CAQH ProView Reports Summary

Transcription

1 Submit Roster From participating organization to CAQH. Ad hoc based on participating organization s need Providers that the participating organization wants to: The roster is uploaded to the Participating Organizations Incoming SFTP Folder OR through the Web Interface. Participating Organization currently using a nonsecured SFTP option, are encouraged to make the switch to use secure SFTP option to transfer roster files. To ensure secure file transfers, change the port number on the SFTP client software to 22. Submit roster data in a Pipe - delimited ASCII One formatted record for each provider based on the current Submit Roster Specifications. File must include all fields even when no data is present. If no data is present the file will return null in its place. All required fields with an R in the table must be populated Can submit multiple rosters, however, the rosters will be processed in the order in which they were received. If a Provider record is in multiple roster files, the data in the previous rosters will be overwritten by the information in subsequent roster files. Add to their roster Update certain fields on existing providers, such as correspondence address or organization s provider ID Delete providers from their roster (provider stays on return roster in an inactive status) Submit a launch roster for new state (i.e. Nevada) Submit a launch roster for allied providers Add providers new to the participating plan Return Roster From CAQH to participating The return roster for each Participating Organization will be created under the CAQH Provider ID and Participating Organization ID are required for all updates and deletes. Pipe - delimited ASCII One formatted record for each provider based on the participating organization s roster, Daily or Weekly determined by participating organization All providers attached to the participating organization whether from the Submit Roster or the Add Provider function on the CAQH ProView PO Portal: CAQH Provider ID CAQH Status Work providers in returned mail status Identify completed providers and eliminate them from February 2015 Page 1 of 5

2 Outgoing directory in their respective accounts within CAQH ProView secure SFTP server. whether active or inactive, according to current Return Roster Specifications. Roster Exception From CAQH to participating organization, available under the PO s Outgoing directory in account within CAQH ProView secure SFTP server. Standard Extract From CAQH to participating Pipe - delimited ASCII One formatted record for each error that occurred during the processing of a Submit Roster or each provider merged during the weekly duplicate process criteria determined by participating File format specified by participating organization: XML ASCII in pipe delimited format Replica in pdf format Weekly every Friday, determined by CAQH Weekly on the specified day determined by participating Created and uploaded to the Participating Organizations SFTP folder. An notification will be sent to the address/es that were specified during on the Provider demographics (based on what was submitted when provider was added to CAQH ProView, not what was supplied on the Submit Roster) Organization specific fields Errors that occurred during the processing of a Submit Roster (invalid format, duplicate within the organization s roster, bad data content, etc.) Providers merged during weekly duplicate process All providers who meet the extract selection criteria below since the last standard extract was generated: Newly complete providers who have authorized the organization (Initial Application Complete status) Reattested providers (Reattestation status) who recredentialing reminder mailings Link organization s provider ID to CAQH s Provider ID Identify reason for the error, correct and resubmit the record Identify duplicate records merged during weekly process to update link between organization s provider ID to CAQH s Provider ID Use Replica applications as a way to implement CAQH with minimal impact on existing workflows. Move towards ASCII or XML as organization becomes more comfortable and looks to incorporate data electronically. Use Excel (for smaller organizations) and/or February 2015 Page 2 of 5

3 NOTE: selection of supporting documents is an option for all files types, however most organizations may not need supporting documents in a standard extract. Create Standard Extract page have authorized the Complete providers (Initial Application Complete or Reattestation status) who newly authorized the Access to format data for analysis. Use the Data Summary table to capture critical data elements that may have changed in a provider s application. The Standard Extract will be returned as a zip file. Each standard extract, regardless of format, contains a Data Summary (with an entry every provider who met the above for inclusion in an extract, including providers who reattested without). ASCII, when unzipped, contains multiple s which are linked by the provider attestation ID. These tables do not contain providers who reattested without changes. Use to feed internal systems within credentialing and/or other areas of the Custom Extract from CAQH to participating organization, available on the Reports Page of the PO CAQH ProView Portal criteria determined by participating File format specified by participating organization: XML Ad hoc based on participating organization s need All complete providers, active on the organization s roster, who have authorized the organization and meet the custom extract criteria. The Custom Extract will be Use as a custom extract to request Replica applications, on multiple providers at a time, who may be coming up for recredentialing. February 2015 Page 3 of 5

4 ASCII in pipe delimited format Replica in pdf format Directory Maintenance Report (DMR) from CAQH to participating organizations, available on the Reports Page of the PO CAQH ProView Portal NOTE: selection of supporting documents is an option for all files types, however it is only recommended with the Replica Format as supporting documents are returned in pdf format. participating organization rostered provider attestation activity. Weekly every Saturday returned as a zip file. ASCII, when unzipped, contains multiple s which are linked by the provider attestation ID. All providers who meet the directory maintenance report criteria and meet the below since the last directory maintenance report was generated: Active on participating organization s roster Authorized participating organization In a complete status (Initial Application Complete, Reattestation). Provider Attest resulted in a data change for the following change types: Data Added Data Deleted Data Changed Use a custom extract to request supporting documents in support of a state specific audit. Use a custom extract to pull a specific application section for further analysis (utilize Excel (for smaller organizations) and/or Access to format data). This report is an activitylog based extract that can help an organization quickly sift through information where changes such as adds, deletes, and updates to the provider s online application data has been made. Captures changes related to directory data, such as practice locations, hospital affiliations, and other pertinent information. Highlights specific data changes to help Participating February 2015 Page 4 of 5

5 Data Unchanged (within the same section where other data has been changed) Organizations streamline the process for maintaining provider directories. February 2015 Page 5 of 5