Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application

HSD Instructions for CY 2015 Applications
This document contains information needed to complete the HSD tables required for the online
application process (you will not need to complete HSD tables if you are applying for an
employer-only SAE). It also contains frequently asked questions (FAQ) regarding HSD
submission and processing, guidance on developing valid addresses and field edits for the MA
Provider and MA Facility tables.

Contents
Specialty Codes for the MA Provider Table ................................................................................... 2
Specialty Codes for the MA Facility Table .................................................................................... 3
HSD Table Instructions................................................................................................................... 4
MA Provider Table ......................................................................................................................... 4
MA Facility Table ........................................................................................................................... 7
HSD Exceptions Guidance - Requesting Exceptions ..................................................................... 9
Appendix A - CY 2015 HSD Submission Frequently Asked Questions ...................................... 10
Appendix B - Guidance on Developing Valid Addresses ............................................................ 19
Appendix C – Field Edits for the MA Provider and Facility Tables ............................................ 21

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SPECIALTY CODES
CMS has created specific specialty codes for each of the physician/provider and facility types.
Applicants must use the codes when completing HSD tables (MA Provider and MA Facility
tables).

Specialty Codes for the MA Provider Table
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001 – General Practice
002 – Family Practice
003 – Internal Medicine
004 – Geriatrics
005 – Primary Care – Physician Assistants
006 – Primary Care – Nurse Practitioners
007 – Allergy and Immunology
008 – Cardiology
010 - Chiropractor
011 – Dermatology
012 – Endocrinology
013 – ENT/Otolaryngology
014 – Gastroenterology
015 – General Surgery
016 – Gynecology, OB/GYN
017 – Infectious Diseases
018 - Nephrology
019 - Neurology
020 - Neurosurgery
021 - Oncology - Medical, Surgical
022 - Oncology - Radiation/Radiation Oncology
023 – Ophthalmology
025 - Orthopedic Surgery
026 - Physiatry, Rehabilitative Medicine
027 - Plastic Surgery
028 - Podiatry
029 - Psychiatry
030 - Pulmonology
031 - Rheumatology
033 - Urology
034 - Vascular Surgery
035 – Cardiothoracic Surgery
000 – OTHER

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Specialty Codes for the MA Facility Table
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040 – Acute Inpatient Hospitals
041 - Cardiac Surgery Program
042 - Cardiac Catheterization Services
043 - Critical Care Services – Intensive Care Units (ICU)
044 - Outpatient Dialysis
045 - Surgical Services (Outpatient or ASC)
046 - Skilled Nursing Facilities
047 - Diagnostic Radiology
048 - Mammography
049 - Physical Therapy
050 - Occupational Therapy
051 - Speech Therapy
052 - Inpatient Psychiatric Facility Services
053 – NOT IN USE
054 - Orthotics and Prosthetics
055 - Home Health
056 - Durable Medical Equipment
057 - Outpatient Infusion/Chemotherapy
058 - NOT IN USE
059 – NOT IN USE
060 – NOT IN USE
061 - Heart Transplant Program
062 - Heart/Lung Transplant Program
063 – NOT IN USE
064 - Kidney Transplant Program
065 - Liver Transplant Program
066 - Lung Transplant Program
067 - Pancreas Transplant Program

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HSD Table Instructions
The tables should reflect the applicants’ executed contracted network on the date of submission.
CMS considers a contract fully executed when both parties have signed. Applicants should only
list providers with whom they have a fully executed updated contract. These contracts should be
executed on or prior to application submission deadline. In order for the automated network
review tool to appropriately process this information, applicants must submit Provider and
Facility names and addresses exactly the same way each time they are entered, including
spelling, abbreviations, etc. Any errors will result in problems with processing of submitted data
and may result in findings of network deficiencies. CMS expects all applicants to fully utilize
the opportunities for pre-checks and to fully review the Automated Criteria Check (ACC) reports
to ensure that their HSD tables are accurate and complete.

