CMS-10433 Network Adequacy Template

Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)

CMS-10433 - Appendix B NA ECP_508.xlsb

QHP Certification

OMB: 0938-1187

Document [xlsx]
Download: xlsx | pdf

Overview

User Control 1
User Control 2
Select ECPs
IndividualECPs
Facility ECPs
IndividualProviders1
Facilities&Pharmacies1
Provider Types
County Names
Errors


Sheet 1: User Control 1

Fields with a tilde "~" indicate a field that would be added for PY 2017 under this PRA package. Note: Files are created based on information entered into the User Control worksheet. The User Control worksheet has been separated into two tabs - User Control 1 and the User Control 2 tab - for 508 compliance purposes.
NA ECP Template
User Control & Details for Template
Notes & Instructions
1. Enter all Issuer Information, then create a new tab using the buttons below to enter data.
2. Ensure automatic calculation is turned on. Formulas -> Caculation Options -> Automatic
3. Data can be entered manually or Copy & Pasted into each tab.
4. All fields in with an asterisk (*) are required
5. Validate data (using the "Validate" button below) after entering in all information.
Exporting Data:
1. Data must pass all validation checks before being exported. Any invalid entries will be displayed in the 'Errors' and must be corrected.
2. Click "Create Documents" to export data from all provider tabs.
3. When prompted, select the folder in which you wish to save the files.
4. All files will be saved as tab delimited text files.
Warning: Files larger than 50mb cannot be uploaded to HIOS/SERFF. Please ensure that each exported text file is less than 50mb. On average, tabs with less than 300,000 records should be okay.
Issuer Information
Issuer ID:*
Source System:*
Market:*
Dental Only:*
State:*
Alternate ECP Standard Issuer:*~ Drop Down:
Yes
No
No. of Networks:* 7
Actions
1. Create New Provider Tab
Please enter all Issuer Information above before creating a new tab
A. New Individual Provider Tab

B. New Facility & Pharmacy Tab

2. Import Network IDs

3. Validate Data
Validate information entered into all tabs. Warning: Depending on data size, validation may take several minutes.

4. Create Supporting Documents
Perform data validation & export data to text files

Refer to Column P on this tab if you would like to delete an existing tab
Validation Status Incomplete

Sheet 2: User Control 2

The User Control worksheet has been separated into two tabs - User Control 1 and the User Control 2 - for 508 compliance purposes.
Current Tabs Number of Rows per Tab Number of Validation Errors Delete Tab? If you would like to delete a provider tab please click 'Delete' for the corresponding tab. WARNING!: Deleted tabs cannot be recovered.
IndividualECPs 9 0 Delete
Facilities&PharmaciesECPs 7 0 Delete
IndividualProviders1 Err:520 0 Delete
Facilities&Pharmacies1 Err:520 0 Delete





























































































































Sheet 3: Select ECPs

Tab 2: Select ECPs
Fields with an "~" indicate a field that would be added for PY 2017 under this PRA package.
Row Number Site Name Organization Name National Provider Identifier ECP Category Number of authorized MDs, DOs, PAs, NPs~ Number of authorized DMDs and DDSs~ Site Street Address 1 Site Street Address 2 Site City Site State Site Zip Code Site County Org Street Address 1 Org Street Address 2 Org City Org State Org Zip Code Org County POC 1 Name POC 1 Title POC 1
Phone #
POC 1
Phone Ext
POC 1 Email URL 1 POC 2 Name POC 2 Title POC 2
Phone #
POC 2
Phone Ext
POC 2 Email URL 2

Sheet 4: IndividualECPs

Tab 3: Individual ECPs
All fields in with an asterisk (*) are required. Fields with an "~" indicate a field that would be added for PY 2017 under this PRA package. Note: The fields in this worksheet will be pre-populated with information pulled from the ECP list, as well as additional fields that the Issuer will need to complete. If the issuer is an “Alternate ECP Standard Issuer” they will be responsible for manually completing all information.
National Provider Number (NPI)*~ Provider Name Prefix~ First Name
of Provider*~
Middle Initial
of Provider~
Last Name
of Provider*~
Suffix of Provider~ Physician /
Non-Physician*~
Specialty Type (area of medicine)*~ Provider Name*~ ECP
Category*~
Street Address*~ Street Address 2~ City*~ State*~ County*~ Zip*~ Provider Type*~ Network
IDs*~
Number of Contracted MDs, DOs, PAs, and NPs*~ Number of Contracted DMDs and DDSs*~





















