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Insure Kids Now
Dental Provider Data Submission Technical Information
Version 3.4
Effective date: September 2017
Centers for Medicare & Medicaid Services (CMS)
Health Resources Services and Administration (HRSA)
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Provider Data Submission Technical Information
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Table of Contents
Section
Page
1
Document Change History
v
1.
Introduction
1
2
1.1
Key Concepts and Deadlines
1
1.2
Technical Assistance Resources
2
1.3
IKN Security Policy
2
Getting Started with the IKN Data Management Website
2.1
Log in and Registration Page
4
2.2
Managing Organization Information
6
2.2.1
2.2.2
2.2.3
2.2.4
2.3
2.3.1
2.3.2
2.3.3
3
4
5
6
3
Add New Organization Feature
Remove Organization Feature
Manage Organizational Profile Feature
Manage Organizational Users
6
7
8
10
Managing Individual User Information
10
View/Update Profile
Manage Password
Manage Registered Organizations
11
11
13
Provider Data File Requirements
14
3.1
What Constitutes a Provider Record
14
3.2
Required Data Fields
15
3.3
File Structure
16
Strategies for Submitting The Provider Data File
18
4.1
Upload to IKN Data Management Website
18
4.2
Edit Provider Data Feature
19
4.3
Client Tool Developed by HRSA
19
4.4
Customized Client Tool Created by Your Organization
21
Editing Coverage Plan Names and Removing Duplicates
22
5.1
Key Definitions
22
5.2
Program/Health Plan Name Validation
22
5.3
Manage Existing Data
25
5.4
Certify Provider Data Feature
26
Data Validation
27
6.1
Data File Submission and Validation Receipt
27
6.2
Geophone Report
28
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6.3
7
Provider Duplicates
32
Updating the Summary of Benefits
33
Appendix A: Entry of Group Practice and Federally Qualified Health Centers Provider Data
36
Appendix B: Text Data File Submission Fields and Information
37
APPENDIX C: Configuring the Insure Kids Now Data Submission Client Tool
51
C.1
Configuring the IKN Client Tool (First Time Use)
52
C.2
Manually Submitting a File
53
C.3
Submitting a File Automatically
56
APPENDIX D: Technical Reference for Creating a Custom Upload Client
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Table of Figures
Page
Figure 1: IKN Data Management Website Login Page ............................................................................................. 5
Figure 2: IKN Data Management Website Home Page ............................................................................................ 6
Figure 3: Add New Organization Feature ............................................................................................................... 7
Figure 4: Remove Organization Feature ................................................................................................................. 8
Figure 5: Manage Organization Profile Feature ...................................................................................................... 9
Figure 6: Manage Organization Users .................................................................................................................. 10
Figure 7: View/Update Profile Feature ................................................................................................................. 11
Figure 8: Manage Password Feature .................................................................................................................... 12
Figure 9: My Registered Organizations ................................................................................................................. 13
Figure 10: Example of Provider Data File .............................................................................................................. 16
Figure 11: Upload Provider Data Feature ............................................................................................................. 18
Figure 12: Edit Provider Data Feature .................................................................................................................. 19
Figure 13: IKN Data Uploader Configuration Window .......................................................................................... 20
Figure 14: IKN Data File Uploader Window .......................................................................................................... 20
Figure 15: Certify Provider Data Feature .............................................................................................................. 26
Figure 16: Data File Submission and Validation Receipt ....................................................................................... 28
Figure 17: Geophone Report: Summary Tab......................................................................................................... 30
Figure 18: Geophone Report: Raw Results ........................................................................................................... 31
Figure 19: Summary of Benefits Feature (Landing Page) ...................................................................................... 33
Figure 20: Summary of Benefits Feature (Benefits Form) ..................................................................................... 34
Figure 21: IKN Data Uploader Configuration Window .......................................................................................... 52
Figure 22: IKN Data File Uploader Window .......................................................................................................... 53
Figure 23: "File Not Found" Error Message Box .................................................................................................... 54
Figure 24: Confirmation Dialog Box Displayed Before an Upload ......................................................................... 54
Figure 25: IKN Data File Uploader Window with Successful Upload Message ....................................................... 55
Figure 26: Error Window for Invalid Username or Password ................................................................................ 56
Figure 27: Error Window for Invalid State ............................................................................................................ 56
Figure 28: Schedule Task Wizard - Starting Screen ............................................................................................... 57
Figure 29: New Trigger Window ........................................................................................................................... 58
Figure 30: Edit Action Window ............................................................................................................................. 59
Figure 31: IKN Data Uploader Configuration Window .......................................................................................... 60
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List of Tables
Page
Table 1: Significant Change History ........................................................................................................................ v
Table 2: System Roles ............................................................................................................................................ 3
Table 3: List of Data Fields ................................................................................................................................... 15
Table 4: Sample Program Name/Health Plan Name Combinations on Validation Page ........................................ 23
Table 5: Sample Data File Content and Outcomes................................................................................................ 24
Table 6: Data Validation Checks ........................................................................................................................... 27
Table 7: Text Data File Submission Fields and Information .................................................................................. 37
Table 8: Error Codes Associated with the IKN Submission Schema....................................................................... 63
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1 Document Change History
Table 1 lists the significant changes to the document, with the most recent changes listed first.
Changes to spelling, punctuation, minor re-wording, and other revisions are not explicitly called
out or described.
Table 1: Significant Change History
Version
Date
Change Description
3.4
September
2017
Added content about the IKN security policy, new system changes
regarding the remove organization feature and made minor
updates to text.
3.3
August 2016
Added information about new security requirements in the Login
and Registration Page and Manage Password sections.
3.2
May 2016
Revised the structure of the document.
Used the term Coverage Plan Name consistently throughout the
document to describe the name displayed on the IKN Dentist
Locator (combination of Program Name and Health Plan Name).
Updated document to reflect the following system changes:
Revised submission rules for summary of benefits content.
Program Type field is now required on the Program/Health
Plan Name validation page.
Revised validation procedures to incorporate validation on
program type field against the content entered on
Program/Health Plan Name validation page.
New services added to summary of benefits template.
3.1
July 10, 2015
Added information about duplicated content rejection rules under
data validation section.
3.0
February 18,
2015
Modified the following fields to indicate they will become optional
after February 18, 2015: Services_Mobility; Sedation; and
Services_Intellectual_Disability.
Added instructions to upgrade IKN Client Tool to latest version.
Minor editorial revisions.
2.9
December 7,
2013
Added content indicating that Program Name is now a required
field.
Added content indicating that all submission files must contain
column headers for all fields, including optional fields. All files must
now contain 27 columns total.
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Version
Date
Change Description
Added description of new features: Program/Health Plan Name
Validation Page and Manage Existing Data Page.
Added section describing features of IKN Data Management
website.
2.8
October 17,
2012
Modified the following fields to indicate they will become required
after January 4, 2013: Services_Mobility; Sedation; and
Services_Intellectual_Disability.
2.7
October 12,
2012
Removed note indicating the following fields will become required
after October 1, 2012: Services_Mobility; Sedation; and
Services_Intellectual_Disability. These fields will remain optional
until further notice.
2.6
July 17, 2012
Added new content regarding five new data fields.
Removed references to eRoom, as states are no longer to submit
data via eRoom.
Added content regarding new website checks.
Added content regarding validation processes and flagged data
report.
Modified text regarding IKN Client Tool configuration for secure
socket layers (SSL) for versions of the tool older than May 2012.
2.5
February 09,
2011
Removed the business rule that allows multiple Specialty entries
only when Group Name is provided.
2.4
December 15,
2010
Changed requirement for the content of New Patients, Phone
Number, and Street Address to be required. Files will no longer be
acceptable with nulls in these fields.
Added words describing new validation requirements on Street
Address rejecting anything that is a Post Office Box.
Raise the acceptable threshold from 20% to3% error tolerance.
Changed the Specialty list and business rule to allow multiple
Specialty entries only when Group Name is provided.
2.3 (draft)
April 5, 2010
Re-worded introduction to describe the project, required data
submission frequency, and submission process goals.
Added policy statement regarding certification of data’s currency
and accuracy in the introduction.
Added a list of upcoming submission deadlines in the introduction.
Added a section describing the IKN data submission service.
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Version
Date
Change Description
Added clarification to the Appendix B regarding required fields
(when they must appear in the file header versus when they must
contain data).
Re-ordered this table so that the most recent changes are listed
first.
2.2 (final)
December 29,
2009
Updated Appendix B to reflect the decision that columns marked as
“Optional” may be omitted from submissions if they do not contain
any data.
Added clarification of Prof_Aff usage and list of accepted values.
Added “Both” as an acceptable value in Program_Type, to eliminate
the need to create otherwise-redundant listings.
Added note about omitting Active_Dt and Inactive_Dt in the data
element table in Appendix B.
2.2 (draft)
December 7,
2009 (draft)
Added this table.
Added version number on title page.
Removed data submission option 3 (links to external sites).
