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 individual provider data. Provider Network Data System information is self-reported. For more information, check out http://www.health.ny.gov/health_care/managed_care/.

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 individual provider data. Provider Network Data System information is self-reported. For more information, check out http://www.health.ny.gov/health_care/managed_care/.

This dataset contains Potentially Avoidable Antibiotic Prescribing observed and risk-adjusted rates for child Medicaid enrollees by provider county beginning in 2010.

Potentially Avoidable Antibiotic Prescriptions are antibiotic prescriptions filled for the treatment of acute respiratory infections for which antibiotics are not indicated, contributing to bacterial drug resistance. Index visits for acute respiratory infections and corresponding prescription fills were identified through the use of previously published methods.

The rates were calculated using Medicaid outpatient claims and encounters, and prescription drug data.

The observed and risk adjusted rates are presented by provider county (including a statewide total).

This column chart illustrates the number of short-stay admissions to a nursing facility by Health Home. The New York State Department of Health (NYSDOH) collects annual data on children’s and adults’ use of health services. This information complements the Health Home Quality Measures information collected for the State Plan Amendment (SPA) and Core Set of health care quality measures. Utilization measures are designed to capture the frequency of certain services. NCQA does not view higher or lower services counts as better or worse performance. Please refer to the Overview document for additional information.

This column chart shows performance measure rates of adult health by Health Home for potentially preventable readmissions and prevention quality indicator- chronic composite. The base dataset contains measures that evaluate the quality of care delivered by Health Homes for the Centers for Medicare & Medicaid Services (CMS) Core Set and Health Home State Plan Amendment (SPA). To support ongoing assessment of the effectiveness of the Health Home model, the CMS has established a recommended Core Set of health care quality measures that it intends to promulgate in the rule making process.
Please refer to the Overview document for additional information.

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/.

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/.

This column chart illustrates the rates of mental health services by Health Home. The New York State Department of Health (NYSDOH) collects annual data on children’s and adults’ use of health services. This information complements the Health Home Quality Measures information collected for the State Plan Amendment (SPA) and Core Set of health care quality measures. Utilization measures are designed to capture the frequency of certain services. NCQA does not view higher or lower services counts as better or worse performance. Please refer to the Overview document for additional information.

This column chart shows performance measurement rates for chlamydia screening in young women by Health Home for the Centers for Medicare & Medicaid Services (CMS) Core Set and Health Home State Plan Amendment (SPA). To support ongoing assessment of the effectiveness of the Health Home model, the CMS has established a recommended Core Set of health care quality measures that it intends to promulgate in the rule making process.
Please refer to the Overview document for additional information.

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/.

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/.

The primary purpose for the Provider Network Data System (PNDS) 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/.

This column chart shows performance measure rates for behavioral health by Health Home for follow-up after hospitalizations. The base dataset contains measures that evaluate the quality of care delivered by Health Homes for the Centers for Medicare & Medicaid Services (CMS) Core Set and Health Home State Plan Amendment (SPA). To support ongoing assessment of the effectiveness of the Health Home model, the CMS has established a recommended Core Set of health care quality measures that it intends to promulgate in the rule making process.
Please refer to the Overview document for additional information.

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/.

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/.

This column chart shows performance measure rates of adult health by Health Home for plan-all cause readmissions. The base dataset contains measures that evaluate the quality of care delivered by Health Homes for the Centers for Medicare & Medicaid Services (CMS) Core Set and Health Home State Plan Amendment (SPA). To support ongoing assessment of the effectiveness of the Health Home model, the CMS has established a recommended Core Set of health care quality measures that it intends to promulgate in the rule making process.
Please refer to the Overview document for additional information.

This dataset contains measures of Health Home member service utilization. The New York State Department of Health (NYSDOH) collects annual data on children’s and adults’ use of health services. This information complements the Health Home Quality Measures information collected for the State Plan Amendment (SPA) and Core Set of health care quality measures. Utilization measures are designed to capture the frequency of certain services. NCQA does not view higher or lower services counts as better or worse performance.

