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Managed Care Institutional Provider Network Data: March 31, 2012

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Open Data NY - DOH Open Data NY - DOH

created Feb 26, 2013

updated Mar 10, 2013

Description

The primary purpose for the Provider Network Data System is to collect data needed to evaluate the provider networks including physicians, hospitals, labs, home health agencies, durable medical equipment providers, etc., for all types of Managed Care plans in New York State, including HIV Special Need Plans (SNP), Family Health Plus (FHP) Buy-In, Programs of All-Inclusive Care for the Elderly (PACE), and Non-PACE Managed Long-Term Care (MLTC) plans. This dataset reflects institutional provider data. Provider Network Data System information is self reported. For more information, go to http://www.health.ny.gov/health_care/managed_care/.

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Meta
Category
Health
Permissions
Public
Tags
directory, managed care, medicaid, plan, provider
Licensing and Attribution
Data Provided By
New York State Department of Health
Source Link
http://www.health.ny.gov/health_care/managed_care/
Dataset Summary
Organization
Office of Health Insurance Programs
Time Period
Cumulative through March 31, 2012
Posting Frequency
Quarterly
Data Frequency
Quarterly
Dataset Owner
Division of Health Plan Contracting & Oversight
Coverage
Statewide
Granularity
County
Units
Managed Care Plan Provider
Notes
Notes
Uses of PNDS Data: 1. Provider eligibility assessment, to assure that only qualified providers are delivering health care to plan members. 2. Comprehensive services assessment to assure that comprehensive health services are available as required under Section 4403 of the Public Health Law. 3. Access and travel assessment of Managed Care Plans serving Medicaid recipients are evaluated against established standards. 4. Finding a Managed Care Plan provider through customized directories of providers by county. 5. Capacity analysis to calculate the potential capacity of a Managed Care Plan's primary care providers. 6. Investigation of Fraud to identify Medicaid providers who have been identified as unable to participate in Medicaid Managed Care during the quarter. 7. Provider network review by appropriate government agencies at the state, county and local government level.
Disclaimers
Limitations
Provider Network Data System information is self reported.
Dataset Information
Agency
Health, Department of