Added planned / contemplated validation rules and details to the
data elements listed in Appendix B.
(not
numbered)
October 10,
2009 (still
dated
October 1,
2009)
Removed reference to data submission option 3 (links to other
websites) being obsolete after November 2009.
(not
numbered)
October 1,
2009
Added notation to data submission option 3 (links to other
websites) that after November 2009 this option would no longer be
available;
Eliminated MS Access data submission format.
Eliminated text file data submission format specification that was
included in the main document—only the format in Appendix B was
retained.
Provided additional / expanded examples and definitions for data
elements and scenarios.
Revised data file submission naming standard / conventions.
Expanded the guidance for submitting group practice and FQHC
data.
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Version
Date
Change Description
Re-ordered the items in the data submission format in Appendix B.
(not
numbered)
September 2017
July 16, 2009
Original version
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1. Introduction
Under the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009, states
are required to report to the federal government information on the dental providers in their
state that serve children enrolled in Medicaid and the Children's Health Insurance Program
(CHIP). States must also report the dental benefits provided under these programs. This
information is posted on the Insure Kids Now (IKN) website (www.insurekidsnow.gov) to
support access to dental care for children enrolled in Medicaid and CHIP. The Centers for
Medicare & Medicaid Services (CMS) and Health Resources and Services Administration (HRSA)
developed an automated data submission and management approach to support states in
reporting this information. This document provides states with the technical guidance needed
to meet these reporting requirements.
Key Concepts and Deadlines
Provider Data File: States must submit a file (or multiple files) that contains specified
information about the Medicaid and CHIP providers in the state that provide dental care to
children. The data are collected and reported such that each listing represents a “provider” who
sees patients that are members of a particular Coverage Plan (also referred to as Program
Name + Health Plan Name) at a specific location.
States – or their contractors and managed care organizations – are required to submit the
updated Provider Data File(s) on a quarterly basis by the following dates:
February 4th
May 4th
August 4th
November 4th
States are encouraged to submit data on a more frequent basis to ensure it is as up to date as
possible.
Summary of Benefits: States must also provide specified information about the scope of
Medicaid and CHIP dental benefits, or summary of benefits, and update this information at
least once in each twelve-month period. The annual submission deadline for a given state is set
to a date one year after the state’s most recent submission.
Role of the IKN Data Management website: States upload the Provider Data File and update
summary of benefits information through the IKN Data Management website, developed by
CMS and HRSA. To ensure beneficiaries have access to the most up-to-date information
possible, states can upload data through this website as often as desired.
IKN Data Management website: https://ikndata.insurekidsnow.gov/WebExternal/Login.aspx
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Technical Assistance Resources
CMS tracks state compliance with the CHIPRA requirements. If data are not submitted by the
submission deadline, a representative from CMS may follow up with the State Administrator to
identify a solution to ensure data are accurate and up to date.
CMS and HRSA are eager to provide technical assistance to states to support them in the data
submission process and promote data completeness and accuracy. While states can seek
technical assistance through multiple avenues, there is no wrong door, and technical assistance
providers work closely to support states during the submission process.
HRSA IKN Technical Help Desk ([email protected]): The help desk can provide
technical support related to the IKN Data Management website, data validation issues,
and reporting requirements.
NetCloud Technical Assistance ([email protected]): NetCloud can support states
to improve the quality of their data and trouble-shoot issues with the Provider Data File.
In addition, NetCloud can help states identify effective data collection strategies.
IKN Security Policy
To increase the security of the data in the IKN Data Management System, CMS and HRSA have
implemented a security policy requiring all user accounts to be disabled after 90 days of
continuous inactivity. To avoid your account being disabled, it is recommended that users log
into the system at least once within each 90 day period.
To help remind users who have not logged into the system and are in jeopardy of having their
account disabled, users will receive three automated email reminders upon ten and five
calendar days and 24 hours prior to the account being disabled.
If your account has been disabled, the account can be reactivated by contacting the State
Administrator or by submitting a request to the IKN Technical Mailbox
at [email protected]. The contact information for your State Administrator is located
in the email notifying you of your account being disabled.
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2 Getting Started with the IKN Data Management Website
States meet their IKN data submission requirements through the IKN Data Management
website. All users may log in to the IKN Data Management website to upload Provider Data
Files and manage personal and organization information. Users with the State Administrator
role may edit Program Name + Health Plan Name combinations, manage existing data, and edit
summary of benefits information. System roles for the IKN Data Management website are
contained in Table 2.
Table 2: System Roles
System Roles
State Administrator
(Upload Admin)
State Uploader
(Uploader)
September 2017
Privileges
Upload and edit data
submission files for their
own state.
Create or remove an
organization.
Manage organization
profile.
Manage personal profile.
Edit summary of benefits
information.
Edit program/health plan
name combinations.
Manage existing data.
Certify provider data.
Upload and edit data
submission files for their
linked state(s).
Manage personal profile.
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Accessible Features
Certify Data
Manage Organization
Profile
Manage Users
Submit Data
Submit Data
Provider Data Submission Technical Information
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Log in and Registration Page
Users access the IKN Data Management
through: https://ikndata.insurekidsnow.gov/WebExternal/Login.aspx. Figure 1 displays the
page where users log in or register for the first time.
New users must create accounts by clicking ‘Register’ and registering it to an existing
organization. If a user’s organization does not yet exist in the system, the user must contact the
State Administrator and ask them to create a new organization. (Typically, this only pertains to
users affiliated with contractors or managed care organizations who upload data on the state’s
behalf). Users can only be registered to one organization. Once a new user has registered to an
organization, the State Administrator must assign them the appropriate privileges by using the
“Manage Organization Users” feature or provide the IKN technical help staff with written
approval to assign upload privileges for their state. The State Administrator may use this
function to modify privileges for state uploaders associated with their organization at any time,
or they may request assistance by emailing [email protected].
State Administrators must register to a valid state government organization. To acquire State
Administrator privileges, users must email [email protected] to request privileges. If
the request comes from a valid state government email address, IKN technical help staff will
then assign the user with State Administrator privileges.
If an account needs to be removed/disabled due to staff changes or some other reason, the
account owner themselves should email their State Administrator or
the [email protected] and request that the account be disabled. This action will
prevent the user from accessing the data management site and will discontinue all automatic
email messages directed to the email address associated with that account.
If users have trouble registering/managing privileges, they can contact the IKN Technical Help
Desk for assistance at [email protected].
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Figure 1: IKN Data Management Website Login Page
Once a user logs in, they are taken to the IKN Data Management website home page, pictured
in Figure 2. The user will primarily use the left hand navigation panel on this home page to
navigate through the site.
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Figure 2: IKN Data Management Website Home Page
Managing Organization Information
The State Administrator may manage the organizations on the IKN Data Management website.
They may add a new organization, remove an organization, manage an existing organization
profile, or manage users of the organization.
2.2.1 Add New Organization Feature
The State Administrator may create a new organization for a contractor/managed care
organization if the organization does not already exist in the system. By adding the new
organization, new users may register to the correct organization (illustrated in Figure 3). This
feature may be accessed by selecting ‘Add New Organization’ under the ‘Manage Organization’
option in the left-hand menu on the IKN Data Management website home page.
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Figure 3: Add New Organization Feature
2.2.2 Remove Organization Feature
The State Administrator may remove a contractor/managed care organization association from
their state. By removing the association, users of the organization will not be able to view, edit,
or update data on the states’ behalf. State Administrators can only remove the association with
the organizations that are associated with their state (illustrated in Figure 4). This feature may
be accessed by selecting ‘Remove Organization’ under the ‘Manage Organization’ option in the
left-hand menu on the IKN Data Management website home page.
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Figure 4: Remove Organization Feature
2.2.3 Manage Organizational Profile Feature
The State Administrator also has rights to edit organizational details by using the ‘Manage
Organization Profile’ feature under the ‘Manage Organization’ option in the left-hand menu on
the IKN Data Management website home page. The 'Manage Organization Profile' page is
shown in Figure 5.
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Figure 5: Manage Organization Profile Feature
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2.2.4 Manage Organizational Users
The State Administrator has the ability to search for users, disable/re-enable user accounts,
update user permissions, and reset user passwords that are only associated with their state.
State Administrators may perform these tasks by using the ‘Manage Organization Users’ feature
under the ‘Manage Organization’ option in the left-hand menu on the IKN Data Management
website home page. The 'Manage Organization Users' page is shown in Figure 6.
It is important to note that after an update is made to a user profile, the ‘Update User’ button
located at the bottom of each search record must be selected to save the recent changes made
to the profile.
Figure 6: Manage Organization Users
Managing Individual User Information
All users have the ability to manage their personal details, password, and related organizations
on the IKN Data Management website.
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2.3.1 View/Update Profile
All users have the option to edit their personal details by selecting ‘View/Update Profile’ under
the ‘Manage Person’ option in the left-hand menu on the IKN Data Management website home
page. The 'View/Update Profile' page is depicted in Figure 7.