Sheet 5: Facility ECPs

Tab 4: Facility ECPs
All fields in with an asterisk (*) are required. Fields with a tilde "~" indicate a field that would be added for PY 2017 under this PRA package. Note: The fields in this worksheet will be pre-populated with information pulled from the ECP list, as well as additional fields that the Issuer will need to complete. If the issuer is an “Alternate ECP Standard Issuer” they will be responsible for manually completing all information.
National Provider Number (NPI)*~ Facility Name*~ Facility Type*~ Provider Name*~ ECP Category*~ Street Address*~ Street Address 2~ City*~ State*~ County*~ Zip*~ Network IDs*~ Number of Contracted MDs, DOs, PAs, and NPs*~ Number of Contracted DMDs and DDSs*~

Sheet 6: IndividualProviders1

Tab 5: Individual Providers
All fields in with an asterisk (*) are required. Fields with a tilde "~" indicate a field that would be added for PY 2017 under this PRA package.
National Provider Number (NPI)* Provider Tier~ Provider Cost Sharing~ First Name
of Provider*
Middle Initial of Provider Last Name
of Provider*
Suffix of Provider Physician / Non-Physician* Specialty Type (area of medicine)* Street Address* Street Address 2 City* State* County* Zip* Network IDs*

































































































Sheet 7: Facilities&Pharmacies1

Tab 6: Facilities and Pharmacies
All fields in with an asterisk (*) are required. Fields with a tilde "~" indicate a field that would be added for PY 2017 under this PRA package.
National Provider Number (NPI)* Facility Tier~ Facility Cost Sharing~ Facility Name* Facility Type* Street Address* Street Address 2 City* State* County* Zip*

Sheet 8: Provider Types

Instructions for populating the Specialty/Facility Types without using the drop-down menu
The lists below show the specialty/facility & pharmacy types that can be entered in the Network Adequacy template. Column B shows the available specialty types that can be entered for Individual Providers. Column C shows the available types that can be entered for Facilities & Pharmacies. If you would like to enter more than 1 specialty/facility type for a record, please comma separate each type. For example if you would like to assign 001 General Practice and 002 Family Medicine specialty types to a provider, please enter the the types as "001 General Practice, 002 Family Medicine". Entering multiple specialty/facility types using any other convention will result in a validation error. The same comma separation technique can be used to assign multiple Network IDs to the same provider. For example, an issuer in Virginia with 3 Network IDs could assign network 1 and network 3 to the same provider by entering "VAN001, VAN003".
Individual Provider Specialty Types Facility & Pharmacy Types
001 General Practice Pharmacy
002 Family Medicine 040 General Acute Care Hospital
003 Internal Medicine 041 Cardiac Surgery Program
004 Geriatrics 042 Cardiac Catheterization Services
005 Primary Care – Physician Assistant 043 Critical Care Services - Intensive Care Units (ICU)
006 Primary Care – Nurse Practitioner 044 Outpatient Dialysis
007 Allergy and Immunology 045 Surgical Services (Ambulatory Surgical Centers/Outpatient)
008 Cardiovascular Disease 046 Skilled Nursing Facilities
010 Chiropractor 047 Diagnostic Radiology (including Ambulatory Health Care Facilities – Radiology and Magnetic Resonance Imaging (MRI)
011 Dermatology 048 Mammography
012 Endocrinology 049 Physical Therapy (including Ambulatory Health Care Facilities - Physical Therapy)
013 ENT/Otolaryngology 050 Occupational Therapist
014 Gastroenterology 051 Speech Therapy
015 General Surgery 052 Psychiatric Hospital
016 Gynecology (OB/GYN) 054 Orthotics and Prosthetics
017 Infectious Diseases 055 Home Health
018 Nephrology 056 Durable Medical Equipment
019 Neurology 057 Ambulatory Health Care Facilities - Infusion Therapy/Oncology/Radiology
020 Neurological Surgery 061 Heart Transplant Program
021 Medical Oncology & Surgical Oncology 062 Heart/Lung Transplant Program
022 Radiation Oncology 064 Kidney Transplant Program
023 Ophthalmology 065 Liver Transplant Program
025 Orthopedic Surgery 066 Lung Transplant Program
026 Physical Medicine & Rehabilitation 067 Pancreas Transplant Program
027 Plastic Surgery 000 OTHER
028 Podiatrist
029 Psychiatry
030 Pulmonary Disease
031 Rheumatology
033 Urology
034 Vascular Surgery
035 Cardiothoracic Surgery
101 Pediatrics
000 OTHER
Dental - General
Dental - Orthodontist
Dental - Periodontist
Dental - Endodontist

