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]
ReportReport TitleTab Name
14aSummary of Provider Network ChangesSummary of Network Changes
14bPrimary Care Physician SummaryPCP Summary
14cPrimary Care Physician NetworkPCP
14dSpecialist NetworkSpecialist
14ePharmacy NetworkPharmacy
14fUrgent Care NetworkUrgent Care
14gHospital NetworkHospital

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
TypeProvider Last NameProvider First NameTitleNPISpecialtyPrimary AddressCityStateZipCountyPhone
ADDITIONS
Primary Care Physicians
ExampleMichaelsonLucasMD1111811111Family Practice111 NW ExpresswayOklahoma CityOK73112Oklahoma405-777-7777

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 Patients96289.57%
PCPs Accepting Existing Patients565.21%
PCPs Closed to New Patients565.21%
Total Number of PCPs1074

14c PCP

Primary Care Physician Network
[Supplier Name]
1/1/25
NPILast NameFirst NameTitleSpecialtyAddressCityStateZipCountyPhoneHMO/MAPD (HMO/MAPD/Both)PCPs Accepting New Patients (Y/N)
Example1111181111MichaelsonLucasMDInternal Medicine111 NW ExpresswayOklahoma CityOK73112Oklahoma405-777-7777BothY

14d Specialist

Specialist Network
[Supplier Name]
1/1/25
NPILast NameFirst NameTitleSpecialtyAddressCityStateZipCountyPhone
Example1111181111MichaelsonLucasMDCardiovascular Disease111 NW ExpresswayOklahoma CityOK73112Oklahoma405-777-7777

14e Pharmacy

Pharmacy Network
[Supplier Name]
1/1/25
Pharmacy NameNABPAddressCityStateZipCountyPhone
ExampleStillman Pharmacy1111111111 NW ExpresswayOklahoma CityOK73112Oklahoma405-777-7777

14f Urgent Care

Urgent Care Network
[Supplier Name]
1/1/25
Urgent Care NameAddressCityStateZipCountyPhone
ExampleAlliance Urgent111 NW ExpresswayOklahoma CityOK73112Oklahoma405-777-7777

14g Hospital

Hospital Network
[Supplier Name]
1/1/25
Hospital NameAddressCityStateZipCountyPhone
ExampleAlliance Hospital111 NW ExpresswayOklahoma CityOK73112Oklahoma405-777-7777

File details come from the government source that posted it. Updated .