Figure 7: View/Update Profile Feature
2.3.2 Manage Password
All users have the option to edit their password by selecting ‘Manage Password’ under the
‘Manage Person’ option in the left-hand menu on the IKN Data Management website home
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page. The 'Manage Password' page is depicted in Figure 8. Users may also update their security
questions and answers by using the ‘Manage Password’ feature.
Users are responsible for managing the privacy of their passwords. Users should not write down
or share passwords or User IDs.
Users must create and use passwords consisting of at least eight (8) characters that cannot be
easily guessed. Passwords must contain a combination of at least three out of four of the
following criteria: English upper-case (A-Z) and lower-case characters (a-z), numerical digits (09), and at least one special character (e.g. @, !, $, %). Users are required to change their
passwords every 90 days. Users are also prohibited from reusing the previous twenty four (24)
passwords. Passwords may only be changed once every 24 hours. If a user attempts to log in
five times within 15 minutes with invalid credentials, the account will be locked for 120 minutes
upon the fifth invalid attempt.
Figure 8: Manage Password Feature
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2.3.3 Manage Registered Organizations
All users have the option to view the organizations they are registered under by selecting ‘My
Registered Organizations’ option in the left-hand menu on the IKN Data Management website
home page. The 'My Registered Organizations' page is depicted in Figure 9.
Figure 9: My Registered Organizations
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3 Provider Data File Requirements
States are required to submit one or more Provider Data Files on a quarterly basis with
information on each dental provider in the state that treats children insured through Medicaid
and CHIP. States may submit more than one file (e.g., one for Medicaid and one for CHIP, or
one for each Coverage Plan the state offers). Each file is required to be clearly identified.
What Constitutes a Provider Record
Each record in the Provider Data File should be a unique combination of:
Provider: An individual, group practice, or health center/other facility. Each record must
have at least one of these three items included. Listing individual providers is preferred,
when possible.
Coverage Plan: This is the name displayed on the IKN Dentist Locator. It is the
combination of the state Program Name and Health Plan Name. The Program Name is
the name by which a Medicaid or CHIP program is known to beneficiaries (e.g.,
TennCare, Kids First, Denti-Cal). The Health Plan Name is any subsidiary plan or option
associated with the program (e.g., Blue Cross/Blue Shield, Mercy Care Plan). For more
information on Coverage Plans, see Chapter 5.
Service Location: A specific physical address to which patients could be directed to
receive care. Mailing addresses, such as Post Office boxes, do not qualify as a physical
address.
Example scenarios: Here are some provider and location scenarios and the expected records
that would be submitted for each:
One Provider in One Plan at One Location: If a provider has one location and sees
patients only from one Coverage Plan, then submit a single complete record for that
provider.
One Provider in One Plan at Multiple Locations: If a provider sees patients from a single
Coverage Plan, but has multiple locations (e.g., three), then submit three complete
records for that provider.
One Provider in Multiple Plans at One Location: If a provider sees patients from more
than one plan, but does so at a single location, then submit a complete record for each
plan in which the provider participates.
One Provider, Multiple Plans, at Multiple Locations: If a provider participates in more
than one plan, and sees patients in those plans at more than one location, then submit a
complete record for each combination of provider, plan, and location. NOTE: Not all
providers necessarily see patients from each plan in which they participate at every
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location where the provider sees patients. That should be accounted for in the data
records submitted.
Practice with More than One Provider and One Location: If a practice has two
providers at a single location, submit two complete records (i.e., one for each provider)
if the providers are willing to be listed by name. Otherwise, submit a single record for
the group practice as an entity, but no details on the individual providers in the practice.
Practice with More than One Provider and Multiple Locations: If a practice has two
providers and multiple locations, then submit a complete record for each provider
associated with each location at which that provider practices.
Required Data Fields
For each file, states must report a column heading for 27 different data elements, listed in Table
3. However, some of these fields are optional, meaning that the data can be left blank. For
more information regarding the specific field requirements, please refer to Table 6 in Appendix
B.
Table 3: List of Data Fields
Data Element Name
Description
Required/Optional
Provider_ID*
Unique Provider Identifier
Required
Prov_Aff
Provider Affiliation
Optional
First_Nm
Provider First Name
Required, if applicable
Middle_Nm
Provider Middle Name
Optional
Last_Nm
Provider Last Name
Required, if applicable
Grp_Prac_Nm
Group Practice Name
Required, if applicable
Fac_Nm
Facility Name
Required, if applicable
Lang_Spoken
Languages Spoken
Optional
Specialty
Provider Specialty
Required
Website
Website address of provider
Optional
Program_Type
Type of Program
Required
Program_Name
Name of Program
Required
Health_Plan_Name
Name of entity providing coverage
Required, if applicable
Phy_Street_Addr
Provider Physical Site Street Address
Required
City
Provider City
Required
State_Abbr
Provider State
Required
ZIP
Provider ZIP Code
Required
Phone_Num
Phone Number
Required
FAX_Num
FAX Number
Optional
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Data Element Name
Description
Required/Optional
New_Patients
Accepts New Patients
Required
Special_Needs
Can Accommodate Special Needs
Required
Active_Ind
Active Status
Required
Central_ appointment_line
Central Appointment Line
Optional
License_Num
Dental License Number
Optional
Services_Mobility
Sedation
Services_Intellectual_Disability
Facility Can Provide Services for Children with
Mobility Limitations
Facility Can Provide Sedation for Children with
Complex Medical or Behavioral Conditions
Facility Can Provide Services for Children Who May
Have Difficulty Communicating or Cooperating
Such as Those with Autism, Mental Retardation, or
Intellectual Disability
Optional
Optional
Optional
*The file must use some method to individually identify providers. IKN prefers the National
Provider Identification number, but another identifier is acceptable so long as it is “persistent”
(i.e., does not change over time), unique to a provider, and used consistently through all data
submitted by the state and its managed care contractors. In cases where only a group practice
or facility (e.g., health center) is represented, use the identifier for the practice or facility rather
than an identifier for a particular individual.
Please refer to Appendix A, Entry of Federally Qualified Health Centers and Group Practice
Provider Data for special instructions for handling FQHC data.
File Structure
The Provider Data File is a text file. Each data value should be vertical pipe ( | ) delimited. (The
pipe symbol separates the fields.), as shown in Figure 10 .
Figure 10: Example of Provider Data File
Provider_ID|Prov_Aff|First_Nm|Middle_Nm|Last_Nm|Fac_Nm|Phy_Street_Addr|City|…
12345|FQHC|John||Smith|Family Dentistry|123 Elm Street|Topeka|…
All fields listed in Table 3 must be included as column headers in all file submissions, even if the
columns contain no data. Every file should have 27 column headers total.
In the data records themselves, for values left blank, two pipes will be together with nothing in
between. Figure 10 shows the first few data fields of the first two lines in a data file. Note that
John Smith has no middle name, but the position is maintained by the two pipes with nothing in
between. Some data elements are optional. An entry may remain blank if there is no content
for these data elements.
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For fields that allow for multiple entries within them (e.g., Language), please use a comma (,) to
separate the multiple entries (e.g., …|Spanish, Chinese|…).
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4 Strategies for Submitting The Provider Data File
Four mechanisms are currently available for the Provider Data File:
1. Upload files to the IKN Data Management
website: https://ikndata.insurekidsnow.gov/WebExternal/Login.aspx
2. Online editing via the IKN Data Management
website: https://ikndata.insurekidsnow.gov/WebExternal/Login.aspx
3. Use the Client Tool developed by HRSA
4. Use the Customized Client Tool created by your organization
(Please refer to Appendix B for the details of how these files need to be laid out and formatted.)
Each of these options is described in the following sections and related appendices.
Upload to IKN Data Management Website
Users can upload their Provider Data Files to the IKN Data Management website. To do so, they
select the ‘Upload Provider Data’ menu option from the left-hand menu on the IKN Data
Management website home page. The Upload Provider Data feature is pictured in Figure 11.
The user must then select the state and Program Type (i.e., CHIP, Medicaid, or Both) for which
they are uploading and specify the file to be uploaded. Once the file has been specified, they
may use the ‘Upload’ button to upload their data. If the user does not want to complete the
upload, then the user may select the 'Cancel' button.
Figure 11: Upload Provider Data Feature
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Edit Provider Data Feature
Users also have the option of editing existing data directly by selecting the ‘Edit Provider Data’
menu option, illustrated in Figure 12. Select the Coverage Plan that contains the record(s) you
would like to edit by clicking “edit” in the first column of the appropriate row. A complete list of
records for that Coverage Plan will appear. You can filter by Provider Name, Facility Name, or
Group Practice name to find the individual record(s) you would like to edit. You can edit
Provider ID, Provider Last Name, Provider First Name, Accommodates Special Needs, Accepts
New Patients, Specialty, Phone Number, Address, City, State, Facility Name, and Group Practice
Name. You can also add or delete individual record(s).