Sheet 9: County Names

County Names used in the Network Adequacy Template
The list below shows the county names that are used and accepted in the Network Adequacy template. If you aren't using the drop-down menus, please ensure that your county names match the names below. A different version of a county name will result in a validation error. The county names below are the same as those in the Service Area template. Only include the county name in the county field, do not include the FIPS code.
State County Name FIPS Code
AK Aleutians East 02013
AK Aleutians West 02016
AK Anchorage 02020
AK Bethel 02050
AK Bristol Bay 02060
AK Denali 02068
AK Dillingham 02070
AK Fairbanks North Star 02090
AK Haines 02100
AK Hoonah Angoon 02105
AK Juneau 02110
AK Kenai Peninsula 02122
AK Ketchikan Gateway 02130
AK Kodiak Island 02150
AK Lake And Peninsula 02164
AK Matanuska Susitna 02170
AK Nome 02180
AK North Slope 02185
AK Northwest Arctic 02188
AK Petersburg 02195
AK Prince Of Wales Hyder 02198
AK Sitka 02220
AK Skagway 02230
AK Southeast Fairbanks 02240
AK Valdez Cordova 02261
AK Wade Hampton 02270
AK Wrangell 02275
AK Yakutat 02282
AK Yukon Koyukuk 02290
AL Autauga 01001
AL Baldwin 01003
AL Barbour 01005
AL Bibb 01007
AL Blount 01009
AL Bullock 01011
AL Butler 01013
AL Calhoun 01015
AL Chambers 01017
AL Cherokee 01019
AL Chilton 01021
AL Choctaw 01023
AL Clarke 01025
AL Clay 01027
AL Cleburne 01029
AL Coffee 01031
AL Colbert 01033
AL Conecuh 01035
AL Coosa 01037
AL Covington 01039
AL Crenshaw 01041
AL Cullman 01043
AL Dale 01045
AL Dallas 01047
AL De Kalb 01049
AL Elmore 01051
AL Escambia 01053
AL Etowah 01055
AL Fayette 01057
AL Franklin 01059
AL Geneva 01061
AL Greene 01063
AL Hale 01065
AL Henry 01067
AL Houston 01069
AL Jackson 01071
AL Jefferson 01073
AL Lamar 01075
AL Lauderdale 01077
AL Lawrence 01079
AL Lee 01081
AL Limestone 01083
AL Lowndes 01085
AL Macon 01087
AL Madison 01089
AL Marengo 01091
AL Marion 01093
AL Marshall 01095
AL Mobile 01097
AL Monroe 01099
AL Montgomery 01101
AL Morgan 01103
AL Perry 01105
AL Pickens 01107
AL Pike 01109
AL Randolph 01111
AL Russell 01113
AL Saint Clair 01115
AL Shelby 01117
AL Sumter 01119
AL Talladega 01121
AL Tallapoosa 01123
AL Tuscaloosa 01125
AL Walker 01127
AL Washington 01129
AL Wilcox 01131
AL Winston 01133
AR Arkansas 05001
AR Ashley 05003
AR Baxter 05005
AR Benton 05007
AR Boone 05009
AR Bradley 05011
AR Calhoun 05013
AR Carroll 05015
AR Chicot 05017
AR Clark 05019
AR Clay 05021
AR Cleburne 05023
AR Cleveland 05025
AR Columbia 05027
AR Conway 05029
AR Craighead 05031
AR Crawford 05033
AR Crittenden 05035
AR Cross 05037
AR Dallas 05039
AR Desha 05041
AR Drew 05043
AR Faulkner 05045
AR Franklin 05047
AR Fulton 05049