MA Provider Table
This table captures information on the specific physicians/providers in the applicant’s contracted
network. If a provider serves beneficiaries residing in multiple counties in the service area, list
the provider multiple times with the appropriate state/county code to account for each county
served. Do NOT list contracted providers in state/county codes where the Medicare
beneficiary could not reasonably access services and that are outside the pattern of care.
Such extraneous listing of providers affects CMS’ ability to quickly and efficiently assess
provider networks against network criteria. You must ensure that the MA Provider Table meets
the following conditions:
• Providers must not have opted out of Medicare;
• Physicians and specialists must not be pediatric providers, as they do not routinely
provide services to the aged Medicare population;
• Physiatry/Rehabilitation Medicine must only be provided by a licensed physician;
Physical Therapists are not qualified to provide the full range of Physiatry services;
• Psychiatrists must only be licensed physicians and no other type of practitioner;
• Physician Assistant and Nurse Practitioner services are limited to primary care, as they
are not able to provide the full range of services independently as a licensed physician.
You are responsible for ensuring contracted providers (physicians and other health care
practitioners) meet State and Federal licensing requirements and your credentialing
requirements for the specialty type prior to including them on the MA Provider Table.
Verification of credentialing documentation may be requested at any time. Including physicians
or other health care practitioners that are not qualified to provide the full range of specialty
services listed in the MA Provider Table will result in inaccurate ACC measurements that may
result in your application being denied.

Column Explanations
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A. SSA State/County Code – Enter the SSA State/County code of the county which the
listed physician/provider will serve. The state/county code is a five digit number. Please
include any leading zeros (e.g., 01010). The state and county codes on the HSD Criteria
Reference Table are the codes you should use. Format the cell as “text” to ensure that
codes beginning with a “0” appear as five digits.
B. Name of Physician or Mid-Level Practitioner – Self-explanatory. Up to 150
characters.
C. National Provider Identifier (NPI) Number – The provider’s assigned NPI number
must be included in this column. Enter the provider’s individual NPI number whether the
provider is part of a medical group or not. The NPI is a ten digit numeric field. Include
leading zeros.
D. Specialty – Name of specialty of listed physician/provider. This should be copied
directly off of the HSD Criteria Reference Table.
E. Specialty Code – Specialty codes are unique codes assigned by CMS to process data.
Enter the appropriate specialty code (001 – 034). Use Specialty Code “000” on the
Provider Table only when requesting an “Alternate Provider” exception.
F. Contract Type – Enter the type of contract the Applicant holds with listed provider by
using a “DC” - Direct Contract or “DS” - Downstream Contract. Use “DC” for direct
contract between the applicant and provider.
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A "DC" - direct contract provider, requires the applicant to complete Col. O - Medical
Group Affiliation with a "DC" and Col. P Employment Status should be marked as
"N/A".
A "DS" - downstream contract is between the first tier entity and other providers
(such as individual physicians).
An Independent Practice Association (IPA) with downstream contracts with
physicians must complete – Col F Contract Type with a “DS”, Col O Medical Group
Affiliation – Enter IPA Name and Col. P employment status is N/A.
Medical Group with downstream contracted physicians complete – Col F Contract
Type with a “DS”, Col O Medical Group Affiliation – Enter Medical Group Name
and Col. P employment status is N/A.
Medical Group with employed providers must complete – Col F Contract Type with a
“DS”, Col O Medical Group Affiliation – Enter Medical Group Name and Col. P
employment status is “E”.

Provider Service Address Columns- Enter the address (i.e., street, city, state and zip code)
of the location at which the provider sees patients. Do not list P.O. Box, house, apartment,
building or suite numbers, or street intersections.

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G. Provider Service Address: Street Address – up to 250 characters
H. Provider Service Address: City – up to 150 characters
I. Provider Service Address: State – 2 characters
J. Provider Service Address: Zip Code – up to 10 characters
K. Provider Previously Listed – Enter "Y" if the provider is listed more than once on the
HSD table. Enter "N" if a provider is not listed more than once on this table (i.e. for
other counties or in the same county for another type of Specialty).

L. If PCP Accepts New Patients? – Indicate if provider is accepting new patients by
entering a "Y" or "N" response.
M. Medical Group Affiliation – Provide name of affiliated Medical Group/Individual
Practice Association MG/IPA) or if applicant has direct contract with provider enter
“DC”.
N. Employment Status – If the provider if employee of medical group or facility enter “E”.
Otherwise enter N/A. This cell may NOT be left blank.
O. Model Contract Amendment – Indicate if contract uses CMS Model MA Contract
Amendment by entering “Y” for yes or “N” for no.