Figure 12: Edit Provider Data Feature
Client Tool Developed by HRSA
Data upload users have the option of uploading data via the IKN Data Submission Client Tool (as
referred to as the IKN Client Tool) instead of the IKN Data Management website. Data files are
processed the same way, regardless of the mechanism used. The primary advantage of the IKN
Client Tool is that it allows users to configure the tool to allow them to upload data by program
as frequently as they like without requiring them to actively log into the IKN Data Management
website and upload their files manually. Developed for data submission purposes only, the IKN
Client Tool, depicted in Figure 13 and Figure 14, does not provide as many features as the IKN
Data Management website. Users who wish to submit their data more frequently or who can
generate their data file automatically tend to prefer the IKN Client Tool. Users who submit their
data on a quarterly basis or generate their file manually prefer the IKN Data Management
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website. In addition to these mechanisms, users also have the option to develop their own
custom client tool.
Figure 13: IKN Data Uploader Configuration Window
Figure 14: IKN Data File Uploader Window
Users may download the IKN Data Submission Client Tool
from http://ikndata.insurekidsnow.gov/clienttool/.
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The tool has a simple configuration interface that collects the user ID, password, location, and
name of the file to upload. The tool uses this information to establish a connection to the data
submission service and upload the designated file. Once the tool is configured, the user may
use it to manually select and upload a file, or set a schedule to run automatically.
NOTE: The tool does not automatically schedule itself to run. The user will need to create a
scheduled task using the Windows Scheduler to automate submissions using this tool. When
the tool runs in unattended mode, it assumes that the file indicated exists. The user does not
have to generate files with unique names each time they submit a file. When the client is
running in automatic mode, name the file to be uploaded the same every time to avoid having
to reset the tool’s configuration.
APPENDIX C: Configuring the Insure Kids Now Data Submission Client Tool includes screen
shots and step-by-step instructions on how to configure and use the client tool to submit data
interactively or through an automated task.
Customized Client Tool Created by Your Organization
If the IKN Data Submission Client Tool does not meet the user’s needs, the user may create a
custom submission client. APPENDIX D: Technical Reference for Creating a Custom Upload
Client includes the technical information (i.e., service address and name, XML structure,
commands, etc.) necessary to construct a custom data submission client. Please note that the
information is intended for use by those organizations that have the programming skills to
create their own upload tool rather than use the Client Tool described above.
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5 Editing Coverage Plan Names and Removing Duplicates
The Provider Data File includes fields for Program Name and Health Plan Name. The Program
Name and the Health Plan Name combined uniquely identify a specific Coverage Plan in which
beneficiaries might be enrolled. Families use this Coverage Plan Name to search for providers
on the IKN Dentist Locator. When a state uploads a Provider Data File with the same Program
Name and Health Plan Name combination (i.e., Coverage Plan Name) as an existing file, the
previously uploaded data are overwritten. To ensure the proper data are overwritten and the
state does not unintentionally create Coverage Plan Name duplicates (the same plan with
slightly different names), the IKN Data Management website requires states to input the
Program Type, Program Name, and Health Plan Name into the Program/Health Plan Name
Validation page. All names in Provider Data Files are checked against the names on this page at
upload.
Key Definitions
Program Type: The program associated with the Provider Data File: Medicaid, CHIP, or
Both. This name does not appear on the IKN Dentist Locator, but is used to validate
consistency in Coverage Plan Names.
Program Name: The name by which a Medicaid or CHIP program is known to
beneficiaries (e.g., TennCare, Kids First, Medicaid, CHIP, etc.) This is the “brand name”
that beneficiaries would see on their membership card.
Health Plan Name: The name of a Health Plan, if any, that is operated under the
program listed in Program Name.
Program/Health Plan Name Validation
The purpose of the Program/Health Plan Name Validation page is to improve data quality and
reduce duplication. This page allows State Administrators to provide a list of Coverage Plan
Names (also referred to as the Program Name + Health Plan Name) against which data
submissions can be validated. Only State Administrators have access to this page.
The Program Type, Program Names, and Health Plan Names entered on the Program
Name/Health Plan Name Validation page are used to validate Program Type, Program Name,
and Health Plan Name combinations submitted in data files for that state. If the Program Type,
Program Name, and Health Plan Name combinations submitted in a specific file do not exactly
match any of the Program Type, Program Name, and Health Plan Name combinations entered
on the Program Name/Health Plan Name Validation page, the file will fail validation and will not
be accepted for publication.
State Administrators have the option to add or modify Program Type, Program Name, and
Health Plan Name combinations through the Program/Health Plan Name Validation page.
Together, the Program Name and the Health Plan Name identify a specific Coverage Plan in
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which beneficiaries might be enrolled. Program Type is a required field for validation purposes,
but it is not displayed to consumers using the Dentist Locator tool. Please keep in mind the
following important facts when updating the Program/Health Plan name validation page:
Program Type is required
Program Name is required
Health Plan Name is optional, but recommended, if applicable
Each combination of Program Type, Program Name, and Health Plan Name should be
unique
Program Name + Health Plan Name = Coverage Plan Name (website display name)
Table 4 represents the Program Type, Program Name, and Health Plan Name combinations
identified by the State Administrator as the Coverage Plan Name for which they expect to
submit data that quarter.
Table 4: Sample Program Name/Health Plan Name Combinations on Validation Page
Program
Type
Program Name
Health Plan Name
Coverage Plan Name (Website display
(Program_Name) (Health_Plan_Name) name)
Medicaid
Healthy Kids
Medicaid
Medicaid
CHIP
Healthy Smiles
Delta Dental
Healthy Smiles Delta Dental
Both
Healthy Smiles
Health Net
Healthy Smiles Health Net
Aetna
Healthy Kids Aetna
Medicaid
When compared against the Program Name and Health Plan Name combinations contained in
Table 4, a data file with the content displayed in Table 5 would produce the outcomes shown in
the table.
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Table 5: Sample Data File Content and Outcomes
Program
Type
Program Name
Health Plan Name
Rows
Reason for rejection
(Program_Name) (Health_Plan_Name) Accepted/Rejected
Medicaid Healthy Kids
Aetna
Medicaid Medicaid
Accepted
N/A
Accepted
N/A
CHIP
Healthy Smiles
Delta Dental
Accepted
N/A
Both
Healthy Smiles
Health Net
Accepted
N/A
Medicaid HealthyKids
Aetna
Rejected
Spelling of HealthyKids
is not consistent with
program name
identified on
Program/Health Plan
Name Validation page
(Healthy Kids).
Medicaid
Medicaid
Rejected
Program name is
required. Combination
of Program Name and
Health Plan Name does
not match combination
identified on
Program/Health Plan
Name Validation page.
Delta Dental
Rejected
Delta Dental is not
associated with the
Program Name Healthy
Kids in the
Program/Health Plan
Name Validation page.
Rejected
The Program/Health
Plan Name Validation
page does not include
any combinations
where Healthy Smiles
Health Net is the
Program Name and the
Health Plan Name is
blank.
CHIP
Healthy Kids
Both
Healthy Smiles
Health Net
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Program
Type
Program Name
Health Plan Name
Rows
Reason for rejection
(Program_Name) (Health_Plan_Name) Accepted/Rejected
CHIP
Healthy Kids
Aetna
Rejected
Program Type does not
match the Program
Type associated with
the specified Program
Name and Health Plan
Name identified on the
Program/Health Plan
Name Validation page.
Manage Existing Data
The purpose of the Manage Existing Data page is to improve data quality and reduce
duplication by allowing State Administrators to delete outdated data. Only State Administrators
have access to this page.
Existing data that is older than one year will be automatically deleted. The Manage Existing
Data page displays the Coverage Plan Names currently displayed on the IKN website, along with
the associated content for the following fields:
Program Type
Program Name
Health Plan Name
Date of last file upload
Name and username of the person who uploaded the most recent data file associated
with that Coverage Plan.
The Coverage Plans displayed on the Manage Existing Data page are divided into two tables:
Table 1: Attention Needed, and Table 2: No Action Required.
Table 1: Attention Needed: This table lists Coverage Plans where the Program
Name/Health Plan Name combinations displayed on the IKN website do not match the
Program Name/Health Plan Name combinations listed on the Program/Health Plan
Name Validation page. Coverage plans without the Program Name are also listed. It is
recommended that State Administrators delete the data listed in this table.
Table 2: No Action Required: This table lists Coverage Plans where the Program
Name/Health Plan Name combinations displayed on the IKN website exactly match the
Program Name/Health Plan Name combinations listed on the Program/Health Plan
Name Validation page. No action is required. If the next file submission matches the
Program Name/Health Plan Name combinations listed here, the data in the new file will
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automatically replace the data listed in this table. State Administrators have the option
to delete data from this table if they wish to, but it is not required.