AR Garland 05051
AR Grant 05053
AR Greene 05055
AR Hempstead 05057
AR Hot Spring 05059
AR Howard 05061
AR Independence 05063
AR Izard 05065
AR Jackson 05067
AR Jefferson 05069
AR Johnson 05071
AR Lafayette 05073
AR Lawrence 05075
AR Lee 05077
AR Lincoln 05079
AR Little River 05081
AR Logan 05083
AR Lonoke 05085
AR Madison 05087
AR Marion 05089
AR Miller 05091
AR Mississippi 05093
AR Monroe 05095
AR Montgomery 05097
AR Nevada 05099
AR Newton 05101
AR Ouachita 05103
AR Perry 05105
AR Phillips 05107
AR Pike 05109
AR Poinsett 05111
AR Polk 05113
AR Pope 05115
AR Prairie 05117
AR Pulaski 05119
AR Randolph 05121
AR Saint Francis 05123
AR Saline 05125
AR Scott 05127
AR Searcy 05129
AR Sebastian 05131
AR Sevier 05133
AR Sharp 05135
AR Stone 05137
AR Union 05139
AR Van Buren 05141
AR Washington 05143
AR White 05145
AR Woodruff 05147
AR Yell 05149
AZ Apache 04001
AZ Cochise 04003
AZ Coconino 04005
AZ Gila 04007
AZ Graham 04009
AZ Greenlee 04011
AZ La Paz 04012
AZ Maricopa 04013
AZ Mohave 04015
AZ Navajo 04017
AZ Pima 04019
AZ Pinal 04021
AZ Santa Cruz 04023
AZ Yavapai 04025
AZ Yuma 04027
CA Alameda 06001
CA Alpine 06003
CA Amador 06005
CA Butte 06007
CA Calaveras 06009
CA Colusa 06011
CA Contra Costa 06013
CA Del Norte 06015
CA El Dorado 06017
CA Fresno 06019
CA Glenn 06021
CA Humboldt 06023
CA Imperial 06025
CA Inyo 06027
CA Kern 06029
CA Kings 06031
CA Lake 06033
CA Lassen 06035
CA Los Angeles 06037
CA Madera 06039
CA Marin 06041
CA Mariposa 06043
CA Mendocino 06045
CA Merced 06047
CA Modoc 06049
CA Mono 06051
CA Monterey 06053
CA Napa 06055
CA Nevada 06057
CA Orange 06059
CA Placer 06061
CA Plumas 06063
CA Riverside 06065
CA Sacramento 06067
CA San Benito 06069
CA San Bernardino 06071
CA San Diego 06073
CA San Francisco 06075
CA San Joaquin 06077
CA San Luis Obispo 06079
CA San Mateo 06081
CA Santa Barbara 06083
CA Santa Clara 06085
CA Santa Cruz 06087
CA Shasta 06089
CA Sierra 06091
CA Siskiyou 06093
CA Solano 06095
CA Sonoma 06097
CA Stanislaus 06099
CA Sutter 06101
CA Tehama 06103
CA Trinity 06105
CA Tulare 06107
CA Tuolumne 06109
CA Ventura 06111
CA Yolo 06113
CA Yuba 06115
CO Adams 08001
CO Alamosa 08003
CO Arapahoe 08005
CO Archuleta 08007
CO Baca 08009
CO Bent 08011
CO Boulder 08013
CO Broomfield 08014
CO Chaffee 08015
CO Cheyenne 08017
CO Clear Creek 08019
CO Conejos 08021
CO Costilla 08023
CO Crowley 08025
CO Custer 08027
CO Delta 08029
CO Denver 08031
CO Dolores 08033
CO Douglas 08035
CO Eagle 08037
CO El Paso 08041
CO Elbert 08039
CO Fremont 08043
CO Garfield 08045
CO Gilpin 08047
CO Grand 08049
CO Gunnison 08051
CO Hinsdale 08053
CO Huerfano 08055
CO Jackson 08057
CO Jefferson 08059
CO Kiowa 08061
CO Kit Carson 08063
CO La Plata 08067
CO Lake 08065
