Insure Kids Now
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Provider Data Submission Technical Information
Attachment B
DRAFT
Insure Kids Now
Provider Data Submission Technical Information
June 16, 2009
Centers for Medicare & Medicaid Services (CMS)
Health Resources Services Administration (HRSA)
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Provider Data Submission Technical Information
Table of Contents
Section
Page
Provider Data Submission Technical Information .......................................................................... 1
What is eRoom? .............................................................................................................................. 1
Option 1: Submission of Oral Health Provider Data Files Produced from a State’s Automatic Data
Processing Systems ......................................................................................................................... 1
Option 2: Use Desktop Data Entry to Produce Oral Health Provider Data Files ............................ 4
Option 3: Direct Entry on Oral Health Provider Data Using eRoom Database ............................... 5
APPENDIX A: Add Files Procedure ............................................................................................... A-1
APPENDIX B: Entry of Federally Qualified Health Centers Provider Data ................................... B-1
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Provider Data Submission Technical Information
Provider Data Submission Technical Information
The Insure Kids Now (IKN) website project entails collecting data about qualified Oral Health
Providers
1
within each State or Territory and development of a locator application to make this
data available to the public over the web. Centers for Medicare & Medicaid Services (CMS) and
Health Resources and Services Administration (HRSA) will be using the eRoom collaborative
environment to collect and disseminate information about the IKN website project and to
coordinate with our State
2
partners in this effort.
What is eRoom?
The eRoom is a secure portal for sharing electronic project data and information including:
documents, databases, files, schedules, calendars. Each State will be part of the IKN community
and have access to the common data and restricted access to their own State information and
data. Only personnel from your State (and the system administrators) will be able to access
your State’s IKN eRoom. Each State is to inform the IKN eRoom Site Administrator of the
personnel who will be granted access to the IKN community and the State specific eRoom. The
administrator will provide the users the log in instructions, identification, and passwords so that
they can gain access to the IKN eRoom. The eRoom will have documents and information on
the fields we are collecting, how the data will be used, the Access Data Collection Tool,
additional instructions for the various types of ways to provide the data, and an eRoom
database for collecting this data.
Because the States manage their provider data in a variety of ways, CMS and HRSA have
identified three options for creating and submitting the required data (in effect large, medium,
and small scale data options). The first is creation of the data files from a State’s automatic data
processing (ADP) system, the second is using a CMS and HRSA provided desktop database tool,
and the third is entry of data in an uncomplicated web data table. The States will need to inform
CMS and HRSA which option the State will employ. Each of the options is described below.
Option 1: Submission of Oral Health Provider Data Files Produced from a State’s
Automatic Data Processing Systems
CMS and HRSA are asking States to provide Oral Health Provider Data in two text files. The first
is the control file which provides identifying information for the data. This control file needs to
be called IKN_CONTROL_XX.txt (where the XX is the State abbreviation) and must contain the
name of preparer, the contact name, contact phone number, contact e-mail (if available), the
1
A qualified oral health provider is one who provides dental services to children enrolled in the State plan (or
waiver) under Medicaid or the State child health plan (or waiver) under the Children's Health Insurance Program
(CHIP).
2
The term State refers to U.S. States, the District of Columbia, and Territories throughout the remainder of the
document.
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Provider Data Submission Technical Information
number of records, and the data as of date. The second file called IKN_XX.txt (where the XX is
the State abbreviation) is a vertical pipe ( | ) delimited file (the pipe separates the fields) which
contains the data elements in the required order as described in Table 1 below.
The first line of the data file shall include the pipe-delimited list of field names (see Table 1
below) as this shall be used in validation of the submission. For values you are leaving blank,
two pipes will be together with nothing in between. Here is an example record showing the first
few data fields of the first two lines in a data file.
Nat_Prov_ID|Prov_Aff|First_Nm|Middle_Nm|Last_Nm|Fac_Nm|Phy_Street_Addr|City|…
12345|FQHC|John||Smith|Family Dentistry|123 Elm Street|Topeka|…
Figure 1. Example of Provider Data File.
Note that John Smith has no middle name, but the position is maintained by the two pipes with
nothing in between. There are some data elements which are optional, if a State does not have
these data elements at this time, a blank entry is acceptable. For fields that allow for multiple
entries within them (i.e. Language), please use a comma (,) to separate the multiple entries
(example: |Spanish, Chinese|.