Certify Provider Data Feature
State Administrators can use the ‘Certify Provider Data’ feature to certify that the data
submitted for their state is accurate and up to date. This feature is accessed by selecting the
‘Certify Provider Data’ menu option on the IKN Data Management website Home Page. Figure
15 pictures the 'Certify Provider Data' feature.
Figure 15: Certify Provider Data Feature
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6 Data Validation
To improve access to dental care, the information on the IKN Dentist Locator must be complete
and accurate. To promote completeness and accuracy the IKN Data Management website
conducts validation checks on the Provider Data Files upon upload. Some validation checks
result in the entire file being rejected, other validation checks result in individual records being
rejected. Provider Data Files with more than 3% of rejected records will be rejected in their
entirety. For a list of common data validation checks, please see Table 6.
Table 6: Data Validation Checks
File
Rejection
Common Data Validation Issues
The file header row does not have 27 data elements
The data elements in the header row are not named correctly (see Appendix
B)
The Coverage Plan Name (i.e., Plan Name + Health Plan Name) does not
match the name on the Program/Health Plan Name Validation Page on the
IKN Data Management website
Record
Rejection
Data is not reported in required fields
ZIP code is in the incorrect format
Sate is in the incorrect format
There is an extra pipe delimiter
Data File Submission and Validation Receipt
After a user uploads a file, a system generated email is sent to the email address registered
under the user’s profile to confirm receipt of the submission. The email includes a Data File
Submission and Validation Receipt (referred to hereafter as the submission receipt) as an
attachment. A sample of this receipt is illustrated in Figure 16. The submission receipt indicates
to users that their file was a) accepted with no rejected rows; b) accepted with rejected rows;
or c) rejected. If a file is rejected, the reason for rejection is provided, but individual rejected
rows are not identified. If a file is accepted with rejected rows, the rejected rows are identified
along with the reason(s) for rejection.
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Figure 16: Data File Submission and Validation Receipt
Geophone Report
The email containing the submission receipt also includes links to Geophone reports, which list
data validation process results and help identify potentially invalid data. The IKN data
management team uses a third party subscription-based electronic service called DOTS
Geophone to check the quarterly submission’s data against information available within public
telephone directories. Reports are generated automatically to identify data that may be invalid.
It is important to note that there is a 24-hour delay between receipt of the email submission
receipt and when the Geophone report links are live due to the time required to validate
submitted data.
The Geophone report is provided as an added service to states to help identify specific lines of
data, which may be invalid, without the expense of extensive manual checks. The validation
process checks every line of data submitted in a single data submission file against their
certified data and categorizes the phone numbers based on the business rules outlined in the
summary tab of the report. However, there may be instances when data flagged as suspect by
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Geophone is in fact correct. If states find upon investigation that data flagged as suspect was in
fact correct as originally submitted, then no further action is required. The intent of the report
is not to categorically declare that certain data is good or bad, but rather to serve as a tool to
assist states in conducting quality control checks on their data.
The following validation rules are used to categorize data in Geophone reports:
Green: The phone number is good, the name matches on provider name, group name,
or facility, and the address.
Blue: a) Name does not match. b) Street address, city, state, and zip all match.
Yellow: Neutral. Geophone has no data.
Orange: a) Name does not match. b) Street address, city, state, or zip matches.
Red: a) The phone number is invalid and the line of data is rejected or b) No name or
geographical information.
A Geophone report is associated with a single data submission file. The report includes two
tabs, a summary tab and a raw results tab:
Summary: The summary tab (shown in Figure 17) includes a breakdown of how all data
rows, for both good and suspect data, were categorized as well as the rules used to
categorize the data. Data categorized as blue or green is considered to have a high
probability of being able to connect a Medicaid or CHIP family to a specific dental
provider. Data categorized as orange or red is considered to have a high probability of
being invalid (i.e., unable to connect a Medicaid or CHIP family to a dental provider).
Data categorized as yellow is data which cannot be verified (i.e., Geophone has no data
against which to validate state data or the numbers were unlisted).
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Figure 17: Geophone Report: Summary Tab
Raw Results: The raw results tab (shown in Figure 18) includes data submitted by the
state and data supplied by Geophone. Data to the left of the black dividing line is the
data submitted by the state, while data to the right is the Geophone data against which
the state data was compared. The raw results tab does not include data verified as good
data. This tab only includes data rows for suspect data (i.e., color rated as orange or
red).
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Figure 18: Geophone Report: Raw Results
Once users have reviewed the Geophone report, they have the option of either correcting
suspect data and resubmitting the file or using the online editing feature in the IKN Data
Management website to correct the data. If the user chooses not to correct the data, the same
potential errors will be reported with each submission. Data in the raw results tab is not
unique. If the Geophone data contained more than one provider name for a phone number, it
would report each line of the Geophone data with each provider the state submitted for that
phone number.
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Provider Duplicates
If the validation process determines that more than 5% of the file content is duplicate data,
then the file will be rejected. Duplicates are individual rows containing exactly the same
content in all columns, including the same spacing. If duplicate content exists but is less than
5% of the file content, the file will be accepted, but duplicate records will be displayed as a
single row of data in the IKN Dentist Locator tool. If the whole file is rejected because the 5%
limit is exceeded, the duplicate rows should be corrected or removed and the file resubmitted
in order to be accepted.
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7 Updating the Summary of Benefits
State Administrators must update the description of dental benefits, or summary of benefits, at
least once every year through the ‘Summary of Benefits’ feature. If a state’s dental benefits
have not changed, to meet the annual update requirement the state must still log on and click
‘Submit’ on the ‘Summary of Benefits’ form (see below for details). This action will register as
an update. The annual update deadline for a given state is set to a date one year after the
state’s most recent Summary of Benefits update.
States that have separate CHIP programs will need to submit two summaries: one for Medicaid
and one for CHIP. States that have implemented their CHIP program entirely as a Medicaid
expansion will need to submit only one summary, the one for Medicaid, as the CHIP dental
benefits will be identical to the Medicaid dental benefits.
Medicaid dental benefits and CHIP dental benefits (if applicable) are recorded on two separate
web forms. A State Administrator should be presented with links to the appropriate form(s) for
their state on the landing page of the ‘Summary of Benefits’ feature.
The 'Summary of Benefits' feature is accessed by selecting the ‘Summary of Benefits’ menu
option on the IKN Data Management website home page. To update the summary of benefits
information for their state, State Administrators must select the program for which they are
updating benefits as shown in Figure 19.
Figure 19: Summary of Benefits Feature (Landing Page)
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After selecting the program for which they wish to update the summary of benefits, State
Administrators can update the benefits provided using the form pictured in Figure 20. The form
is pre-populated with the information submitted from the previous year, so states only need to
input any changes to their benefits and click ‘Submit.’ Once submitted, this data is published on
www.insurekidsnow.gov as ‘Description of Dental Benefits,’ and available through links to noneditable (i.e., pdf) reports under each state. These reports are dynamically generated based on
the data entered by the State Administrators in the Summary of Benefits feature of the IKN
Data Management website.
State Administrators will be expected to provide the following content on the summary of
benefits form:
Whether or not the services listed on the form are covered under the selected program
Whether or not specific services are available only with prior authorization
The frequency at which beneficiaries are entitled to receive the specified services (for
example, twice a year)
Service specific limitations (for example, age limits, cost thresholds, etc.)
Any specific criteria for coverage
Figure 20: Summary of Benefits Feature (Benefits Form)
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State Administrators will receive automated email reminders prior to the submission deadline
at the following intervals:
90 days before the submission deadline
60 days before the submission deadline
30 days before the submission deadline
2 weeks before the submission deadline
One day before the submission deadline
Day of the submission deadline
Once the summary of benefits information has been submitted for the specified program, the
State Administrator will stop receiving email reminders until the next year’s submission cycle.
If a State Administrator fails to either update or verify the summary of benefits information for
two years in a row, the summary of benefits information will be deleted from the system. If this
information is deleted, a State Administrator will need to fill out a blank summary of benefits
form.
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Appendix A: Entry of Group Practice and Federally Qualified
Health Centers Provider Data
Many Federally Qualified Health Centers (FQHC) provide dental services through contracts with
local private practices. Some contracted oral health providers supplying these services may not
want their practice information listed on IKN. If the billing is done through the FQHC’s National
Provider Identifier (NPI), the user does not have to provide the names and addresses of
individual oral health providers that are seeing clients through contracts with FQHCs. Instead,
when providing information for FQHCs, the user should separately list the addresses of all clinic
locations that provide oral health services. For entries identified as an FQHC, IKN will only list
the facility name, address, and phone number but not the provider's name.
If the data include group practices, please identify each member of the practice with the
applicable NPI, if possible. If providers who are members of a group practice do not wish to
have their individual names listed on the website, the user may submit one record for each
location where members of a group practice see patients, using only the group practice name
for the listing. The user should include a unique identifier for these practices just as they would
when identifying an FQHC. As with FQHCs, this identifier should NOT be the NPI for an
individual.
Do not put group practice or facility names in the columns reserved for names of individuals.
