Participating Provider Files (Par Files)

HealthLink and National Capital PPO par files have select new features that began in May 2006. The new features include:

• A field location for National Provider Identifiers (NPIs);
• Consistent presentation of the data elements at field 59 for all file types;
• The Healthlink or NCPPO affiliated hospital for individual practitioners (staff privileges) using the NCPPO and HealthLink 6-digit provider ID; and
• Improvements in field length for provider service locations.

The par file changes will allow payors who use "par files" for production of their own or vendor-produced paper provider directories to identify the correct hospital affiliations by use of a code (and reference table) as well as indicate providers who are board certified in the "board status" field. The NCPPO and HealthLink specialty codes are cross-referenced to national specialties (using taxonomy codes).

Those payors using "par files" to mark their provider records for the correct participation status will have the ability to automatically program their systems to accept a full-file with the new field for the NPI.

All file types to have consistent data elements starting at field 59 (the current versions vary in content at this point to the end of the files).

Field 58 is a "P" or "G" indicator, to signify if the provider is contracted at the individual practitioner lever (P) or the group level (G), the latter may be the contracting method for a PHO.

Field 59 is the "line of business" which tells if the provider participated in the HMO or PPO, corresponding to the type of file.

The Payor Relations Specialists will work with each payor or payor?s vendor to:

• Ensure a FTP Transmission method set-up is established (if not already done);
• The payor is ready to test or receive the new file types; and
• That we document the purpose of the payor?s use of the par file, so we can ensure the correct file type is transmitted.

Healthlink has developed an enhanced par file for payor clients. The new par file format includes the following improvements:

Better par file documentation, and field definitions. A placeholder for NPI (national provider identifiers) for the use of the NPI number. Improved hospital privilege data references. Consistency between par file options at field 59---line of business (such as PPO or HMO tiers). Additional space to accommodate providers with many service locations.

Summary of Par Files:

Par File Types:

• Healthlink PPO
• Healthlink HMO (for Open Access II and III)
• Healthlink OA Combined Files (for OA III Only)
• NCPPO Medical
• NCPPO Performance Network
• Devon Health Services (4 NCPPO wrap states) (special timing)
• TriState Health Coalition (Quincy IL provider grouping)
• NCPPO Bi-Monthly Full Files (for directory use for Maryland regulation compliance)

Par File Overview and Preferred Transmission Method:

• Full Electronic File
• ASCII Format, Comma-Delimited or Fixed-Width Versions
• Each Par Provider Listed with Multiple Service Addresses for Each Record (as needed)
• Hospital and other facilities are included on the file
• Preferred transmission method ? FTP without Encryption (file contains no PHI); Push to Payor or Payor?s Vendor

National Provider Identifier:

• In the beginning the par file will include placeholders for NPI, but the information will not be present
• The ten-digit NPI numbers will be populated in the NPI field on all file types, in the last position on each par file (in case payors are not ready to accept the field at that time)

New Par File Documentation:

• On www.HealthLink.com or www.NCPPO.com websites

National Capital Preferred Provider Organization, Inc. ("NCPPO") is a Maryland corporation. HealthLink®, Inc., is an Illinois corporation. Both are organizers of independently contracted provider networks, which are made available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. Neither has control nor right of control over the professional, medical judgment of contracted providers, nor are they liable for any acts or failures to act, by contracted providers. Neither is an insurance company and neither has liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. Both companies are subsidiaries of WellPoint, Inc.