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MA Facility Table
Only list the providers that are contracted Medicare-certified providers. Please do not list any
additional providers or services except those included in the list of facility specialty codes.
Additionally, do NOT list contracted facilities in state/county codes where the Medicare
beneficiary could not reasonably access services and that are outside the pattern of care.
Such extraneous listing of providers affects CMS’ ability to quickly and efficiently assess
provider networks against network criteria.
If a facility offers more than one of the defined services and/or provides services in multiple
counties, the facility should be listed multiple times with the appropriate “SSA State/County
Code” and “Specialty Code” for each service.

Column Explanations:
A. SSA State/County Code – Enter the SSA State/County code of the county for which the
listed facility will serve. The county code should be a five digit number. Please include
any leading zeros (e.g., 01010). The state and county codes on the HSD Criteria
Reference Table are the codes that applicants should use. Format the cell as “text” to
ensure that codes beginning with a “0” appear as five digits.
B. Facility or Service Type – Name of facility/service type of listed facility. This should be
copied directly off of the HSD Criteria Reference Table.
C. Specialty Code – Specialty codes are unique 3 digit numeric codes assigned by CMS to
process data. Enter the Specialty Code that best describes the services offered by each
facility or service. Include leading zeros.
D. CMS Certification Number (CCN) – Enter the facility’s CMS Certification Number in
this column. The CCN verifies the facility is Medicare certified and for what type of
service. The CCN for facilities have 6 digits. The first 2 digits identify the State in which
the provider is located. The last 4 digits identify the type of facility. You must obtain the
CCN from the provider. The following facilities must have a valid CCN to be listed in
the MA Facility Table: 040- Acute Inpatient Hospitals, 044 Outpatient Dialysis, 046Skilled Nursing Facilities, 052-Inpatient Psychiatric Facility Services, and 055-Home
Health. Do not place the facility's NPI number in this column. The NPI number is the
primary identifier for Medicare claims and does not represent Medicare certification.
Refer to CMS Manual Publication 100-07 State Operations Provider Certification Section
2779.
E. National Provider Identifier (NPI) Number – Enter the provider’s assigned NPI
number in this column. The NPI is a ten digit numeric field. Include leading zeros.
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F. Number of Staffed, Medicare-Certified Beds – For Acute Inpatient Hospitals, Critical
Care Services – Intensive Care Units (ICU)s, Skilled Nursing Facilities, and Inpatient
Psychiatric Facility Services, enter the number of Medicare-certified beds for which the
Applicant has contracted access for Medicare Advantage enrollees. This number should
not include Neo-Natal Intensive Care Unit (NICU) beds.
G. Facility Name – Enter the name of the facility. Field Length is 150 characters.
Provider Service Address Columns- Enter the address (i.e., street, city, state and zip code)
from which the provider serves patients. Do not list P.O. Box, house, apartment, building
or suite numbers, or street intersections. For Home Health and Durable Medical
Equipment, indicate the business address where one can contact these vendors.
H. Provider Service Address: Street Address – up to 250 characters
I. Provider Service Address: City – up to 150 characters
J. Provider Service Address: State – 2 characters
K. Provider Service Address: Zip Code – up to 10 characters
L. Model Contract Amendment – Indicate if contract uses CMS Model MA Contract
Amendment by entering “Y” for yes or “N” for no.

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HSD Exceptions Guidance - Requesting Exceptions
If an applicant’s HSD Automated Criteria Check report indicates the submitted network does not
meet the minimum provider/bed number, time and/or distance requirements for any individual
provider/facility type in a particular county, Applicant may request an Exception for that
deficiency under the following circumstances:

* Patterns of care for Medicare beneficiaries residing in the county do not support need for the
minimum number of the specific provider/facility type within the time and/or distance
requirements.
* (Limited to RPPO applicants) – The RPPO applicant is relying on Alternative Arrangements
to meet access requirements for this provider/facility type in this county.
Applicants requesting Exceptions must complete the CMS Exceptions Template for each
provider/facility type in each county for which an exception is requested and provide the
appropriate information requested in the template. Additionally, all Exceptions must be
requested and supported with appropriate documentation within the timeframe established by
CMS.
NOTE: Beginning in 2014 (with the submission of CY2015 applications), applicants requesting
partial counties should use the Exceptions Template and Exceptions request process to address
deficient providers / facilities when applicable.

