Names List Guidance

  • Guidance is also available in Portable Document Format (PDF)
MCD Sponsorship Request Toolkit
Guidance: Completing the Names List
What is the Names List?
  • The Names List is a tracker that records the names of everyone who will access Medicaid Confidential Data (MCD) on behalf of the sponsored MCD Requestor.
  • The requirement for a Names List is included in the MCD data-sharing agreement.
Do I need to use a specific form or template?
  • Yes, sponsored MCD requestors must use the Names List Form to identify all individuals accessing MCD on the requestor´s behalf.
How do I name the Names List File?
  • The Names List File must be in a standardized format when it is submitted.
  • The standard filename convention is "Entity Name_DUA Number_Names List_MM-DD-YYYY" where:
    • Entity Name is your legal organization/business name.
    • DUA Number is the Data Use Agreement Identification number that is provided and is listed on the DUA and DUA Addendum documents.
    • "Names List" indicates the type of document.
      • "MM-DD-YYYY" is the date that the Names List is submitted. This is updated with every new Names List submission.
How do I complete the fields in the Names List Template?
  • The Data Use Agreement (DUA) Number – the DUA Identification number is provided on the DUA and DUA Addendum documents.
  • NAME (Last) – l ast name of user accessing the MCD. Must be provided for each user on the Names List.
  • NAME (First) – f irst name of user accessing the MCD. Must be provided for each user on the Names List.
  • Company – Name of organization/business where the named user is employed.
  • Address, City, State and Zip code – Address of the location/ office of MCD Requestor.
  • Email ID – Official organizational email address of the named user
  • Effective Date – Effective Date in mm-dd-yyyy/ (xx-xx-xxxx) format is the date when the named user starts accessing or using MCD
  • End Date – End date in mm-dd-yyyy/ (xx-xx-xxxx) format is the date when the named user stops accessing or using MCD. You may leave this blank if the end data is unknown.
Questions? Contact us! doh.sm.medicaid.data.exchange@health.ny.gov