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Insure Kids Now
Dental Provider Data Submission Technical Information
Version 3.12
Effective date: December 2023
Centers for Medicare & Medicaid Services (CMS)
Health Resource Services and Administration (HRSA)
Insure Kids Now
Table of Contents
Section
1
Page
Introduction ....................................................................................................................... 1
1.1 Key Concepts and Deadlines .......................................................................................................... 1
1.2 Technical Assistance Resources ..................................................................................................... 3
2
1.3 IKN Security Policy ........................................................................................................................ 3
Getting Started with the IKN Data Management Website ..................................................... 3
2.1 Log in and Registration Page .......................................................................................................... 4
2.2 Managing Organization Information ............................................................................................... 6
2.2.1
Add New Organization Feature ................................................................................ 6
2.2.2
Remove Organization Feature.................................................................................. 7
2.2.3
Manage Organizational Profile Feature ...................................................................... 8
2.3 Managing Individual User Information..........................................................................................10
3
2.3.1
View/Update Profile ............................................................................................................... 11
2.3.2
Manage Password .................................................................................................................. 11
2.3.3
Manage Registered Organizations............................................................................................. 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
3.3.1 Text File ...................................................................................................................................... 16
3.3.2 Microsoft Excel Workbook ............................................................................................................ 17
4.
3.4 Excluded Providers ......................................................................................................................17
Strategies for Submitting The Provider Data File ................................................................. 18
4.1 Upload to IKN Data Management Website ...................................................................................18
5.
4.2 Edit Provider Data Feature ..........................................................................................................19
Editing Coverage Plan Names and Removing Duplicates ..................................................... 20
5.1 Key Definitions............................................................................................................................20
5.2 Program/Health Plan Name Validation .........................................................................................20
5.3 Manage Existing Data ..................................................................................................................23
6.
5.4 Certify Provider Data Feature .......................................................................................................24
Data Validation ................................................................................................................ 25
6.1 Data File Submission and Validation Receipt .................................................................................25
6.2 Geophone Report........................................................................................................................26
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6.3 Provider Duplicates .....................................................................................................................30
7. Updating the Summary of Benefits .................................................................................... 30
Appendix A: Entry of Group Practice and Federally Qualified Health Centers Provider Data ....... 33
Appendix B: Text Data File Submission Fields and Information .................................................. 34
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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: View/Update Profile Feature ........................................................................................................ 11
Figure 7: Manage Password Feature ........................................................................................................... 12
Figure 8: My Registered Organizations ........................................................................................................ 13
Figure 9: Example of Provider Data Text File ................................................................................................ 16
Figure 10: Example of Provider Data Microsoft Excel Workbook..................................................................... 17
Figure 11: Upload Provider Data Feature..................................................................................................... 18
Figure 12: Edit Provider Data Feature ......................................................................................................... 19
Figure 13: Delete Health Plan Feature ......................................................................................................... 24
Figure 14: Certify Provider Data Feature ..................................................................................................... 24
Figure 15: Data File Submission and Validation Receipt ................................................................................ 26
Figure 16: Geophone Report: Summary Tab................................................................................................. 28
Figure 17: Geophone Report: Raw Results ................................................................................................... 29
Figure 18: Summary of Benefits Feature (Landing Page) ................................................................................ 31
Figure 19: Summary of Benefits Feature (Benefits Form) ............................................................................... 32
List of Tables
Page
Table1: Significant Change History ................................................................................................................ IV
Table 2: System Roles .................................................................................................................................. 3
Table 3: List of Data Fields ...........................................................................................................................15
Table4: Sample Program Name/Health Plan Name Combinations on Validation Page ........................................ 21
Table5: Sample Data File Content and Outcomes........................................................................................... 22
Table 6: Data Validation Checks ................................................................................................................... 25
Table7: Text Data File Submission Fields and Information ............................................................................... 35
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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
3.12
December
2023
• Updated content about submitting the Summary of Benefits.
3.11
June 2023
• Added content about how to remove programs from IKN.
3.9
December
2020
• Added content about new file format accepted for data submissions.
3.8
December
2020
• Added content about excluding dental providers.
• Updated Figure 12
3.7
November
2019
3.6
September
2019
• Removed the System Role content that is specific to the Upload Admin
role – manage organization user permissions were removed.
• Removed the Manage Organization Users section.
• Removed content that recommends users to contact their State
Administrators regarding account issues.
• Updated Figures and text to reflect the new re-designed website.
3.5
November
2017
• Removed content referencing the IKN Client Submission Tool
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.
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3.2
May 2016
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• 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.
3.1
December 2023
July 10, 2015
• New services added to summary of benefits template.
• Added information about duplicated content rejection rules
under data validation section.
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Version
Date
Change Description
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.
• 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 May2012.
2.5
December 2023
February 09,
2011
• Removed the business rule that allows multiple Specialty entries
only when Group Name is provided.