Each distinct physical location at which a provider (as defined by their National Provider
Identifier or State Medicaid Number) works needs a record. As guidance, some provider and
location scenarios and the expected pipe-delimited data records are described below:
One Provider at One Location: If a provider has one location then the IKN_XX.txt file
would have a single complete record for that provider.
One Provider with Multiple Locations: If a provider has three locations then the
IKN_XX.txt file would have three complete records for that provider.
Practice with More than One Provider and One Location: If a practice has two
providers at a single location then the IKN_XX.txt file would have two complete records
(one for each provider).
Practice with More than One Provider and Multiple Locations: If a practice has two
providers and three locations then the IKN_XX.txt file would have complete records for
each provider associated with each location at which that provider practices.
Please refer to Appendix B, Entry of Federally Qualified Health Centers Provider Data for
special instructions for handing of the Federally Qualified Health Center (FQHC) data.
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Table 1. Oral Health Provider Data Elements.
Data Element
Name
Description
Required
Comments
Nat_Prov_ID
National Provider Identifier
Required
Will not be available on the
IKN website. Could be the
State Medicaid Number if
the provider does not have
a NPI
Prov_Aff
Provider Affiliation
Required
For entry purposes use the
provided codes:
PP = Private Practice
CHC = Community Health
Center
HD = Health Department
OTH = Other
First_Nm
Provider First Name
Required
Note: See FQHC exception
Appendix B
Middle_Nm
Provider Middle Name
Optional
Note: See FQHC exception
Appendix B See FQHC
exception
Last_Nm
Provider Last Name
Required
Note: See FQHC exception
Appendix B See FQHC
exception
Grp_Prac_Nm
Group Practice Name
Required
Only if applicable.
Active_Ind
Active Status
Required
Enter Y or N.
Active_Dt
Active Date
Optional
mm/dd/yyyy
Inactive_Dt
Inactive Date
Optional
mm/dd/yyyy
Fac_Nm
Facility Name
Optional
Applies in cases where the
practice location is
associated with or
contained in a facility such
as a hospital, school, or
community health center
Phy_Street_Addr
Provider Physical Site Street
Address
Required
No P.O. Box or R.R. Box.
Only a physical location
where services are
provided.
City
Provider City
Required
State_Abbr
Provider State
Required
Two character postal
abbreviation.
ZIP
Provider ZIP Code
Required
99999-9999
Phone_Num
Phone Number
Required
999-999-9999 x999
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Provider Data Submission Technical Information
Data Element
Name
Description
Required
Comments
FAX_Num
FAX Number
Optional
999-999-9999 x999
Lang_Spoken
Languages Spoken
Optional
Only enter languages other
than English that are
spoken at the facility. A
blank entry indicates that
only English is spoken.
NOTE: Use a comma (,) to
separate multiple entries
Specialty
Provider Specialty
Required
Select any and all from list:
General Dentist; Pediatric
Dentist; Oral Surgeon;
Orthodontist; Endodontist;
Periodontist.
NOTE: Use a comma (,) to
separate multiple entries
New_Patients
Accepts New Patients
Required
Enter Y or N.
Special_Needs
Can Accommodate Special
Needs
Required
Enter Y or N.
Website
Website Address
Optional
Managed_Care
Affiliation with Managed
Care Plans
Optional
Name of the Managed Care
Organization
When creating the pipe-delimited data file, use only the column names exactly as provided.
Additional, missing, or miss-ordered data elements will impede the loading of your State’s data.
The created data submission files IKN_CONTROL_XX.txt (control) and IKN_XX.txt (pipe-
delimited provider data) will be uploaded by the State into their IKN eRoom by the required
date as noted in the cover letter. Please refer to Appendix A, Add Files Procedure for
assistance with the file upload process. Remember a state’s submission is not complete unless
both the control and provider data files have been uploaded in the State’s eRoom.
Option 2: Use Desktop Data Entry to Produce Oral Health Provider Data Files
For States which would like to manage this data on their own, but will not be exporting the data
from an existing database system, a small straightforward Microsoft Access database tool is
available for download from the IKN eRoom. This tool opens a switchboard menu for navigation
to (1) the State Control Information data entry window, (2) the oral health provider information
data entry window, (3) a printable report to facilitate State review of the data, and (4) the IKN
files export function which will to produce the submission files in the correct format (see
Table 1 above) and save them to a location on the user’s workstation or network. The process
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Provider Data Submission Technical Information
of data entry process starts with entry of the State control information; this is the State
identifying information which is used in validating a State’s submission. The second step is
entry/review of the provider data. There are some data elements which are optional, if a State
does not have these data elements at this time, a blank entry is acceptable; please refer to
Table 1 above for the required and optional data elements. Next is the automatic production of
the data files (the final button on the switchboard menu). At this point the State is ready to
submit their data; this is accomplished by logging into the eRoom and uploading the two
required data files into their eRoom by the specified date. Please refer to Appendix A, Add Files
Procedure for assistance with the file upload process. A benefit of using the desktop tool is that
States can update their own IKN provider data using this tool as required (not just for the
quarterly submissions) and make use of this data for their own reporting purposes. Remember
a state’s submission is not complete unless both the control and provider data files have been
uploaded in the State’s eRoom.