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Appendix A - CY 2015 HSD Submission Frequently Asked
Questions
CMS has developed a series of frequently asked questions (FAQ) regarding the HSD table
submission process. These FAQs provide additional technical guidance on the following topics:
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Requirements for participating in the HSD pre-checks
Understanding the HSD submission statuses
Reviewing the HSD Status Report and ACC Report
Informational messages versus errors
MA Provider and MA Facility table formats and edit checks
Address Information Report statuses (duplicate address, invalid address)
Zip –Distributive Process

Please contact Greg Buglio at either [email protected] or 410-786-6562 for technical
questions regarding the CY 2015 HSD submission.
1. What is the schedule for HSD pre-checks?
Response: CMS will be providing weekly HSD pre-check processing during the application
season. The pre-check process will run on the following dates (all of these dates are
Thursdays): January 16, 2014, January 23, 2014, January 30, 2014, February 6, 2014, and
February 13, 2014. In order for tables to be included in a pre-check, both tables must be
uploaded and unloaded successfully prior to the cut off time of 8PM Eastern Time.
2. How can I participate in the HSD pre-check process?
Response: To participate in the HSD pre-check, an applicant must:
a. Successfully submit (upload and unload) both the MMP Provider Table and MMP
Facility Table into HPMS by the weekly pre-check deadline of Thursday at 8:00
PM Eastern Time. Question 1 lists the dates that pre-checks will occur.
b. As long as both tables upload and unload successfully by Thursday of a given
week, at 8:00 p.m. EST, your files will be included in that week’s pre-check
process.
c. If you reupload one or both files in a subsequent week during the pre-check
window, again making sure that the files upload and unload successfully, they
will automatically be included in the next round of pre-check processing.
d. There is no need to check any box indicating your desire to be included in the precheck process.
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e. NOTE – HPMS will email the Application Contact AND the person who
completed the upload when the Unload process has completed. The email will
indicate if the Unload was successful or unsuccessful. If unsuccessful, the email
will indicate the errors and will indicate a File Confirmation ID. If you contact
the HPMS help desk for assistance in fixing the Unload errors, please reference
the File Confirmation ID, located in the email you receive. This will allow the
HPMS help desk to quickly reference your files. You will receive a separate
email for both the Provider Table and the Facility Table.
3. Where and when can I view my pre-check or final application HSD processing results?
Response: The results of the HSD processing will be available in the HSD Automated
Criteria Check (ACC) report. This report should be available between one and three days
after the pre-check or final application deadline, depending on how many files are submitted
and the size of those files. In prior years, the ACC reports have been available in one to two
days. You may access this report at the following link: HPMS Home Page>Contract
Management>Basic Contract Management>Select Contract Number>Submit Application
Data>HSD Submission Reports>HSD Automated Criteria Check Report.
Note: More information about using the ACC report, and all HSD reports, is available in the
Online Application User’s Manual, located under “Documentation” on the Basic Contract
Management screen.
4. HPMS is showing a message that both of my tables have been “successfully uploaded” to the
system. Does this mean that my submission will automatically be processed during the next
pre-check or final submission processing?
Response: Not necessarily. Successfully uploading your tables is the first step. However, in
order to participate in the HSD pre-check process or to final submit your application, your
submission must also pass the “unload” validation edits. The HSD validation process may
take some time to complete, depending upon the size of your data tables and the number of
other organizations submitting data at the same time. Consequently, CMS strongly urges
applicants to submit your tables as soon as possible so that there is sufficient time to
complete the unload validation process, retrieve your results, and resubmit your tables if you
encounter fatal unload errors.
5.

