the standards and/or provider types are not reportable within the grid, use the Comment Box to report the data. While the Department does not set targets or determine industry norms, the Department will question targets outside of the industry norm or improperly set. Examples of improperly set targets are using driving distance rather than provider-to-member data or using NC census data and/or the total of all licensed providers in NC including by provider type; NCGS When evaluating norms” the Department reviews insurers with similar size “industry membership. Standards can vary depending on the type of carrier and membership. Full-service carriers with large membership may have standards ranging from 1 PCP per 100 members to 1:1,000 members. Carriers with medium membership and small/medium networks may have standards ranging from 1:500 to 1:1,200. Standards for mental health/chemical dependency providers may range from 1:500 to 1:5,000. Specialist standards can from 1:2,000 members to 1:10,000, and facilities, including mental health/chemical dependency, can range from 1:10,000 to 1:50,000. The premise is that Specialty (including MH/CD) providers are limited; therefore, the ratio can be higher than general type providers (i.e. PCPs, General Dentists, Optometrists). Full-Service carriers must specify in the Comment Box the type of providers included in the Specialist Physicians and Non-MD Providers columns. The Carrier MUST report at least the top 10 utilized provider types applicable to the Specialist Physicians and Non-MD Providers columns. When listing the provider types in the Comment Box it must be clear to the Department whether the same standard applies to all or if standards vary (each standard must be disclosed). messages will occur if the network type is not checked, if more than one network type is checked and/or if a provider type cell within a geographic area is left blank. Explanations must be provided in the Comment Box for any message or if is entered in a cell. “ERROR” “N/A”
the standards and/or provider types are not reportable within the grid, use the Comment Box to report the data. While the Department does not set targets or determine industry norms, the Department will question targets outside of the industry norm or improperly set. Examples of improperly set targets are using driving distance rather than provider-to-member data or using NC census data and/or the total of all licensed providers in NC including by provider type; NCGS When evaluating “industry norms” the Department reviews insurers with similar size membership. Standards can vary depending on the type of carrier and membership. Full-service carriers with large membership may have standards ranging from 1 PCP per 100 members to 1:1,000 members. Carriers with medium membership and small/medium networks may have standards ranging from 1:500 to 1:1,200. Standards for mental health/chemical dependency providers may range from 1:500 to 1:5,000. Specialist standards can from 1:2,000 members to 1:10,000, and facilities, including mental health/chemical dependency, can range from 1:10,000 to 1:50,000. The premise is that Specialty (including MH/CD) providers are limited; therefore, the ratio can be higher than general type providers (i.e. PCPs, General Dentists, Optometrists). Full-Service carriers must specify in the Comment Box the type of providers included in the Specialist Physicians and Non-MD Providers columns. The Carrier MUST report at least the top 10 utilized provider types applicable to the Specialist Physicians and Non-MD Providers columns. When listing the provider types in the Comment Box it must be clear to the Department whether the same standard applies to all or if standards vary (each standard must be disclosed). messages will occur if the network type is not checked, if more than one network type is checked and/or if a provider type cell within a geographic area is left blank. Explanations must be provided in the Comment Box for any “ERROR” message or if “N/A” is entered in a cell.