Value Based Payment (VBP)

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Element # Name Direction Allowed Values Data Type Required/Optional Length Start End
1 Plan_ID# Organization ID used to submit the IDSS to NCQA. This ID is consistent across all Lines of Business. ###### VARCHAR R 6 1 6
2 Product_Line A member's product line at the end of the measurement period. 1 = MEDICAID
2 = SNP
11 = HARP		 NUMBER R 2 7 8
3 Unique_Member_ID# Medicaid Client ID Number (CIN) *The field is alphanumeric and should be treated as text field. This field is mandatory – do not leave it blank!   VARCHAR R 8 9 16
4 County_of_Residence Enter the 3-digit county FIPS code for each member's residence of county. ### NUMBER R 3 17 19
5 Zip_Code_of_Residence   ##### NUMBER R 5 20 24
6 Practice_Tax_ID# Populate with valid TINs only. This field is mandatory – do not leave it blank! ######### NUMBER R 9 25 33
7 PCMH_Site_ID# PCMH Site ID# - NCQA generated ID   NUMBER O 11 34 44
8 Practice_Site_ID# Internal plan practice site ID#   VARCHAR O 13 45 57
9 Practice_Name This field is mandatory – do not leave it blank!   TEXT R 50 58 107
10 Practice_Address_Line_1     TEXT R 35 108 142
11 Practice_Address_Line_2     TEXT O 35 143 177
12 Practice_Address_Line_3     TEXT O 35 178 212
13 Practice_Address_City     TEXT R 25 213 237
14 Practice_Address_State     TEXT R 2 238 239
15 Practice_Address_Zip_Code   ##### NUMBER R 5 240 244
16 Practice_Telephone_Number   ########## NUMBER O 10 245 254
17 Provider_NPI National Provider Identifier – 10 Digit ID ########## NUMBER R 10 255 264
18 Provider_First_Name     TEXT R 15 265 279
19 Provider_Middle_Initial     TEXT O 1 280 280
20 Provider_Last_Name     TEXT R 35 281 315
21 VBP_Contractor_Tax_ID# Populate with valid TINs only. If member is NOT in a VBP level 1 or higher arrangement set to '999999999'. ######### NUMBER R 9 316 324
22 VBP_Contractor_DBA_Name If member is NOT in a VBP level 1 or higher arrangement set to '999999999'.   NUMBER R 50 325 374
23 VBP_Contractor_Type   1 = Provider/Hospital
2 = IPA
3 = ACO
9 = Unknown		 NUMBER R 1 375 375
24 VBP_Arrangement_Type Refer to Section C, #2b of the DOH 4255 – Provider Contract Statement and Certification form. 1 = TCGP
2 = IPC
3 = HARP
4 = HIV/AIDs
5 = Maternity
6 = Off Menu		 NUMBER R 1 376 376
25 DOH_VBP_Contract_ID# Number provided by DOH in Agreement approval letter, begins with DOH ID ### #### NUMBER R 4 377 380
26 MCO_Unique_Contract_ID# Plan generated ID used to submit contract to DOH; Section A, #3 of the 4255.   VARCHAR R 50 381 430
27 Prov_Att_start_date MMDDYYYY – Must be between 1/1/2019 and 12/31/2019 MMDDYYYY DATE R 8 431 438
28 Prov_Att_end_date MMDDYYYY – Must be between 1/1/2019 and 12/31/2019 MMDDYYYY DATE R 8 439 446
# Field Name Description/Specifications
1 Plan_ID# Enter your Organization ID used to submit the IDSS to NCQA. This ID is consistent across all Lines of Business.
2 Product_Line Enter the member's product line at the end of the measurement period . Enter the corresponding number (1) Medicaid, (2) SNP, (11) HARP.
3 Unique_Member_ID# Enter member's Medicaid Client Identification Number (CIN). The field should be continuous without any spaces or hyphens. The field is alpha-numeric and should be treated as a text field. This field is mandatory – do not leave it blank!
4 County_of_Residence Enter the Federal Information Processing Standard (FIPS) code for the member's county of residence. Please refer to Appendix IV, Table 5 - NYS FIPS Codes by County at the end of this manual for a complete listing of NYS FIPS codes.
5 Zip_Code_of_Residence Enter the 5-digit zip code of the member's residence.
6 Practice_Tax_ID# Enter the 9-digit Federally assigned Tax Identification number for the Practice of the member's provider. Populate with valid TINs only. This field is mandatory – do not leave it blank!
7 PCMH_Site_ID# Enter the NCQA assigned number associated with your Patient-Centered Medical Home (PCHM.)
8 Practice_Site_ID# Enter your internal site ID assigned by the plan.
9 Practice_Name Enter the complete name of the provider's practice. This field is required, do not leave blank.
10 Practice_Address_Line_1 Enter the physical address of the practice location. (Enter up to 3 lines)
11 Practice_Address_Line_2
12 Practice_Address_Line_3
13 Practice_Address_City Enter the city in which the practice is located.
14 Practice_Address_State Enter the 2-digit abbreviation for the state in which the practice is located.
15 Practice_Address_Zip_Code Enter the 5-digit zip code in which the practice is located.
16 Practice_Telephone_Number Enter the practice's main phone line, it should be in the format of ########## with no intervening "-".