Will I be notified when the HSD tables unload successfully or unsuccessfully?
Response: HPMS will email the Application Contact (found on the Contact screen in
Contract Management) when the HSD tables have gone through the Unload process. The
email will indicate if the Unload was successful. If unsuccessful, the email will provide
details on the errors encountered and will list a File Confirmation ID. You may contact the
HPMS help desk for assistance in resolving Unload errors. Be sure to reference the File

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Confirmation ID so the HPMS help desk is able to quickly find your files and reports. A
separate email will be sent for both the Provider Table and the Facility Table.
6. How can I verify if my submission passed the “unload” validation edits successfully?
Response: You must look at the HSD Status Report on the Online Application page.
Applicants must use the following navigation path to access this report:
Contract Management > Basic Contract Management > Select Contract Number > Submit
Application Data > HSD Status Report
7. When I access the HSD Status Report, the report provides the following message:
“Currently, there is no HSD Status Report for this contract.” What does this mean?
Response: This message means that your HSD submission is still in the “unload” validation
process. If you encounter this message, CMS strongly recommends that you check the report
at a later time. Once your submission completes the “unload” validation process, you will
see a link for each of the files (MA Provider File and MA Facility File). Also, the
Application Contact will be emailed when the Unload Process has completed.
8. The HSD Status Report indicates that my MA Provider and MA Facility submissions have
been “Unloaded Successfully.” What does that mean?
Response: Achieving the “Unloaded Successfully” status indicates that your submission has
passed all of the validation edits. If both the MA Provider and MA Facility Tables unload
successfully, your submission will be processed in the HSD pre-check or the final submission
process.
9. The HSD Status Report indicates that one or both of the HSD tables has an “Unload Failed”
status. What does that mean?
Response: An “unsuccessful unload” means that validation errors are present on your file(s)
and that until the errors are corrected, your submission will not be included in the next HSD
pre-check or final submission process. You must review your error report, make the
necessary corrections to your file(s), resubmit the file(s) to HPMS, and pass the “unload”
process.
10. In the HSD Status Report, some messages are marked as informational. What does that
mean?
Response: Messages marked as “informational” are intended to highlight certain data
scenarios. You should review all informational messages to determine if the data being
highlighted is correct or if it requires a change. For example, you will receive an
informational message if your file does not have a row assigned to a county for a required
specialty. If you do have a provider of that specialty serving that county, you would update
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your file to add the row. If you do not have a provider of that specialty serving the county,
and you intend to submit an exception request, then no updates are required to your file. It is
important to note that informational messages do NOT prevent a file from passing “unload”
validation and moving on to the pre-check.
11. One of the informational messages states that I entered Provider codes of “000”. I thought
this was allowed?
Response: You may enter three zeros for provider types of “other” only for alternate
providers listed as part of an exception request. This message is simply a courtesy which
provides you with a quick view of where you entered the three zeros. Note: You may not
enter “000” on the MA Facility Table. Entry of “000” on the MA Facility Table is
considered an error and will prevent your submission from moving on to either the pre-check
or final submission process.
12. Some of the error messages indicate that I am missing data from fields on the table, but when
I look at my upload file, those fields are populated. Why am I getting this message?
Response: If your submission contains any formatting errors, you should first correct the
formatting errors and then resubmit your file(s) to HPMS. Formatting errors will skew the
unload validation of the files and may result in errors reading the files.
13. Do I need to include every pending non-employer county on the MA Provider and MA
Facility tables?
Response: Yes.
14. Are we required to list at least one of every provider and facility type for each of our pending
non-employer only counties?
Response: The requirements are as follows:
a. On the MA Provider Table, you must include at least one type of Primary Care
Physician (provider codes 001-006) for every pending non-employer county in your
application.
b. On the MA Facility Table, you must include at least one Acute Inpatient Hospital
(facility code 040) for every pending non-employer county in your application.
c. You must complete all required fields on both of the tables.
d. You must adhere to the edit rules for both of the tables.
e. Please read the HSD Instructions, located above, to determine which fields are
required and which are optional.
Note: The HSD Status Report will continue to list every county where a provider or
facility code has not been provided. Other than the edits indicated in points a. and b.
above, these messages are informational and will not prevent your files from being
processed.
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15. Can we include placeholder or dummy data on the MA Provider and MA Facility tables for
the pre-check?
Response: No. The inclusion of placeholder of dummy data will skew the results you receive
in the ACC reports.
16. What format must we use to submit the MA Provider and MA Facility Tables?
Response: You should use the following steps to ensure you are using the correct format:
a. Download the templates for the MA Provider and MA Facility Tables in the MA
download section on the Application Start Page.
b. Complete your files in Excel.
c. Save the files as tab-delimited text files (.txt).
d. Zip the .txt files.
e. Upload each file on the HSD Upload page.
Note: These instructions are also available on the HSD Upload Page.
17. Can you explain what the meaning of the “actual time” and “actual distance” fields on the
ACC report?
Response: The “actual time” and “actual distance” values reflect the percentage of
beneficiaries with access to at least one provider/facility within the required time or distance
criteria.
18. Can you explain when a listed provider is included in the Minimum Number of Providers
calculation?
Response: A submitted provider is included in the Number of Providers calculation when
he/she is located within the prescribed time and/or distance of at least one sample beneficiary
listed on the Sample Beneficiary file.
19. I have listed twenty different providers for a specific county/specialty combination, and I
meet the Minimum Number of Providers check. How is it possible that I failed the Time
and/or Distance check?
Response: When performing the Minimum Number of Providers check for a specific
county/specialty combination, HPMS starts with the Provider addresses and ensures that at
least one sample beneficiary is within the time and/or distance indicated in the criteria. The
Time and/or Distance checks start with each of the sample beneficiaries in the county and
determine that at least 90% of them have at least one of the measured providers within the
prescribed Time and/or Distance criteria.
