CMS-10636 LOI Group to NPI Matrix Template

Triennial Network Adequacy Review for Medicare Advantage Organizations and 1876 Cost Plans (CMS-10636)

LOI Group to NPI matrix template.xlsx

Three-Year Network Adequacy Review for Medicare Advantage Organizations

OMB: 0938-1346

Document [xlsx]
Download: xlsx | pdf
Medical Group Practice Name National Provider Identifier (NPI) Number Letter of Intent Filename (Group Level)

Instructions:


National Provider Identifier (NPI) Number - individual provider NPIs listed in this column must also be included on the HSD file submission.


Letter of Intent Filename (Group Level) - Letter of Intent Filename must include the group level provider or facility name. For example: H0001_Virginia Hospital Center Arlington Health System.pdf








































































































































































































































































































































































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