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 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/.

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/.

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.

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 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 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 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 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 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. This dataset reflects institutional 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 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 institutional 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 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 institutional 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 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 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. This dataset reflects institutional 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 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 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 institutional 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 the number of Medicaid Low Birth Weight newborns (numerator), the number of zip code Medicaid newborns (denominator), and observed rate for Agency for Healthcare Research and Quality Prevention Quality Indicator 9 (PQI 9) – Newborn Low Birth Weight Rate for Medicaid enrollees beginning in 2012.
The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately.
The observed rate for Low Birth Weight is presented by resident zip code (including a statewide
total). The observed rate for low birth weight by resident county: code (including a statewide total) can be found here: https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/aapx-etcg. For more information, check out: http://www.health.ny.gov/health_care/medicaid/. The "About" tab contains additional details concerning this dataset.

The dataset contains the number of Medicaid Low Birth Weight newborns (numerator), the number of county Medicaid newborns (denominator), and observed rate for Agency for Healthcare Research and Quality Prevention Quality Indicator 9 (PQI 9) – Newborn Low Birth Weight Rate for Medicaid enrollees beginning in 2012.
The Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately.
The observed rate for Low Birth Weight is presented by resident county (including a statewide total). The observed rate for low birth weight by resident zip code (including a statewide total) can be found here: https://health.data.ny.gov/Health/Medicaid-Inpatient-Prevention-Quality-Indicators-P/vk5f-rgqm/. For more information, check out: http://www.health.ny.gov/health_care/medicaid/. The "About" tab contains additional details concerning this dataset.

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/ .

This dataset includes Medicaid Managed Care, Commercial HMO, and Commercial PPO performance data from the Quality Assurance Reporting Requirements (QARR) by member demographic characteristics. QARR is largely based on measures of quality developed and published by the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®). Plans are required to submit quality performance data each year. Demographic information analyzed in this report includes members’ sex, age, race/ethnicity, Medicaid aid category, cash assistance status, behavioral health conditions including serious mental illness (SMI) and substance use disorder (SUD), payer status, and region of residence. Measuring the quality of care, and the ability to measure disparities in care is an important first step to a better understanding of the underlying factors that drive differences in care among certain populations within Medicaid Managed Care, Commercial HMO, and Commercial PPO.

*Due to COVID-19 impacts, measures requiring hybrid review are not included in this dataset for year 2019.

These data are published annually for Medicaid Managed Care in the Health Care Disparities in New York State Report and on the NYSDOH website: http://www.health.ny.gov/health_care/managed_care/reports/