CO Larimer 08069
CO Las Animas 08071
CO Lincoln 08073
CO Logan 08075
CO Mesa 08077
CO Mineral 08079
CO Moffat 08081
CO Montezuma 08083
CO Montrose 08085
CO Morgan 08087
CO Otero 08089
CO Ouray 08091
CO Park 08093
CO Phillips 08095
CO Pitkin 08097
CO Prowers 08099
CO Pueblo 08101
CO Rio Blanco 08103
CO Rio Grande 08105
CO Routt 08107
CO Saguache 08109
CO San Juan 08111
CO San Miguel 08113
CO Sedgwick 08115
CO Summit 08117
CO Teller 08119
CO Washington 08121
CO Weld 08123
CO Yuma 08125
CT Fairfield 09001
CT Hartford 09003
CT Litchfield 09005
CT Middlesex 09007
CT New Haven 09009
CT New London 09011
CT Tolland 09013
CT Windham 09015
DC District Of Columbia 11001
DE Kent 10001
DE New Castle 10003
DE Sussex 10005
FL Alachua 12001
FL Baker 12003
FL Bay 12005
FL Bradford 12007
FL Brevard 12009
FL Broward 12011
FL Calhoun 12013
FL Charlotte 12015
FL Citrus 12017
FL Clay 12019
FL Collier 12021
FL Columbia 12023
FL De Soto 12027
FL Dixie 12029
FL Duval 12031
FL Escambia 12033
FL Flagler 12035
FL Franklin 12037
FL Gadsden 12039
FL Gilchrist 12041
FL Glades 12043
FL Gulf 12045
FL Hamilton 12047
FL Hardee 12049
FL Hendry 12051
FL Hernando 12053
FL Highlands 12055
FL Hillsborough 12057
FL Holmes 12059
FL Indian River 12061
FL Jackson 12063
FL Jefferson 12065
FL Lafayette 12067
FL Lake 12069
FL Lee 12071
FL Leon 12073
FL Levy 12075
FL Liberty 12077
FL Madison 12079
FL Manatee 12081
FL Marion 12083
FL Martin 12085
FL Miami 12086
FL Monroe 12087
FL Nassau 12089
FL Okaloosa 12091
FL Okeechobee 12093
FL Orange 12095
FL Osceola 12097
FL Palm Beach 12099
FL Pasco 12101
FL Pinellas 12103
FL Polk 12105
FL Putnam 12107
FL Saint Johns 12109
FL Saint Lucie 12111
FL Santa Rosa 12113
FL Sarasota 12115
FL Seminole 12117
FL Sumter 12119
FL Suwannee 12121
FL Taylor 12123
FL Union 12125
FL Volusia 12127
FL Wakulla 12129
FL Walton 12131
FL Washington 12133
GA Appling 13001
GA Atkinson 13003
GA Bacon 13005
GA Baker 13007
GA Baldwin 13009
GA Banks 13011
GA Barrow 13013
GA Bartow 13015
GA Ben Hill 13017
GA Berrien 13019
GA Bibb 13021
GA Bleckley 13023
GA Brantley 13025
GA Brooks 13027
GA Bryan 13029
GA Bulloch 13031
GA Burke 13033
GA Butts 13035
GA Calhoun 13037
GA Camden 13039
GA Candler 13043
GA Carroll 13045
GA Catoosa 13047
GA Charlton 13049
GA Chatham 13051
GA Chattahoochee 13053
GA Chattooga 13055
GA Cherokee 13057
GA Clarke 13059
GA Clay 13061
GA Clayton 13063
GA Clinch 13065
GA Cobb 13067
GA Coffee 13069
GA Colquitt 13071
GA Columbia 13073
GA Cook 13075
GA Coweta 13077
GA Crawford 13079
GA Crisp 13081
GA Dade 13083
GA Dawson 13085
GA Decatur 13087
GA Dekalb 13089
GA Dodge 13091
GA Dooly 13093
GA Dougherty 13095
GA Douglas 13097
GA Early 13099
GA Echols 13101
GA Effingham 13103
GA Elbert 13105