17 Provider_NPI This is the unique 10-digit National Provider Identifier (NPI) of the provider the member was serviced by during the reporting period. This should be a provider organization which had frequent contact with the member and, therefore, could potentially affect the need for hospitalization or not. A member may be serviced by multiple providers during the same time period (provide one row of data for every provider a member was serviced by).
18 Provider_First_Name Enter the provider full first name
19 Provider_Middle_Initial Enter the provider's middle initial.
20 Provider_Last_Name Enter the provider's last name.
21 VBP_Contractor_Tax_ID# This is the unique 9-digit tax identification number of the VBP Contractor (not the provider) that the member is assigned to for a Level 1 or higher VBP arrangement during the reporting period. A member can only be assigned to one VBP contactor at a time. If not applicable, fill with 999999999.
22 VBP_Contractor_DBA_Name The "Doing Business As" (DBA) name is the operating name of a company, as opposed to the legal name of the company. The VBP Contractor may be an ACO, IPA, individual provider or hospital.
23 VBP_Contractor_Type In this field, enter '1' if the contractor is a provider (provider includes hospitals), '2' if the contractor is an IPA, '3' if the contractor is an ACO, '9' if Unknown
24 VBP_Arrangement_Type In this field, enter "1" if the VBP arrangement type is a TCGP arrangement, "2" if it is an IPC arrangement, "3" if it is a HARP arrangement, "4" if it is an HIV/AIDs arrangement, "5" if it is a Maternity arrangement, "6" if it is an Off Menu arrangement. This information can be found in Section C, #2b of the DOH 4255 – Provider Contract Statement and Certification form.
25* DOH_VBP_Contract_ID# This is the number provided by DOH in the Agreement approval letter for your VBP arrangement, it begins with DOH ID ####. * You must populate either field 25 or 26, preferably both fields should be populated.
26* MCO_Unique_Contract_ID# This is the contract identifier created by your plan, which is a required component of all contracts submitted for review (it can be found in Section A, #3 of the DOH 4255, it is also typically in the footer of your contract documents. * You must populate either field 25 or 26, preferably both fields should be populated.
27 Prov_Att_start_date This is the attribution start date with the provider, when the member was first attributed to the provider. This date must be during the reporting period. It should be in the format of MMDDYYYY with no intervening "-" or "/". The format is the same if data is submitted via a fixed-width file or CSV.
28 Prov_Att_end_date This is the attribution end date with the provider, when the member was last attributed to the provider. This date must be during the reporting period. It should be in the format of MMDDYYYY with no intervening "-" or "/". The format is the same if data is submitted via a fixed-width file or CSV.
Field Name Plan_ID# Product_Line Unique_Member_ID# County_of_Residence Zip_Code_of_Residence Practice_Tax_ID# PCMH_Site_ID# Practice_Site_ID# Practice_Name Practice_Address_Line_1 Practice_Address_Line_2 Practice_Address_Line_3 Practice_Address_City Practice_Address_State Practice_Address_Zip_Code Practice_Telephone_Number Provider_NPI Provider_First_Name Provider_Middle_Initial Provider_Last_Name VBP_Contractor_Tax_ID_# VBP_Contractor_DBA_Name VBP_Contractor_Type VBP_Arrangement_Type DOH_VBP_Contract_ID# MCO_Unique_Contract_ID# Prov_start_date Prov_end_date
Column Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446
Data Example 1 1 2 3 4 5 6 0 1 W A 3 6 4 5 3 X 1 2 3 1 2 1 1 0 1 2 3 4 5 6 7 8 9 A B C 0 0 1 2 3 4 - 5 A B C 1 2 3 4 5 6 7 - 8 9 A B C H e a l t h C l i n i c W e s t 1 2 3 H e a l t h H i g h w a y M e d i c a l A r t s B u i l d i n g S u i t e 6 3 2 Y o u r T o w n N Y 1 2 3 4 5 5 1 8 9 6 3 4 5 8 2 N 9 8 7 6 5 4 3 2 1 A d d i s o n M J o h n s o n - W i l l i a m s 1 2 3 4 5 6 7 8 9 H e a l t h C l i n i c N Y 1 1 0 9 8 3 A B C . H e a l t h C l i n i c 4 . 1 2 . 1 8 0 1 0 1 2 0 1 9 0 4 3 0 2 0 1 9
Data Example 2 (same member as example one but attributed to a different provider) 1 2 3 4 5 6 0 1 W A 3 6 4 5 3 X 1 2 3 1 2 1 1 0 1 2 3 4 5 6 7 8 9 A B C 0 0 1 2 3 4 - 5 A B C 1 2 3 4 5 6 7 - 8 9 A B C H e a l t h C l i n i c W e s t 1 2 3 H e a l t h H i g h w a y M e d i c a l A r t s B u i l d i n g S u i t e 6 3 2 Y o u r T o w n N Y 1 2 3 4 5 5 1 8 9 6 3 4 5 8 2 N 1 2 3 4 5 6 7 8 9 A d d i s o n M J o h n s o n - W i l l i a m s 1 2 3 4 5 6 7 8 9 H e a l t h C l i n i c N Y 1 1 0 9 8 3 A B C . H e a l t h C l i n i c 4 . 1 2 . 1 8 0 5 0 1 2 0 1 9 1 2 3 1 2 0 1 9