Exhibit_34_Network_Detailed_Reports.xlsx
XLSX spreadsheet 61 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 file is an Excel-based exhibit for network detailed reporting, specifically for the OEIBA (Oklahoma Employees Insurance and Benefits Act) Program, prepared by a supplier for quarterly submission to the Oklahoma Office of Management and Enterprise Services (OMES). The document provides a comprehensive template for reporting network changes and provider network details across seven distinct tabs, with a consistent reporting deadline of 60 days following the close of each calendar quarter. The reporting tabs cover network changes, primary care physicians (PCPs), specialists, pharmacies, urgent care facilities, and hospitals, requiring detailed information including provider names, National Provider Identifier (NPI) numbers, addresses, specialties, and contact information.
The reporting template is designed to track network composition and changes, with specific sections for additions and deletions across various provider categories. The PCP summary tab, for example, includes metrics such as the total number of unique PCPs, those accepting new patients, and those closed to new patients. Providers must be reported with comprehensive details including NPI, name, title, specialty, address, county, phone number, and participation status in HMO/MAPD programs. The reporting is to be submitted electronically via a secure email domain (EGIDVendorReporting@omes.ok.gov) as an Excel file, ensuring standardized and consistent network tracking for the state's insurance program.
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Text version
Report Cover
| Exhibit 34: Network Detailed Reports |
| [Supplier Name] |
| OEIBA Program |
| [Date] |
| *60 days following the close of the calendar quarter | ||
| Report | Report Title | Tab Name |
| 34a | Summary of Provider Network Changes | Summary of Network Changes |
| 34b | Primary Care Physician Summary | PCP Summary |
| 34c | Primary Care Physician Network | PCP |
| 34d | Specialist Network | Specialist |
| 34e | Pharmacy Network | Pharmacy |
| 34f | Urgent Care Network | Urgent Care |
| 34g | Hospital Network | Hospital |
| Notes: | |
| 1) Submit reports quarterly using this template. | |
| 2) Send via email by secure domain to: EGIDVendorReporting@omes.ok.gov | |
| 3) Completed template must be submitted electronically as an Excel file. | |
| ` |
34a Summary of Network Changes Due Date 60 days following the close of the calendar quarter
| Summary of Provider Network Changes |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| 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
34b PCP Summary Due Date 60 days following the close of the calendar quarter
| Primary Care Physician Summary |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| 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 Unique PCPs | 1074 |
34c PCP Due Date 60 days following the close of the calendar quarter
| Primary Care Physician Network |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| 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 |
34d Specialist Due Date 60 days following the close of the calendar quarter
| Specialist Network |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| 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 |
34e Pharmacy Due Date 60 days following the close of the calendar quarter
| Pharmacy Network |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| Pharmacy Name | NABP | Address | City | State | Zip | County | Phone | |
| Example | Stillman Pharmacy | 1111111 | 111 NW Expressway | Oklahoma City | OK | 73112 | Oklahoma | 405-777-7777 |
34f Urgent Care Due Date 60 days following the close of the calendar quarter
| Urgent Care Network |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| Urgent Care Name | Address | City | State | Zip | County | Phone | |
| Example | Alliance Urgent | 111 NW Expressway | Oklahoma City | OK | 73112 | Oklahoma | 405-777-7777 |
34g Hospital Due Date 60 days following the close of the calendar quarter
| Hospital Network |
| [Supplier Name] |
| Reporting Date [Date Start - Date End] |
| 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 .