GA Emanuel 13107
GA Evans 13109
GA Fannin 13111
GA Fayette 13113
GA Floyd 13115
GA Forsyth 13117
GA Franklin 13119
GA Fulton 13121
GA Gilmer 13123
GA Glascock 13125
GA Glynn 13127
GA Gordon 13129
GA Grady 13131
GA Greene 13133
GA Gwinnett 13135
GA Habersham 13137
GA Hall 13139
GA Hancock 13141
GA Haralson 13143
GA Harris 13145
GA Hart 13147
GA Heard 13149
GA Henry 13151
GA Houston 13153
GA Irwin 13155
GA Jackson 13157
GA Jasper 13159
GA Jeff Davis 13161
GA Jefferson 13163
GA Jenkins 13165
GA Johnson 13167
GA Jones 13169
GA Lamar 13171
GA Lanier 13173
GA Laurens 13175
GA Lee 13177
GA Liberty 13179
GA Lincoln 13181
GA Long 13183
GA Lowndes 13185
GA Lumpkin 13187
GA Macon 13193
GA Madison 13195
GA Marion 13197
GA Mcduffie 13189
GA Mcintosh 13191
GA Meriwether 13199
GA Miller 13201
GA Mitchell 13205
GA Monroe 13207
GA Montgomery 13209
GA Morgan 13211
GA Murray 13213
GA Muscogee 13215
GA Newton 13217
GA Oconee 13219
GA Oglethorpe 13221
GA Paulding 13223
GA Peach 13225
GA Pickens 13227
GA Pierce 13229
GA Pike 13231
GA Polk 13233
GA Pulaski 13235
GA Putnam 13237
GA Quitman 13239
GA Rabun 13241
GA Randolph 13243
GA Richmond 13245
GA Rockdale 13247
GA Schley 13249
GA Screven 13251
GA Seminole 13253
GA Spalding 13255
GA Stephens 13257
GA Stewart 13259
GA Sumter 13261
GA Talbot 13263
GA Taliaferro 13265
GA Tattnall 13267
GA Taylor 13269
GA Telfair 13271
GA Terrell 13273
GA Thomas 13275
GA Tift 13277
GA Toombs 13279
GA Towns 13281
GA Treutlen 13283
GA Troup 13285
GA Turner 13287
GA Twiggs 13289
GA Union 13291
GA Upson 13293
GA Walker 13295
GA Walton 13297
GA Ware 13299
GA Warren 13301
GA Washington 13303
GA Wayne 13305
GA Webster 13307
GA Wheeler 13309
GA White 13311
GA Whitfield 13313
GA Wilcox 13315
GA Wilkes 13317
GA Wilkinson 13319
GA Worth 13321
HI Hawaii 15001
HI Honolulu 15003
HI Kauai 15007
HI Maui 15009
IA Adair 19001
IA Adams 19003
IA Allamakee 19005
IA Appanoose 19007
IA Audubon 19009
IA Benton 19011
IA Black Hawk 19013
IA Boone 19015
IA Bremer 19017
IA Buchanan 19019
IA Buena Vista 19021
IA Butler 19023
IA Calhoun 19025
IA Carroll 19027
IA Cass 19029
IA Cedar 19031
IA Cerro Gordo 19033
IA Cherokee 19035
IA Chickasaw 19037
IA Clarke 19039
IA Clay 19041
IA Clayton 19043
IA Clinton 19045
IA Crawford 19047
IA Dallas 19049
IA Davis 19051
IA Decatur 19053
IA Delaware 19055
IA Des Moines 19057
IA Dickinson 19059
IA Dubuque 19061
IA Emmet 19063
IA Fayette 19065
IA Floyd 19067
IA Franklin 19069
IA Fremont 19071
IA Greene 19073
IA Grundy 19075
IA Guthrie 19077
IA Hamilton 19079
IA Hancock 19081
IA Hardin 19083
IA Harrison 19085
IA Henry 19087
IA Howard 19089
IA Humboldt 19091
IA Ida 19093
IA Iowa 19095
IA Jackson 19097
IA Jasper 19099
IA Jefferson 19101
