Ending Date of Service Single, Pull-down 50 words. list. 1: Yes, 2: No 6.8.5 Can Applicant supply all applicable Provider Tax ID Numbers (TINs), National Provider Identifiers (NPIs), and National Council for Prescription Drug Programs (NCPDP) Numbers (pharmacy only) for individual providers? If not, or if yes with deviation, explain. Provider IDs to be Response Yes, unless values represent individual If No or Yes with Supplied provider Social Security numbers deviation, explain. TIN Single, Unlimited. 50 words. list. 1: Yes, 2: No NPI Single, Unlimited. 50 words. list. 1: Yes, 2: No NCPDP Number Single, Unlimited. 50 words. list. 1: Yes, 2: No 6.8.6 Can Applicant provide detailed coding for diagnosis, procedures, etc. on all claims for all data sources? If not, or if yes with deviation, explain. Coding to be Provided Response If No or Yes with deviation, explain. Diagnosis Coding Single, Pull-down list. 50 words. 1: Yes, 2: No Procedure Coding (CPT, HCPCS) Single, Pull-down list. 50 words. 1: Yes, 2: No Revenue Codes (Facility Only) Single, Pull-down list. 50 words. 1: Yes, 2: No Place of Service Single, Pull-down list. 50 words. 1: Yes, 2: No NDC Code (Drug Only) Single, Pull-down list. 50 words. 1: Yes, 2: No
Ending Date of Service Single, Pull-down list. 1: Yes, 2: No 50 words. 6.8.5 Can Applicant supply all applicable Provider Tax ID Numbers (TINs), National Provider Identifiers (NPIs), and National Council for Prescription Drug Programs (NCPDP) Numbers (pharmacy only) for individual providers? If not, or if yes with deviation, explain. Provider IDs to be Supplied Response Yes, unless values represent individual provider Social Security numbers If No or Yes with deviation, explain. TIN Single, list. 1: Yes, 2: No Unlimited. 50 words. NPI Single, list. 1: Yes, 2: No Unlimited. 50 words. NCPDP Number Single, list. 1: Yes, 2: No Unlimited. 50 words. 6.8.6 Can Applicant provide detailed coding for diagnosis, procedures, etc. on all claims for all data sources? If not, or if yes with deviation, explain. Coding to be Provided Response If No or Yes with deviation, explain. Diagnosis Coding Single, Pull-down list. 1: Yes, 2: No 50 words. Procedure Coding (CPT, HCPCS) Single, Pull-down list. 1: Yes, 2: No 50 words. Revenue Codes (Facility Only) Single, Pull-down list. 1: Yes, 2: No 50 words. Place of Service Single, Pull-down list. 1: Yes, 2: No 50 words. NDC Code (Drug Only) Single, Pull-down list. 1: Yes, 2: No 50 words.
Qualified%20Health%20Plan%20Certification%20Application%20Fourth%20Quarter%202017%20Smal....docx