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Appendix B: Text Data File Submission Fields and Information
Table 7: Text Data File Submission Fields and Information
Data Element Name
Description
Required
Comments
Test / Validation Plan
Provider_ID
Unique
Provider
Identifier
Required
Must be unique to a provider in your state.
Test for length.
Test for non-numeric characters which is
possible if the ID is not the NPI.
Test for duplication (i.e., does a given
number appear in conjunction with
multiple names? The number should be
unique as a combination of Provider,
“Coverage Plan” and Service Location.)
Format: Does the data conform to the
format for an NPI?
(See http://www.cms.hhs.gov/NationalPr
ovIdentStand/Downloads/npifinalrule.pdf
). Failure to meet this standard triggers a
manual scrutiny of the data.
Column name must be present in file
header.
For individual providers, the National Provider
Identifier (NPI) is preferred, but IKN will accept an
alternate (e.g., State Medicaid Provider ID) as long
as it is used for ALL submitted files from your state
and any contractor organizations.
For group practices and health centers, please
include an alternate ID that uniquely identifies the
practice or facility.
IKN will not display this data element, but it may be
used for “behind-the-scenes” activities such as data
cleansing and statistics.
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Prov_Aff
Provider
Affiliation
Optional
Select one or more of the two-letter codes from the
following list:
Validate against the list of accepted values
provided in the Comments column.
PP = Private Practice
Codes are preferred to text.
CHC = Community Health Center
Use as many values as apply to the
specific location.
The list of accepted values is likely to
change over time.
Column name must be present in file
header.
Data may be blank on individual data
lines.
If present, Last_Nm must also contain a
value.
No numbers or punctuation except
hyphens.
Column name must be present in file
header.
Data may be blank on individual data
lines.
FQHC = Federally Qualified Health Center
HD = Health Department
OTH = Other
NOTE: Use a comma (,) to separate multiple entries
First_Nm
Provider First
Name
Required, if
applicable
(Must be
present in
file header;
may be
blank on
individual
data lines)
September 2017
Refer to Group Practice / FQHC exception specified
in Appendix A.
Please do not enter special symbols or middle name
for this field.
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Middle_Nm
Provider
Middle Name
Optional
Refer to Group Practice / FQHC exception specified
in Appendix A.
No numbers or punctuation except
hyphens and periods for initials.
Column name must be present in file
header.
Data may be blank on individual data
lines.
If present, First_Nm must also contain a
value.
If missing, either Grp_Prac_Nm or Fac_Nm
must have a value.
No numbers
No punctuation except for comma,
apostrophe, period, or hyphen.
If commas or periods are present, must
contain “Jr.”, “Sr.”, etc.
No credentials (e.g., “DDS”, “MD”, etc.)
No group practice names or facility
names.
Column name must be present in file
header.
Data may be blank on individual data
lines.
Last_Nm
Provider Last
Name
Required, if
applicable
Refer to Group Practice / FQHC exception specified
in Appendix A.
(Must be
present in
file header;
may be
blank on
individual
data lines)
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Grp_Prac_Nm
Group Practice
Name
Required, if
applicable
Only if applicable.
No facility names.
If blank/empty, either individual name or
facility name must have a value.
Column name must be present in file
header
Data may be blank on individual data
lines.
Double quotes and special characters like
‘/’, ‘\’, ‘;’ are not allowed.
No group practice names.
If blank/empty, either individual name or
group practice name must have a value.
Column name must be present in file
header.
Data may be blank on individual data
lines.
Double Quotes and special characters like
‘/’, ‘\’, ‘;’ are not allowed.
(Must be
present in
file header;
may be
blank on
individual
data lines)
Fac_Nm
Facility Name
Required, if
applicable
Applies in cases where the practice location is
associated with or contained in a facility such as a
hospital, school, or community health center.
(Must be
present in
file header;
may be
blank on
individual
data lines)
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Lang_Spoken
Languages
Spoken
Optional
Only enter languages other than English that are
spoken at the facility. A blank entry indicates that
only English is spoken.
Will be standardized to match the list.
Must use commas as the delimiter. No
other punctuation will be recognized as a
delimiter.
NOTE: Use a comma (,) to separate multiple entries.
No numbers.
“All” and “Other” will be removed.
Special instructions (e.g. “Translator
required” may be removed.)
Column name must be present in file
header
Data may be blank on individual data
lines.
All submitted values will be standardized
to match the list.
Must use commas as the delimiter. No
other punctuation will be recognized as a
delimiter.
Specialties not in the list will be stripped
from the content.
Column name must be present in file
header.
Specialty
Provider
Specialty
Required
Select one or more from the following list:
Endodontics
General Dentistry
Oral and Maxillofacial Surgery
Orthodontics and Dentofacial Orthopedics
Pediatric Dentistry
NOTE: Use a comma (,) to separate multiple entries.
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Website
Website
address of
provider
Optional
Provider’s website, if any.
Column name must be present in file
header.
Data may be blank on individual data
lines.
If not null, validate the applicability of the
result page against dentistry (i.e., dds,
dentist, dental, chip, medicaid, kids,
health, smile, orthodontic, pediatric, oral,
dentistry, llc, orthopedics, maxillofacial,
dentofacial, periodontics, and
prosthodontics.)
Column name must be present in file
header.
Must be CHIP, Medicaid, or Both.
“Both” can be used when a given listing
would be identical in all other respects
(including Program Name and Health Plan
Name), to eliminate duplication.
Sites will be checked to ensure the url is associated
with a functioning site and that the site includes
content related to dentistry.
Program_Type
September 2017
Type of
Program
Required
Select from:
CHIP (i.e., CHIP Standalone/Separate)
Medicaid (i.e., Medicaid or Medicaid Expansion)
Both
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Program_Name
Name of
Program
Required
The name by which a Medicaid or CHIP program is
known to beneficiaries (e.g., TennCare, Kids First,
Medicaid, CHIP, etc.) This is the “brand name” that
beneficiaries would see on their membership card.
When used in combination with the
Health_Plan_Name, this uniquely identifies a
specific Coverage Plan in which beneficiaries might
be enrolled. The Program Name plus Health Plan
Name combined is the Coverage Plan which families
use to search for providers on the public IKN
Website.
Validate quarterly data submissions
against Program and Health Plan name
combinations identified on
“Program/Health Plan Name Validation”
page in IKN Data Management Website.
Column name must be present in file
header.
Avoid using the same name for both the
Program Name and the Health Plan Name.
(Must be
present in
file header;
may be
blank on
individual
data lines)
Avoid using the same value for both Program Name
and Health Plan Name. For example, filling each
value with “Medicaid” would result in a listing
labeled “Medicaid Medicaid”.
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Health_Plan_Name
Name of entity
providing
coverage
Required, if
applicable
The name of a Health Plan, if any, that is operated
under the program listed in Program_Name. This is
the second part of the “brand name”. When used in
combination with the Program_Name, this uniquely
identifies a specific Coverage Plan in which
beneficiaries might be enrolled. The Program Name
plus Health Plan Name combined is the Coverage
Plan which families use to search for providers on
the public IKN Website.
Validate quarterly data submissions
against Program and Health Plan name
combinations identified on
“Program/Health Plan Name Validation”
page in IKN Data Management Website.
Column name must be present in file
header
Data may be blank on individual data
lines.
Avoid using the same name for both the
Program Name and the Health Plan Name.
Physical location (i.e., street address) where services
are provided. Please include Floor Number and
Room Number, where applicable.
Should be the actual practice location, not
a billing office.
(Must be
present in
file header;
may be
blank on
individual
data lines)
Avoid using the same value for both Program Name
and Health Plan Name. For example, filling each
value with “Medicaid” would result in a listing
labeled “Medicaid Medicaid”.
Must match Health Plan name listed on
“Program/Health Plan Name Validation” on IKN
Data Management Website to prevent duplication.
Phy_Street_Addr
Provider
Physical Site
Street Address
Required
Mailing addresses such as P.O. Box or Rural Route
information will be rejected. This information will
be used to display the practice location on a map,
and to provide routing instructions to patients.
Mailing addresses such as P.O. boxes or rural route
numbers cannot be used for this purpose.
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Will be standardized using bulk mailing
support software and data.
P.O. Box/Drawer will be rejected.
Column name must be present in file
header.
Provider Data Submission Technical Information
Insure Kids Now
Data Element Name
Description
Required
Comments
Test / Validation Plan
City
Provider City
Required
City or town in which the provider/practice is
located.
U.S. addresses will be standardized using
bulk mailing support software and data
(e.g. “Balto” would be replaced with
“Baltimore” for an address in Baltimore,
MD.)
Must agree with the indicated State and
ZIP code.
Must not contain state abbreviation as
part of the city name.
Column name must be present in file
header.
Must be a valid two-character USPS state
or territory postal abbreviation, or a
standard Canadian provincial
abbreviation.
Column name must be present in file
header.