IA Johnson 19103
IA Jones 19105
IA Keokuk 19107
IA Kossuth 19109
IA Lee 19111
IA Linn 19113
IA Louisa 19115
IA Lucas 19117
IA Lyon 19119
IA Madison 19121
IA Mahaska 19123
IA Marion 19125
IA Marshall 19127
IA Mills 19129
IA Mitchell 19131
IA Monona 19133
IA Monroe 19135
IA Montgomery 19137
IA Muscatine 19139
IA Obrien 19141
IA Osceola 19143
IA Page 19145
IA Palo Alto 19147
IA Plymouth 19149
IA Pocahontas 19151
IA Polk 19153
IA Pottawattamie 19155
IA Poweshiek 19157
IA Ringgold 19159
IA Sac 19161
IA Scott 19163
IA Shelby 19165
IA Sioux 19167
IA Story 19169
IA Tama 19171
IA Taylor 19173
IA Union 19175
IA Van Buren 19177
IA Wapello 19179
IA Warren 19181
IA Washington 19183
IA Wayne 19185
IA Webster 19187
IA Winnebago 19189
IA Winneshiek 19191
IA Woodbury 19193
IA Worth 19195
IA Wright 19197
ID Ada 16001
ID Adams 16003
ID Bannock 16005
ID Bear Lake 16007
ID Benewah 16009
ID Bingham 16011
ID Blaine 16013
ID Boise 16015
ID Bonner 16017
ID Bonneville 16019
ID Boundary 16021
ID Butte 16023
ID Camas 16025
ID Canyon 16027
ID Caribou 16029
ID Cassia 16031
ID Clark 16033
ID Clearwater 16035
ID Custer 16037
ID Elmore 16039
ID Franklin 16041
ID Fremont 16043
ID Gem 16045
ID Gooding 16047
ID Idaho 16049
ID Jefferson 16051
ID Jerome 16053
ID Kootenai 16055
ID Latah 16057
ID Lemhi 16059
ID Lewis 16061
ID Lincoln 16063
ID Madison 16065
ID Minidoka 16067
ID Nez Perce 16069
ID Oneida 16071
ID Owyhee 16073
ID Payette 16075
ID Power 16077
ID Shoshone 16079
ID Teton 16081
ID Twin Falls 16083
ID Valley 16085
ID Washington 16087
IL Adams 17001
IL Alexander 17003
IL Bond 17005
IL Boone 17007
IL Brown 17009
IL Bureau 17011
IL Calhoun 17013
IL Carroll 17015
IL Cass 17017
IL Champaign 17019
IL Christian 17021
IL Clark 17023
IL Clay 17025
IL Clinton 17027
IL Coles 17029
IL Cook 17031
IL Crawford 17033
IL Cumberland 17035
IL Dekalb 17037
IL Dewitt 17039
IL Douglas 17041
IL Dupage 17043
IL Edgar 17045
IL Edwards 17047
IL Effingham 17049
IL Fayette 17051
IL Ford 17053
IL Franklin 17055
IL Fulton 17057
IL Gallatin 17059
IL Greene 17061
IL Grundy 17063
IL Hamilton 17065
IL Hancock 17067
IL Hardin 17069
IL Henderson 17071
IL Henry 17073
IL Iroquois 17075
IL Jackson 17077
IL Jasper 17079
IL Jefferson 17081
IL Jersey 17083
IL Jo Daviess 17085
IL Johnson 17087
IL Kane 17089
IL Kankakee 17091
IL Kendall 17093
IL Knox 17095
IL La Salle 17099
IL Lake 17097
IL Lawrence 17101
IL Lee 17103
IL Livingston 17105
IL Logan 17107
IL Macon 17115
IL Macoupin 17117
IL Madison 17119
IL Marion 17121
IL Marshall 17123
IL Mason 17125
IL Massac 17127
IL Mcdonough 17109
IL Mchenry 17111
IL Mclean 17113
IL Menard 17129
IL Mercer 17131
IL Monroe 17133
IL Montgomery 17135
IL Morgan 17137
IL Moultrie 17139
IL Ogle 17141