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NOTE: If your network consists of five specialists who all practice from the same building,
and one sample beneficiary lives across the street from the practice, within the Time and/or
Distance criteria, then all five will be included in the Minimum Number of Providers check.
However, at least 90% of all beneficiaries must have at least one of these provider types
within the time and/or distance of their specific location to pass the time and/or distance
checks.
20. How is an address identified as a “duplicate” on the Address Information report?
Response:
Providers are considered duplicates when they have the:
a. Same state/county code
b. Same provider code
c. Same NPI number
d. Same address or different address (i.e., a different address is still considered a
duplicate for the provider).
Note: When a different address is listed with the same state/county code, provider code
and NPI number combination, we will include the address in the calculation for “actual
time” and “actual distance,” but we will only count the provider once in determining the
minimum number of provider’s calculation.
Facilities are considered duplicates when they have the:
a. Same state/county code
b. Same facility code
c. Same NPI number
d. Same address
Note: A different address for a facility, even with the same state/county code, facility
code, and NPI number, is not considered a “duplicate.”
21. If a provider or facility appears on the Address Information Report, are they still used in the
automated calculations for the minimum number of providers, time, and distance?
Response: There are four reasons why an address may be listed on the Address Information
Report, and depending on the status, the address may or may not be included in the
automated processing. The four statuses are:
a. Zip-Distributive – when an address is listed on this report with a reason of ZipDistributive, it means that it was not located in our mapping software. As long as the
zip code is valid, the software will include it in the ACC process by providing a
randomly generated geo-code within the zip code based on population density. The
randomly generated geo-code will be the same for the address every time the ACC
process is invoked.
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b. Invalid Address – an address is considered invalid if it is not contained in the
mapping software and the zip code is not valid. The address is not included in any
automated processing.
c. Duplicate Record – Please see question 16 above for an explanation of Duplicate
addresses for Providers and Facilities.
d. Not Supported by ACC – identifies addresses affiliated with certain situations which
are not supported by the automated review process and require a manual review.
22. How can I avoid having addresses listed as “Invalid” or “Zip-Distributive” on the Address
Information Report?
Response: Please see Appendix B for guidance on developing valid addresses for the
purposes of the HSD automated review.
23. Can you explain the methodology CMS employs in determining the time and distance check
for providers and facilities?
Response: CMS will provide additional information on the methodology for determining
time and distance results in a separate communication.
24. What are all of the edit checks applied to the MA Provider Table and MA Facility Table?
Response: Please see Appendix C for a listing of the field edits on the MA Provider Table
and the MA Facility Table.
25. Can I list providers or facilities that are part of my network as serving a county other than
where their office is located?
Response: Yes. You should associate providers or facilities within a given county on your
table(s) based on whether they serve beneficiaries residing within the county, not whether
they are physically located in the county itself.
26. If only one of the files is successfully submitted and unloaded, will that file go through the
pre-check or final-submit process?
Response: In order for a submission to go through the pre-check or final-submit process,
both the MA Provider and MA Facility tables must be uploaded and unloaded successfully
prior to the established deadline.
27. What do the various messages in the HSD Status Report mean and which of these messages
will prevent my submission from going through the pre-check process?
Response:
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a. File Processing Error – These are errors in the format of the submitted file. These
errors may prevent the system from reading the file correctly. Your HSD
submission will not be included in the pre-check process until you correct the
errors and successfully resubmit the HSD file(s).
b. Record Invalid – A record contains a restricted character. Restricted characters
are the greater than symbol, the less than symbol and the semi-colon ( < > ;).
Your HSD submission will not be included in the pre-check process until you
correct the errors and successfully resubmit the HSD file(s).
c. SSA State/County Not in Pending Service Area – The state/county code you
provided is not part of your contract’s non-employer only pending Service Area.
Your HSD submission will not be included in the pre-check process until you
correct the errors and successfully resubmit the HSD file(s).
d. Invalid/Missing Provider/Specialty Code – You have either entered an invalid
specialty code or you have not entered a Primary Care Physician (provider codes
001-006) for every pending non-employer only county in your service area. Your
HSD submission will not be included in the pre-check or final application process
until you correct the errors and successfully resubmit the HSD file(s).
e. Invalid/Missing Facility Code – You have either entered an invalid specialty code
or you have not entered an Acute Inpatient Hospital (facility code 040) for every
pending non-employer only county in your service area. Your HSD submission
will not be included in the pre-check or final application process until you correct
the errors and successfully resubmit the HSD file(s).
f. Invalid Data Type – There is a processing error in the record due to incorrect data
type (example – alpha character in a numeric-only field). Your HSD submission
will not be included in the pre-check process until you correct the errors and
successfully resubmit the HSD file(s).
g. Invalid Length – There is a processing error in the record due to an invalid length
in a field. Your HSD submission will not be included in the pre-check process
until you correct the errors and successfully resubmit the HSD file(s).
h. Invalid Data - There is a processing error in the record due to invalid data. Your
HSD submission will not be included in the pre-check process until you correct
the errors and successfully resubmit the HSD file(s).
i. Required Field Missing – A required field or fields is missing from the record.
Your HSD submission will not be included in the pre-check process until you
correct the errors and successfully resubmit the HSD file(s).
j. Provider/Specialty Code 000 Found – For the Provider Table version of the report
– this is an informational message only. It is not an error. You will still be
included in the pre-check process. For the Facility Table, you are not permitted to
list “000”. If this message appears on the Facility Table version of the report,
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your HSD submission will not be included in the pre-check process until you
correct the errors and successfully resubmit the HSD file(s).
k. Informational Messages – These messages provide you with information about
your submission. If there are missing provider codes or facility codes for a
county or counties, they will be listed here. You will still be included in the precheck process.