The data used in the Health Home Utilization Measures are taken from the following sources:
• Medicaid Data Mart: Claims and encounters data generated from the Medicaid Data Warehouse (MDW).

Please refer to the Overview document for additional information.

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/.

Revalidation disclaimer: The next anticipated revalidation date is an estimated date that may be subject to change based on factors such as a timing lag, updates made to an enrollment file prior to revalidation, and the State’s ability to extend the date for certain providers. Therefore, providers should make sure the correspondence address on their enrollment file is current, and providers should not submit a revalidation package until they receive a notice in the mail to do so. The notice will contain the deadline for submitting the revalidation.

This is a list of active Medicaid fee-for-service (FFS), Managed Care Only and Ordering, Prescribing, Referring, Attending (OPRA) providers. Data elements include the provider’s Medicaid Provider ID, NPI, provider or facility name, Medicaid type, profession or service, provider specialty, service address, city, state, zip code, county, telephone number, latitude, longitude, enrollment begin date, next anticipated revalidation date, date the file was extracted from the data warehouse and a Medically Fragile Children and Adults Directory Indicator.

This dataset contains measures that evaluate the quality of care delivered by Health Homes for the Centers for Medicare & Medicaid Services (CMS) Core Set and Health Home State Plan Amendment (SPA). To support ongoing assessment of the effectiveness of the Health Home model, the CMS has established a recommended Core Set of health care quality measures that it intends to promulgate in the rulemaking process.
The data used in the Health Home Quality Measures are taken from the following sources:
• Medicaid Data Mart: Claims and encounters data generated from the Medicaid Data Warehouse (MDW).
• QARR Member Level Files: Sample of the health plan eligible member’s quality.
• New York State Delivery System Inform Incentive Program (DSRIP) Data Warehouse: Claims and encounters data generated from the Medicaid Data Warehouse (MDW).

Please refer to the Overview document for additional information.

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 health plans in New York State. Beginning in 2017, the PNDS includes Medicaid Managed Care (MMC), HIV Special Need Plans (SNP), Health and Recovery Plans (HARP), Child Health Plus (CHP), Programs of All-Inclusive Care for the Elderly (PACE), Non-PACE Managed Long-Term Care (MLTC) plans, Qualified Health Plans (QHP), Essential Plans (EP), and commercial plans (commercial plan reporting will be incomplete until Q2 2017). This dataset reflects individual provider data. Provider Network Data System information is self-reported by health plans. The PNDS data dictionary can be found at http://www.health.ny.gov/health_care/managed_care/docs/dictionary.pdf . To use the NYS Provider & Health Plan Look-Up Tool, click on the following link, https://pndslookup.health.ny.gov/ .

The dataset contains Potentially Preventable Visit (PPV) observed, expected, and risk-adjusted rates for Medicaid beneficiaries by patient county beginning in 2011. The Potentially Preventable Visits (PPV) obtained from software created by 3M Health Information Systems are emergency visits that may result from a lack of adequate access to care or ambulatory care coordination. These ambulatory sensitive conditions could be reduced or eliminated with adequate patient monitoring and follow up.

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 individual provider data. Provider Network Data System information is self-reported. For more information, check out http://www.health.ny.gov/health_care/managed_care/.

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 health plans in New York State. Beginning in 2017, the PNDS includes Medicaid Managed Care (MMC), HIV Special Need Plans (SNP), Health and Recovery Plans (HARP), Child Health Plus (CHP), Programs of All-Inclusive Care for the Elderly (PACE), Non-PACE Managed Long-Term Care (MLTC) plans, Qualified Health Plans (QHP), Essential Plans (EP), and commercial plans (commercial plan reporting will be incomplete until Q2 2017). This dataset reflects individual provider data. Provider Network Data System information is self-reported by health plans. The PNDS data dictionary can be found at http://www.health.ny.gov/health_care/managed_care/docs/dictionary.pdf. To use the NYS Provider & Health Plan Look-Up Tool, click on the following link, https://pndslookup.health.ny.gov/.