A’. If created over 60 days from the requesting the file, it will default to ‘U’. Although this defaults when left blank, manually adding this value will force the record type. Mediware can only assume when this is used, everything in the request file will be added as new.

Types ‘T’ and ‘L’ types do not default and must be manually specified if the record type is for a new Taxonomy or Location. Mediware can only assume that when ‘T’ or ‘L’ is used, only and all taxonomies (or locations) are updated.

NCTracks Site Number

The fifth segment is not mandatory. When included in the Provider Upload request, the system will attempt to match the number with that specific sites in tb_sites.nctracks_num (or tb_cred_sites.nctracks_num when using the Credentialing\Cred+ modules). When theNCTracks number is contained in the file, AlphaMCS will only send an update to NCTracks pertaining to the NCTracks site number included.If the NCTracks site number isn’t included in the file, the process will use site/location information based on provider ID/NPI.

Column 5 / #|#|#|@|018 / When the NCTracks number is contained in the file, AlphaMCS will only send an update pertaining to the NCTracks site number included.

File Example:

1488|5018|1902228935|L|

1144|2530|1114261286|U

1182|2447|1912256223||114

1488|4959|1710230834|L|

1161||1780996652|T|124

1047||1164435798|L|

-1|5011|1821116518|A|080

Example Errors and Causes

ERROR / DEFINED
Provider ID must be specified / The prv_idcolumn(1) cannot be blank. If sending Clinician string, include '-1' in the string at the prv_id column(1) field
Clinician and Provider are not mapped / The clin_idcolumn(2) needs to be a valid clin_id or blank. If requesting clinician update, clinician must be mapped to a provider and effective in the provider associations tab in Provider Network.
DOB is missing / DOB is required for clinicians, check DOB in in Clinician Maint [tb_clinicians]
SSN is missing / SSN is required for clinicians, check SSN in Clinician Maint [tb_clinicians]
Provider ZIP must be 9 digits / Provider Zip code must be 9 digits, check zip code in Provider Maint Site Tab [tb_sites]
Provider ZIP must not start with 00000 / Provider zip code cannot start with 00000, check zip code in Provider Maint Site Tab [tb_sites]
No valid taxonomies on file / There must be at least 1 valid taxonomy for the provider(clinician). Check Provider Network (both Clinicians and Providers) to identify an active and effective Taxonomy. Check and make sure it is a valid taxonomy against the GPF matrix [dbo.tb_provider_upload_matrix].
License Code Missing / Provider license missing [tb_site_designations] for level 3 taxonomy code [dbo.tb_provider_upload_matrix.P_TAXON_LVL_3_CD]
Org Type Discrepancy / When the Taxonomy does not match the organizational type (Individual/Clinician vs. Organization/Provider)
NCTracks Site Number and NPI Number combination does not exist in AlphaMCS / The system cannot find a matchingNCTracks site number and NPI number in tb_sites

Items to know

There is no hierarchical difference between a clinician and a provider. Because of this, clinicians and providers are treated the same in the context of this upload file, with the only difference being the main NPI and the institution codes.

The Provider Upload Request File should be perceived as three different types of request strings. (1) Provider and Clinician Request string, a string with both a prv_id and clin_id; (2) Provider only request string, a string with a valid prv_id and clin_id is blank; (3) Clinician only request string, with -1 as the prv_id and a valid clin_id.

The NPI number referenced on the provider upload request file will be used as the Provider NPI for the Provider in the upload request. If the PUR string is for a clinician, then the clinician NPI is set regardless of what NPI is on the request string.

Only a total of 10 locations and a total of 10 taxonomies can be submitted on a single file at one time. Anything over 10 is truncated from the file.

Correct Request String Format and information request types

Clinician and Provider String 1234|6789|1234567890||

Providers: / Lists Provider Info derived from the prv_id listed in the prv_id column(1) field
Lists All Site (site_id) Location(address) information for the derived prv_id
Lists All Taxonomy for each site derived from the prv_id (unless NCTracks Site number included in the file)
Clinicians: / Lists Clinician Info derived from the clin_id listed in the clin_id column(2) field
Lists All Site (site_id) Location(address) information for the derived clin_id (tb_clins_to_providers) (unless NCTracks Site number included in the file)
Lists Clinician Taxonomy

Clinician Only String: -1|6789|1234567890||

Clinicians: / Lists Clinician Info derived from the clin_id listed in the clin_id column(2) field
Lists All Site (site_id) Location(address) information for the derived clin_id (tb_clins_to_providers) (unless NCTracks Site number included in the file)
Lists Clinician Taxonomy

Provider Only String: 1234||1234567890||

Providers: / Lists Provider Info derived from the prv_id listed in the prv_id column(1) field
Lists All Site (site_id) Location(address) information for the derived prv_id(unless NCTracks Site number included in the file)
Lists All Taxonomy for each site derived from the prv_id

Submitting Provider Upload Files

Provider upload files should be submitted to NCTracks by the MCO. After submission is complete, a submission receipt file will be received listing any errors or a success message. One thing to be aware of is the SEQ NUM maps back to the clinician ID (when a clinician) or provider ID (when a provider). Also, the message “Application in Enrollment Tracking Stage” is benign and is normal for brand new enrollments.

Interpreting Provider Upload Files

The provider upload file is a fixed width format with one line per provider. This format can be difficult to decipher so a decoder was written to help view the individual string parts (asp_generate_provider_upload_decode). To decode the upload string, either paste the string into the SET @provider_upload_string = ‘upload string here’ line below or retrive the string directly from tb_provider_upload_dets.

DECLARE @provider_upload_stringvarchar(MAX)

SET @provider_upload_string=(SELECTupload_textFROMdbo.tb_provider_upload_detsWHEREupload_det_id= 1)

EXECUTEasp_generate_provider_upload_decode@provider_upload_string

Job Schedule

A job was created to automatically process the request files from the Provider_Upload_Request folders. As of 6/26/2015 this jobs runs daily at 2:30 pm.