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Appendix B - Guidance on Developing Valid Addresses
The following list the most common errors encountered with listing addresses in the HSD files.
1.

Do not put the Business Name in the address line.
Example:
Address
Dupage Obstetrics and
Gynecology

2.

City

State

Zip

Amf Ohare

IL

60666

Reason
Address listed as
Office Name

Do not list an intersection as the address.
Example:

3.

Address

City

State

Zip

E 65th St at Lake Michigan

Chicago

IL

60649

Reason
Intersection

Do not include a house, apartment, building or suite number in the address.
Example:
Address
306 US ROUTE ONE,
BLDG C-1
5900 B LK WRIGHT DR

4.

City

State

Zip

Scarborough

ME

04074

Norfolk

VA

23502

Reason
Should remove
“BLDG C-1”
Should remove “B”

Enter the complete Street Number and Street Name in the address line.
Example:
Address
21 Cir Dr

City
Barrington

State

Zip

IL

60010

VA

23502

State

Zip

LK WRIGHT DR
Norfolk

5.

Reason
Should enter “21
Circle Dr.”
Missing house
number

Do not enter extra words in the address line.
Example:
Address

City

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Reason

450 W Hwy 22 Medical

Barrington
IL

60010

Portland

ME

04101

Address

City

State

Zip

5900 LK Right DR

Norfolk
VA

23502

449 FOREST AVE PLZ

6.