State_Abbr
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Provider State
Required
Two character postal abbreviation.
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Data Element Name
Description
Required
Comments
Test / Validation Plan
ZIP
Provider ZIP
Code
Required
99999-9999 (last four digits optional) for U.S.
addresses
Column name must be present in file
header.
Where the State_Abbr is in the U.S. or its
territories, or where it is NULL:
(see NOTE
following
table)
(Must be
present in
file header;
may be
blank on
individual
data lines)
or
Only numeric characters and,
optionally, a hyphen between the
fifth and sixth digits if the total length
is more than 5 characters.
o
After any non-numeric characters
have been removed, value must be
exactly five or exactly nine characters
in length.
o
Six character input (i.e., five digits and
a trailing hyphen) are acceptable. The
hyphen will be removed during
processing.
o
Will be standardized using bulk
mailing support software and data.
Letter-number-letter number-letter-number for
Canadian Postal Codes (e.g., X0X 0X0)
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Where the State_Abbr is a Canadian
Province:
o
Must be 6 alphanumeric characters,
optionally separated into two groups
of three characters with a space.
o
Must be in the proper format for, and
meet the validation rules for,
Canadian Postal Codes
(see http://www.infinitegravity.ca/po
stalcodeformat.htm for a description
of the format and validation.)
Provider Data Submission Technical Information
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Data Element Name
Description
Required
Phone_Num
Phone Number Required
Comments
Test / Validation Plan
999-999-9999 x999 (extension optional)
Contains only digits and, optionally,
standard telephone number punctuation/
formatting.
Phone number must be in service.
Minimum of ten digit-only characters
after all non-numeric characters have
been removed.
Inputs whose length exceeds ten
characters after non-numeric characters
have been removed will display any
remaining digits as extensions.
Valid with geophone system, otherwise,
feedback to data owner.
Column name must be present in file
header.
Contains only digits and, optionally,
standard telephone number punctuation/
formatting.
Minimum of ten digit-only characters
after all non-numeric characters have
been removed.
Inputs whose length exceeds ten
characters after non-numeric characters
have been removed will display any
remaining digits as extensions.
Column name must be present in file
header.
Data may be blank on individual data
lines.
Phone number verification will be checked using
geophone system.
FAX_Num
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FAX Number
Optional
999-999-9999 x999 (extension optional)
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Data Element Name
Description
Required
Comments
Test / Validation Plan
New_Patients
Accepts New
Patients
Required
Enter Y, N, or U.
Column name must be present in file
header.
Data cannot be blank on individual data
lines.
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
Column name must be present in file
header.
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
Column name must be present in file
header.
Data may be blank on individual data
lines.
'Y' for active or 'N' for inactive are valid
values.
If not supplied, the assumption is that the
provider is active in the indicated
Coverage Plan at the indicated practice
location. However, 'Y' will not be entered
in the data, so searches that explicitly
include this term will not select records
where the value is blank.
Special_Needs
Can
Accommodate
Special Needs
Required
Enter Y, N, or U.
Note: The data will be displayed along with a
notation that the provider should be contacted for
details in cases where the indicator is 'Y'.
Active_Ind
Active Status
Required
(Must be
present in
file header;
may be
blank on
individual
data lines)
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Enter the provider’s status as of the date of the
update. Use 'Y' to indicate that the provider is
currently active and 'N' if inactive. Only active
providers will be displayed on the national provider
locator website.
Note: If a given provider will remain inactive for the
entire reporting cycle, they do not need to be
included.
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Central_
appointment_line
Central
Appointment
Line
Optional
Enter Y, N, or U.
Column name must be present in file
header.
Use 'Y' to indicate that the phone number is a
centralized billing or appointment line that serves
multiple providers and 'N' if it is not. Use 'U' if it is
unknown.
'Y', 'N', or 'U' are valid values.
Dental License
Number
Optional
Data must be entered as text.
Column name must be present in file
header.
May contain letters and numbers.
No punctuation.
No credentials (i.e., DDS, MD, etc.)
Enter Y, N, or U.
Column name must be present in file
header.
Use 'Y' to indicate that the facility is equipped to
provide dental services for children who have
mobility limitations such as those who use a
wheelchair and 'N' if it is not. Use 'U' if it is
unknown.
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
License_Num
(However,
Must be unique to a specific provider.
states must
submit data
either in this
field OR in
the
Provider_ID
field)
Services_Mobility
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Facility Can
Provide
Services for
Children with
Mobility
Limitations
Optional
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Data Element Name
Description
Required
Comments
Test / Validation Plan
Sedation
Facility Can
Provide
Sedation for
Children with
Complex
Medical or
Behavioral
Conditions
Optional
Enter Y, N, or U.
Column name must be present in file
header.
Use 'Y' to indicate that the facility can provide
sedation if needed by children with complex
medical or behavioral conditions and 'N' if it cannot.
Use 'U' if it is unknown.
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
Enter Y, N, or U.
Column name must be present in file
header.
Use 'Y' to indicate that the facility can provide
services for children who may have difficulty
communicating or cooperating such as those with
autism, mental retardation, or intellectual disability
and 'N' if it cannot. Use 'U' if it is unknown.
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
Services_Intellectual Facility Can
Optional
_Disability
Provide
Services for
Children Who
May Have
Difficulty
Communicatin
g or
Cooperating
Such as Those
with Autism,
Mental
Retardation, or
Intellectual
Disability
NOTE: The purpose of these data is to help beneficiaries (prospective patients) locate dental health care providers that accept the beneficiaries’ coverage. It is
important to know where the provider practices in order to do so, and a means for the beneficiary to contact the provider to obtain more information.
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APPENDIX C: Configuring the Insure Kids Now Data Submission
Client Tool
Starting March 6, 2015, a new version of the Insure Kids Now Data Submission Client Tool will be
available at https://ikndata.insurekidsnow.gov/clienttool/. Users of the client tool must install the
updated version of the IKN Data Submission Client Tool to continue accessing the features of the tool.
The new tool connects to a new Microsoft Windows Communications Foundation (WCF) file upload
service via Secure Sockets Layer (SSL). It removed the field for Program from the client tool interface as
this information is now retrieved through the submitted file.
This section of the documents provides instructions about installing and configuring the tool in
addition to using it to upload data.
This appendix describes the Windows-compatible data upload client tool1 available
at https://ikndata.insurekidsnow.gov/clienttool/. The tool has a simple configuration interface that
collects the user ID, password, location and name of the file to upload. It uses that information to
establish the connection to the service and upload the designated file.
The following notes describe unique requirements for the IKN Data Submission Client Tool:
1. Once the tool has been configured, the tool may be used to either manually select and upload a
file, or set it on a schedule to run automatically. The tool does not automatically schedule itself
to run.
2. Each user ID (username) is associated with only one state. If the user prepares data for several
states (for example, if the user is part of a managed care organization contracted to several
states), the user must have a separate ID for each state for which they are submitting data.
Data cannot be submitted for one state using an ID associated with another state
The tool comes pre-configured with the information needed to connect to the IKN data receiver
service. Do not change this part of the configuration in any way. Before installing this version, you
must uninstall any existing IKN Client Tool version on your computer, or you will encounter fatal
installation error. To uninstall, go to Add or Remove Programs group in the Control Panel and uninstall
IKN Data Uploader.
To obtain and install the tool:
1.
2.
3.
4.
Go to https://ikndata.insurekidsnow.gov/clienttool/.
Click to download the Client Tool.
Choose Save as to save the .zip file to local drive.
Unzip and Install
1
At this time, the IKN Client Tool has been developed using the Microsoft .NET platform. If the user’s organization uses
something other than Windows, they will not be able to use this version of the tool.
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C.1
Configuring the IKN Client Tool (First Time Use)
1. Open the IKN Client Tool by choosing [Insure Kids Now -> IKN Data Submission Client] from the
Start -> Programs menu. Figure 21 shows the IKN Data Uploader Configuration window that is
displayed.
Figure 21: IKN Data Uploader Configuration Window
2. On the IKN Data Uploader Configuration window, set the initial user ID in the username field,
and password information to be used for submissions. The user name and password must
match the user name and password used to access the IKN Data Management website
(https://ikndata.insurekidsnow.gov/WebExternal/Login.aspx). The step of setting the ID and
password in the tool does not need to be repeated unless the user needs to update or change
this information.
Select the state for the provider list to be uploaded.
3. Indicate the file to be uploaded by clicking “Browse” and navigating to the folder that contains
the file. Then select the file to upload. The tool enforces the following restrictions:
a. The upload file must already exist. The tool will not allow the user to enter the name of
a non-existent file.
b. The tool only allows text files with names ending in .TXT.
c. The tool will use the same folder and file name for each upload, unless the user changes
the setting prior to uploading.
4. Click the “Save Configuration Settings” button to save the settings. The user can now use the
IKN Client Tool to submit data. Alternatively, click the "Cancel" button to close the
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configuration form without saving any changes. Note: The tool will not upload data until all
configuration settings are supplied. In addition, the IKN Client Tool does not require
configuration changes from one upload to the next unless the user needs to change one or
more of the pieces of information entered in the steps outlined above.