IL Peoria 17143
IL Perry 17145
IL Piatt 17147
IL Pike 17149
IL Pope 17151
IL Pulaski 17153
IL Putnam 17155
IL Randolph 17157
IL Richland 17159
IL Rock Island 17161
IL Saint Clair 17163
IL Saline 17165
IL Sangamon 17167
IL Schuyler 17169
IL Scott 17171
IL Shelby 17173
IL Stark 17175
IL Stephenson 17177
IL Tazewell 17179
IL Union 17181
IL Vermilion 17183
IL Wabash 17185
IL Warren 17187
IL Washington 17189
IL Wayne 17191
IL White 17193
IL Whiteside 17195
IL Will 17197
IL Williamson 17199
IL Winnebago 17201
IL Woodford 17203
IN Adams 18001
IN Allen 18003
IN Bartholomew 18005
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WI Waukesha 55133
WI Waupaca 55135
WI Waushara 55137
WI Winnebago 55139
WI Wood 55141
WV Barbour 54001
WV Berkeley 54003
WV Boone 54005
WV Braxton 54007
WV Brooke 54009
WV Cabell 54011
WV Calhoun 54013
WV Clay 54015
WV Doddridge 54017
WV Fayette 54019
WV Gilmer 54021
WV Grant 54023
WV Greenbrier 54025
WV Hampshire 54027
WV Hancock 54029
WV Hardy 54031
WV Harrison 54033
WV Jackson 54035
WV Jefferson 54037
WV Kanawha 54039
WV Lewis 54041
WV Lincoln 54043
WV Logan 54045
WV Marion 54049
WV Marshall 54051
WV Mason 54053
WV Mcdowell 54047
WV Mercer 54055
WV Mineral 54057
WV Mingo 54059
WV Monongalia 54061
WV Monroe 54063
WV Morgan 54065
WV Nicholas 54067
WV Ohio 54069
WV Pendleton 54071
WV Pleasants 54073
WV Pocahontas 54075
WV Preston 54077
WV Putnam 54079
WV Raleigh 54081
WV Randolph 54083
WV Ritchie 54085
WV Roane 54087
WV Summers 54089
WV Taylor 54091
WV Tucker 54093
WV Tyler 54095
WV Upshur 54097
WV Wayne 54099
WV Webster 54101
WV Wetzel 54103
WV Wirt 54105
WV Wood 54107
WV Wyoming 54109
WY Albany 56001
WY Big Horn 56003
WY Campbell 56005
WY Carbon 56007
WY Converse 56009
WY Crook 56011
WY Fremont 56013
WY Goshen 56015
WY Hot Springs 56017
WY Johnson 56019
WY Laramie 56021
WY Lincoln 56023
WY Natrona 56025
WY Niobrara 56027
WY Park 56029
WY Platte 56031
WY Sheridan 56033
WY Sublette 56035
WY Sweetwater 56037
WY Teton 56039
WY Uinta 56041
WY Washakie 56043
WY Weston 56045

Sheet 10: Errors

Below are the validation errors that were identified in the submitted data. Please correct these errors. You must have a valid template before you can export data to text files. Click on the Cell address that is underlined and highlighted in blue to navigate to the specified error. Note: If one or more rows are deleted in a provider tab or data is reorganized, cell hyperlinks in that tab may no longer be accurate. Please re-run the data validation on the 'User Control' tab to refresh the hyperlinks if this occurs.
Provider Tab Cell Validation Error Message
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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