Should remove
“Medical”
Should remove
“PLZ”

Enter a valid Street Name.
Example:

7.

Reason
Correct name should
be “LK WRIGHT
DR”

Enter correct Street Address and Zip Code combination in the address line.
Example:
Address
5900 LK WRIGHT DR

City
Norfolk

State

Zip

VA

21043

Reason
Should correct zip
code to be 23502

8. Enter the correct Street Number in the address line.
Example:
Address
12 LK WRIGHT DR

City
Norfolk

State

Zip

VA

23502

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Reason
12 is not a valid
street number.

Appendix C – Field Edits for the MA Provider and Facility Tables
The following chart lists the SYSTEM edits for the MA Provider Table and the MA Facility Table. A field marked
as “not required” means the system will not reject the file if the field is blank. It does not imply that the field should
be blank. Please read the HSD Instructions, located above, to determine which fields are required and which are
optional.

MA Provider Table
Field

Description

SSA State/County Code
Name of Physician or MidLevel Practitioner
National Provider
Identifier (NPI) Number

VARCHAR2(5)

Specialty

VARCHAR2(150)

Provider Specialty Code
Contract Type
Provider Street Address
Provider City

VARCHAR2(3)
VARCHAR2(150)
VARCHAR2(250)
VARCHAR2(150)

Provider State Code
Provider Zip Code
Provider Previously Listed

VARCHAR2(2)
VARCHAR2(10)
VARCHAR2(1)

Contracted Hospital NPI
Number
If PCP, Accepts New
Patients
Does MCO Delegate
Credentialing
If Credentialing is
Delegated, List Entity
Medical Group Affiliation
Employment Status
Uses CMS MA Contract
Amendment

VARCHAR2(150)
VARCHAR2(10)

Rule
Required (not null) and validated against valid
values (SSA County Code). Must be pending
non-employer county attached to contract.
Required (not null)
Required (not null) and validated that it is 10
digit numeric

VARCHAR2(1)

Required (not null)
Required (not null) and validated against valid
values
Required (not null)
Required (not null)
Required (not null)
Required (not null). Validate the state code
against the valid list of state abbreviations
Required (not null)
Not Required
Required if Contract Hospital Where Privileged
is provided; otherwise Not Required. If NOT
NULL, validate that it is 10 digit numeric
Required only for provider types 001-006;
otherwise not required.

VARCHAR2(1)

Not Required

VARCHAR2(250)

Not Required

VARCHAR2(150)
VARCHAR2(150)

Not Required
Required (not null)

VARCHAR2(1)

Required (not null); Y for yes, N for no.

VARCHAR2(10)

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MA Facility Table
Field

Description

SSA State/County Code
Facility or Service Type

VARCHAR2(5)
VARCHAR2(150)

Facility Specialty Code

VARCHAR2(3)

CMS Certification Number
(CCN)
National Provider
Identifier (NPI) Number

VARCHAR2(20)
VARCHAR2(10)

Rule
Required (not null) and validated against valid
values (SSA County Code). Must be pending
non-employer county attached to contract.
Required (not null)
Required (not null) and validated against valid
values
Required for 040- Acute Inpatient Hospitals,
044 Outpatient Dialysis, 046-Skilled Nursing
Facilities, 052-Inpatient Psychiatric Facility
Services, and 055-Home Health and 061-067
All Transplant Facilities.
Not Required for all other facility types.
Required (not null) and validated that is 10
digit numeric

# of Staffed, MedicareCertified Beds
Facility Name
Provider Street Address
Provider City

VARCHAR2(10)
VARCHAR2(150)
VARCHAR2(250)
VARCHAR(150)

Provider State Code

VARCHAR2(2)

Verify that entry is numeric since used in a
calculation. Required but only for the
following facility types: Acute Inpatient
Hospital (040), Critical Care Services - ICU
(043), Skilled Nursing Facilities (046),
Inpatient Psychiatric Facility (052).
Required (not null)
Required (not null)
Required (not null)
Required (not null). Validate the state code
against the valid list of state abbreviations.

Provider Zip Code
Uses CMS MA Contract
Amendment

VARCHAR2(10)

Required (not null)

VARCHAR2(1)

Required (not null); Y for yes, N for no.

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