Please refer to Appendix B, Entry of Federally Qualified Health Centers Provider Data for
special instructions for handing of the Federally Qualified Health Center (FQHC) data.
Option 3: Direct Entry on Oral Health Provider Data Using eRoom Database
Option 3 is the only one which will not require uploading any data files.
Each State will have its own eRoom CHIP Oral Health Care Providers Database. This database
will allow the State to key in their provider data from scratch or start with the import of a CSV
file and edit it in the eRoom. The State would complete their data entry by the required date
and HRSA/CMS will directly retrieve the data from each State’s eRoom database. There are
some data elements which are optional, if a State does not have these data elements at this
time, a blank entry is acceptable; please refer to Table 1 above for the required and optional
data elements. This may be the best option for States where there are a limited number of
providers (under 50) or provider lists where there is little change from quarter to quarter, since
data can be updated over the web and HRSA/CMS will be responsible for storing and backing up
the data. If a State needs to use their data, the eRoom database can be exported using a button
on the database page (see Figure 2 below).
When States are entering data in its eRoom database, keep in mind that each distinct physical
location at which an oral health provider (as defined by their National Provider Identifier or
State Medicaid Number) works needs a record. As guidance, some provider and location
scenarios and the expected data entries are described below:
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Provider Data Submission Technical Information
One Provider at One Location: If a provider has one location then the eRoom database
would have a single complete record for that provider.
One Provider with Multiple Locations: If a provider has three locations then the eRoom
database would have three complete records for that provider.
Practice with More than One Provider and One Location: If a practice has two
providers at a single location then the eRoom database would have two complete
records (one for each provider).
Practice with More than One Provider and Multiple Locations: If a practice has two
providers and three locations then the eRoom database would have complete records
for each provider associated with each location at which that provider practices.
Please refer to Appendix B, Entry of Federally Qualified Health Centers Provider Data for
special instructions for handing of the Federally Qualified Health Center (FQHC) data.
Figure 2. eRoom Database Page.
CSV Export
Button
Import
Button
Add Record
Button
HTML Export
Button
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Provider Data Submission Technical Information
APPENDIX A: Add Files Procedure
The procedure to add files is described here. The description is uses the specific instances of
adding the IKN_CONTROL_XX.txt control file and the IKN_XX.txt pipe-delimited provider data
file). Remember a state’s submission is not complete both files have been uploaded in the
state’s eRoom.
The process for doing this is to first log into your state IKN eRoom. After logging in the user will
see an eRoom as displayed in Figure 1 below (there will be more items in the state eRooms, this
is just for demonstration). Click the <add file> button.
Figure 1. Example State IKN eRoom.
Add file button.
Next the Add File page will appear (see Figure 2 below); the user can browse their
desktop/server to find the location where the data files are located, select the control file and
then click the <OK> button. Then repeat this for the provider data file.
Figure 2. eRoom Add File Page.
Browse to locate file.
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APPENDIX B: Entry of Federally Qualified Health Centers Provider Data
Many Federally Qualified Health Centers (FQHCs) provide dental services through contracts
with local private practices. It is understood that many of these oral health providers supplying
these services through these contractual arrangements may not want their practice information
listed on the IKN website. It is not necessary to provide the name and address of oral health
providers that are seeing clients through contracts with FQHCs, assuming that the billing is
done through the FQHC’s National Provider Identifier (NPI). Instead, it is requested that when
providing information for FQHCs, that the addresses of all clinic locations that provide oral
health services are listed separately and that a name of an FQHC staff person be identified. For
entries identified as an FQHC, only the name, address and phone number will be listed on the
IKN website and not the provider name.
| File Type | application/pdf |
| File Title | Insure Kids Now |
| Subject | Insure Kids Now, IKN, oral, dental, provider, data elements |
| Author | CMS/CMSO |
| File Modified | 2009-06-19 |
| File Created | 2009-06-19 |