Exhibit_14_Bid_Submission_Network_Detailed_Reports.xlsx
XLSX spreadsheet 60 KB Posted
- Attached to
- OEIBA Program Commercial HMO, MSP, and MAPD Plans State and local contract opportunity
- Solicitation number
- EV00000681
- Issued by
- Oklahoma County, Hobart City, Oklahoma
About this file
This Excel file is an Exhibit 14 Bid Submission Network Detailed Reports template for an OEIBA Program, designed to capture comprehensive provider network information for a potential health services contract covering the period from 1/1/24 to 12/31/24. The document provides a structured framework for reporting network changes across multiple provider categories, including primary care physicians (PCPs), specialists, hospitals, pharmacies, and urgent care facilities. The template requires detailed information such as provider names, National Provider Identifiers (NPIs), specialties, addresses, contact information, and patient acceptance status.
The file includes seven distinct tabs tracking network composition and changes, with Tab 14b highlighting that the network consists of 1,074 total PCPs, of which 962 (89.57%) are accepting new patients, 56 (5.21%) are accepting only existing patients, and 56 (5.21%) are closed to new patients. Each network category (PCP, Specialist, Pharmacy, Urgent Care, Hospital) has a corresponding tab with placeholder example entries demonstrating the required data fields. The template is designed for electronic submission in Excel format and appears to be part of a standardized reporting requirement for a state or local healthcare network contract opportunity.
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Text version
Report Cover
| Exhibit 14: Bid Submission Network Detailed Reports |
| [Supplier Name] |
| OEIBA Program |
| [Date] |
| Report | Report Title | Tab Name |
| 14a | Summary of Provider Network Changes | Summary of Network Changes |
| 14b | Primary Care Physician Summary | PCP Summary |
| 14c | Primary Care Physician Network | PCP |
| 14d | Specialist Network | Specialist |
| 14e | Pharmacy Network | Pharmacy |
| 14f | Urgent Care Network | Urgent Care |
| 14g | Hospital Network | Hospital |
Note: Completed template must be submitted electronically as an Excel file.
14a Summary of Network Changes
| Summary of Provider Network Changes |
| [Supplier Name] |
| Reporting Date 1/1/24-12/31/24 |
| Type | Provider Last Name | Provider First Name | Title | NPI | Specialty | Primary Address | City | State | Zip | County | Phone | |
| ADDITIONS | ||||||||||||
| Primary Care Physicians | ||||||||||||
| Example | Michaelson | Lucas | MD | 1111811111 | Family Practice | 111 NW Expressway | Oklahoma City | OK | 73112 | Oklahoma | 405-777-7777 |
Specialists
Hospitals
Pharmacy
Urgent Care
| DELETIONS | |
| Primary Care Physicians |
Specialists
Hospitals
Pharmacy
Urgent Care
14b PCP Summary
| Primary Care Physician Summary |
| [Supplier Name] |
| Reporting Date: 1/1/2025 |
| Example: | ||
| PCPs Accepting New Patients | 962 | 89.57% |
| PCPs Accepting Existing Patients | 56 | 5.21% |
| PCPs Closed to New Patients | 56 | 5.21% |
| Total Number of PCPs | 1074 |
14c PCP
| Primary Care Physician Network |
| [Supplier Name] |
| 1/1/25 |
| NPI | Last Name | First Name | Title | Specialty | Address | City | State | Zip | County | Phone | HMO/MAPD (HMO/MAPD/Both) | PCPs Accepting New Patients (Y/N) | |
| Example | 1111181111 | Michaelson | Lucas | MD | Internal Medicine | 111 NW Expressway | Oklahoma City | OK | 73112 | Oklahoma | 405-777-7777 | Both | Y |
14d Specialist
| Specialist Network |
| [Supplier Name] |
| 1/1/25 |
| NPI | Last Name | First Name | Title | Specialty | Address | City | State | Zip | County | Phone | |
| Example | 1111181111 | Michaelson | Lucas | MD | Cardiovascular Disease | 111 NW Expressway | Oklahoma City | OK | 73112 | Oklahoma | 405-777-7777 |
14e Pharmacy
| Pharmacy Network |
| [Supplier Name] |
| 1/1/25 |
| Pharmacy Name | NABP | Address | City | State | Zip | County | Phone | |
| Example | Stillman Pharmacy | 1111111 | 111 NW Expressway | Oklahoma City | OK | 73112 | Oklahoma | 405-777-7777 |
14f Urgent Care
| Urgent Care Network |
| [Supplier Name] |
| 1/1/25 |
| Urgent Care Name | Address | City | State | Zip | County | Phone | |
| Example | Alliance Urgent | 111 NW Expressway | Oklahoma City | OK | 73112 | Oklahoma | 405-777-7777 |
14g Hospital
| Hospital Network |
| [Supplier Name] |
| 1/1/25 |
| Hospital Name | Address | City | State | Zip | County | Phone | |
| Example | Alliance Hospital | 111 NW Expressway | Oklahoma City | OK | 73112 | Oklahoma | 405-777-7777 |
File details come from the government source that posted it. Updated .