What is the The Provider file is submitted CHIA requires monthly frequency of monthly. submission of this file to insure submission? matching algorithms and reporting requirements of TME / RP. What is the format Each submission must be a An asterisk cannot be used of the file? variable field length asterisk within an element in lieu of delimited file. another character. Example: if the file includes in the Last Name, the system will read an incorrect number of elements and drop the file. What does each A row represents a unique CHIA is required to analyze row in a file instance of a provider entity, information on providers, represent? and that provider’s affiliation to clinicians, hospitals, physician another entity, or a provider’s groups and integrated delivery affiliation to a specific location. systems for the purposes of standardization and reporting. How does CHIA A provider is an entity CHIA analyzes information on define a provider? associated with either: providers, clinicians, hospitals, providing services to physician groups and integrated patients delivery systems. submitting claims for services on behalf of a servicing provider providing business services or contracting arrangements for a servicing provider. How is a unique Conceptually, a unique CHIA realizes that submitters provider to be provider is an instance of a store their provider data in a defined? provider (who), with a variety of formats and data particular affiliation structures. It has been (relationship), at a particular determined that this method location (where), during a provides the greatest flexibility timeframe (when). in analyzing the various ways CHIA will utilize multiple data submitters maintain provider elements to create a unique relationships. provider record within each carrier/submitter file.
What is the frequency of submission? The Provider file is submitted monthly. CHIA requires monthly submission of this file to insure matching algorithms and reporting requirements of TME / RP. What is the format of the file? Each submission must be a variable field length asterisk delimited file. An asterisk cannot be used within an element in lieu of another character. Example: if the file includes in the Last Name, the system will read an incorrect number of elements and drop the file. What does each row in a file represent? A row represents a unique instance of a provider entity, and that provider’s affiliation to another entity, or a provider’s affiliation to a specific location. CHIA is required to analyze information on providers, clinicians, hospitals, physician groups and integrated delivery systems for the purposes of standardization and reporting. How does CHIA define a provider? A provider is an entity associated with either: providing services to patients submitting claims for services on behalf of a servicing provider providing business services or contracting arrangements for a servicing provider. CHIA analyzes information on providers, clinicians, hospitals, physician groups and integrated delivery systems. How is a unique provider to be defined? Conceptually, a unique provider is an instance of a provider (who), with a particular affiliation (relationship), at a particular location (where), during a timeframe (when). CHIA will utilize multiple data elements to create a unique provider record within each carrier/submitter file. CHIA realizes that submitters store their provider data in a variety of formats and data structures. It has been determined that this method provides the greatest flexibility in analyzing the various ways submitters maintain provider relationships.
v6-apcd-provider-file-submission-guide-FINAL.docx