5. The IKN Data Submission Client Configuration window closes, and the IKN Data File Uploader
window is displayed. The IKN Data File Uploader window is shown in Figure 22.
Figure 22: IKN Data File Uploader Window
C.2
Manually Submitting a File
User may also submit files manually using the IKN Client Tool. Users would use the following steps to
manually submit a file.
1. If it is not already open, open the IKN Client Tool by choosing Shortcut for IKN Data Submission
Client from the Start menu; alternatively click StartAll ProgramsCMS IKN Data
Submission Client. The IKN Data File Uploader window is displayed.
2. The previously-saved State information is displayed, along with the name of the file to be
uploaded. You can change this information here, but the changes are not saved permanently to
the tool’s configuration settings. To make the changes permanent, use the “Settings” option on
the tool’s menu to re-open the IKN Data Uploader Configuration window.
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3. Select a file to upload, if the user plans to upload something other than the already-specified
file. If the file specified is not found, the tool displays an error message as shown in Figure 23.
Figure 23: "File Not Found" Error Message Box
After uploading a file, the tool automatically moves it to a folder named “processedFiles”
underneath the folder where the client tool is installed. The file name is also changed to include
the date and time that it was uploaded. This is a safeguard, intended to help prevent accidental
submission of the same file more than once.
4. On the IKN Data File Uploader window, click the “Upload file” button to send the file. The tool
displays a confirmation dialog, as shown in Figure 24, before actually transmitting the file. The
user must click the "OK" button in the Confirmation Dialog box in order for the file to be
uploaded. If the user wishes to stop the upload, then the user should select the "Cancel" button
in the Confirmation Dialog Box.
Figure 24: Confirmation Dialog Box Displayed Before an Upload
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5. When the upload is completed, the tool will display a message like the one shown on the status
line of the IKN Data File Uploader window (Figure 25).
Figure 25: IKN Data File Uploader Window with Successful Upload Message
6. If the user is submitting more than one file (e.g., one file for each program or for a collection of
health plans), repeat Steps 3 through 5 for each file being submitted.
7. When the user is finished, close the tool by clicking on the "Exit" button.
The IKN Data Submission Client Tool will not work if a user's username, password, state, is incorrect in
the IKN Upload Tool's system user data. The username and password must match the username and
password used to access the IKN Data Management website
(https://ikndata.insurekidsnow.gov/WebExternal/Login.aspx). If the entered username or password
does not match what is on file in the upload system user data, the IKN Client Tool displays an Error
window, which notes that authentication failed. This Error window is shown in Figure 26.
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Figure 26: Error Window for Invalid Username or Password
Similarly, if the state and username do not match the registration information, the IKN Client Tool
displays an Error window, which indicates the user does not have privileges to upload files for the
selected state. This Error window is shown in Figure 27.
Figure 27: Error Window for Invalid State
Use the “Settings” option on the IKN Data File Uploader window to open the IKN Data Uploader
Configuration window, verify that the user has the correct information saved, and re-try the
submission.
C.3
Submitting a File Automatically
Users may also configure the Windows Scheduler to automatically submit a file by using the following
steps.
1. Create the file, ensuring that the name and location of the file match what is already stored in
the IKN Client Tool configuration information.
2. Open the Windows Scheduler by clicking Start -Control Panel Administrative Tools Task
Scheduler. Right click “Task Scheduler Library” and Click on Create Task.
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Figure 28: Schedule Task Wizard - Starting Screen
Under General tab, enter a name for the task. "IKN Data Submission Client" is the suggested
name. In the Security options section, the job is defaulted to run under the windows login user. If
selecting Run whether user is logged on or not, consult with the organization’s network
administrators for further guidance.
3. Under Triggers tab, click on the “New” button to open up New Trigger window. Choose the
scheduling option that corresponds to the intended data generation and submission frequency.
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Figure 29: New Trigger Window
4. Set the time the data should be submitted and select whether the task will be performed every
day, only on week days, or on every specified day (e.g. every 3 days). Click OK to close.
5. Under Actions tab, click the “New” button. Click Browse and navigate to the folder C:\Program
Files (x86)\CMS\IKN Data Uploader\. Click IKNClient.exe file to choose this program. Enter
“yes” in “Add arguments (Option):” to indicate the unattended mode. Click OK. Click OK again
to finish. You are done with scheduling a job for client tool.
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Figure 30: Edit Action Window
6. Once the scheduled task is created, an important step is to right click the job to run. This brings
up the IKN – Data File Upload utility Configuration Screen. Follow up the instructions for First
Time Use to save the configuration.
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Figure 31: IKN Data Uploader Configuration Window
7. Repeat Step 6 when IKN user’s password expires every 90 days to reset the configuration for
the IKN client tool.
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APPENDIX D: Technical Reference for Creating a Custom Upload
Client
This appendix provides the technical information needed to design a data submission client tool, if the
user does not want to use the tool described in Appendix C. This is a guide for technical personnel with
at least intermediate computer programming skills and knowledge of Windows Communication
Foundation (i.e., “service oriented architecture”). It is not a teaching tool or a detailed “how-to” guide.
The user must also adjust the pseudo code for the development environment. The information is
provided in C-Sharp/Microsoft .NET format in the examples contained in the following steps.
1. Create the proxy by adding the Web reference to the WCF:
Location of the Web
service: https://IKNData.insurekidsnow.gov/IKNUploadService/UploadFileService.svc
Opening this address with a Web browser will publish the service’s capabilities and service
schema.
2. The service exposes a WCF operation contract, UploadFileWithUserInfo, which takes a
FileRelatedInfo type object, Username, password and System.IO.Stream type object as
parameters, and returns a returnMessage type object as a response.
3. The following pseudo code may be used to construct input parameters, call the WCF method,
and get return messages:
using
using
using
using
using
using
using
using
using
using
System;
System.ComponentModel;
System.Deployment.Application;
System.Xml;
System.Windows.Forms;
IKNClient.Properties;
System.IO;
System.Collections;
System.ServiceModel;
WCFServiceRef;//add and name your own service reference
private string UploadFileMethod()
{
FileRelatedInfo fileUploadInfo = new FileRelatedInfo();
fileUploadInfo.FileName = FileName;
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fileUploadInfo.LastModifiedDate = FileLastWriteTime;
fileUploadInfo.TimeStamp = DateTime.Now;
fileUploadInfo.StateCode = stateCode;
FileUploadMessage inValue = new FileUploadMessage();
inValue.FileInformation = fileUploadInfo;
inValue.Password = GetHash(password);
inValue.UserName = UserName;
inValue.FileByteStream = FileByteStream;
returnMessage retVal = inValue .UploadFileWithUserInfo(inValue);
UserName = retVal.UserName;
FileDetail = retVal.FileDetail;
String[] ErrorList = retVal.ErrorMsgs;
UnexpectedErrorMessage = retVal.UnexpectedErrorMessage;
}
private string GetHash(string source)
{
HashAlgorithm hashProvider = new SHA1Managed();
byte[] bytHash;
byte[] bytIn = Encoding.GetEncoding(1252).GetBytes(source);
bytHash = hashProvider.ComputeHash(bytIn);
string hex = BitConverter.ToString(bytHash);
return hex.Replace("-", "");
}
4. Errors related to individual requests will be communicated back to the calling system using the
following structure:
public partial class returnMessage
{
public string UserName;
public string[] ErrorMsgs;
public IKNUploadService.FileRelatedInfo FileDetail;
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public string UnexpectedErrorMessage;
}
Errors that users should know about are in the ErrorMsgs property. Using the ErrorMsgs, the
client system can retrieve and utilize the error details for display or logging purposes. Table
8contains a list of error messages associated with the IKN Submission schema.
Table 8: Error Codes Associated with the IKN Submission Schema
Error Message
1. User name does not exist in the system.
2. The user account has been disabled or the password has expired.
3. User name and password do not match.
4. User does not have file upload privileges. Please contact the
State Administrator to request file upload privileges. For
additional technical assistance, contact technical support at
[email protected].
5. User is not authorized to upload files for the selected state.
Please contact the State Administrator to request file upload
privileges. For additional technical assistance, contact technical
support at [email protected].
6. User is not authorized to upload files for the selected state.
Please contact the State Administrator to request file upload
privileges. For additional technical assistance, contact technical
support at [email protected].
7. File size exceeds 40MB limit. Please upload a smaller file. For
additional technical assistance, contact technical support
at [email protected].
When the upload is successful, Type returnMessage response object returns no errors in ErrorMsgs
property.
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Provider Data Submission Technical Information
| File Type | application/pdf |
| File Title | Insure Kids Now |
| Subject | Provider Data Submission Technical Information |
| Author | HRSA Contractor |
| File Modified | 2017-10-23 |
| File Created | 2017-10-23 |