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Version
Date
Change Description
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% to 3% error tolerance.
• Changed the Specialty list and business rule to allow
multiple Specialty entries only when Group Name is
provided.
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Version
Date
Change Description
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.
• 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 titlepage.
• 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
October 10,
numbered)
2009 (still
dated
October 1,
2009)
(not
numbered)
October 1,
2009
• Removed reference to data submission option 3 (links toother
website) being obsolete after 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.
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Version
Date
Change Description
• 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.
• Re-ordered the items in the data submission format in
Appendix B.
(not
numbered)
December 2019
July 16, 2009
• Original version
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Provider Data Submission Technical Information
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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.
1.1 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
Dental Provider Data: As a reminder, states are required under 42 CFR 455.436 to determine the
exclusion status of providers through routine checks of Federal databases, such as the List of
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Excluded Individuals/Entities (LEIE). Excluded providers should not appear in dental provider lists
that are submitted to IKN. If a provider is added to the LEIE or another applicable database, states
should edit their IKN provider lists to remove these providers as soon as possible, no later than by
the next quarterly submission. Contact [email protected] for assistance.
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1.2 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.
•
Akria Technologies ([email protected]): Akria Technologies can support
states to improve the quality of their data and trouble-shoot issues with the Provider
Data File. In addition, Akria Technologies can help states identify effective data
collection strategies.
1.3 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 60 days of
continuous inactivity. To avoid your account being disabled, it is recommended that users log
into the system at least once within each 60 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 submitting a request
to the IKN Technical Mailbox at [email protected].
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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 + HealthPlan 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)
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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
• Submit Data
•
Submit Data
Provider Data Submission Technical Information
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2.1 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 anew user has registered to an
organization, the IKN technical help staff must assign them the appropriate privileges after
written approval to assign upload privileges for their state is received from the State
Administrator.
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 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 navigation bar or quick links on this home page to
navigate through the site.
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Figure 2: IKN Data Management Website Home Page
2.2 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, or manage an existing organization
profile.
2.2.1 Add New Organization Feature
The State Administrator may create a new organization fora 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 navigation bar 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
navigation bar 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 navigation bar on the
IKN Data Management website homepage. The 'Manage Organization Profile' page is shown in
Figure 5.
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Figure 5: Manage Organization Profile Feature
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2.3 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 navigation bar on the IKN Data Management website home
page. The 'View/Update Profile' page is depicted in Figure 6.
Figure 6: 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 navigation bar on the IKN Data Management website home page. The 'Manage
Password' page is depicted in Figure 7. 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.
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Users must create and use passwords consisting of at least fifteen (15) 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
(0- 9), and at least one special character (e.g. @, !, $, %). Users are required to change their
passwords every 60 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 7: 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 navigation bar on the IKN Data Management website
home page. The 'My Registered Organizations' page is depicted in Figure 8.
Figure 8: 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 foreach Coverage Plan the state offers). Each file is required to be clearly identified.
3.1 What Constitutes a Provider Record
Each record in the Provider Data File should be a unique combination of:
a. 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.
b. 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 HealthPlan 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.
c. 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:
d. 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.
e. 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.
f. 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.
g. 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.
h. 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 foreach
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.
i. 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.
3.2 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 7 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
Fac_Nm
Group Practice Name
Facility Name
Required, if applicable
Required, if applicable
Lang_Spoken
Languages Spoken
Optional
Specialty
Website
Provider Specialty
Website address of provider
Required
Optional
Program_Type
Type of Program
Required
Program_Name
Name of Program
Required
Health_Plan_Name
Phy_Street_Addr
Name of entity providing coverage
Provider Physical Site Street Address
Required, if applicable
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
Special_Needs
Accepts New Patients
Can Accommodate Special Needs
Required
Required
Active_Ind
Central_ appointment_line
Active Status
Central Appointment Line
Required
Optional
License_Num
Dental License Number
Optional
Facility Can ProvideServices forChildren with Mobility
Optional
Limitations
Facility Can ProvideSedation for Childrenwith
Optional
Complex Medicalor Behavioral Conditions
Services_Mobility
Sedation
Facility Can ProvideServicesforChildren Who May
Have Difficulty Communicating or Cooperating
Services_Intellectual_Disability
Such asThose with Autism, MentalRetardation,or
Intellectual Disability
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 overtime), 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.
3.3 File Structure
Provider data is accepted in two formats: Text (pipe delimited) (*.txt) and Microsoft Excel
Workbook (*.xlsx).
3.3.1 Text File
If the Provider Data is in a text file, each data value should be vertical pipe ( | ) delimited. (The
pipe symbol separates the fields.), as shown in Figure 9.
Figure 9: Example of Provider Data Text File
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 9 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
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these data elements. 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|…).
3.3.2 Microsoft Excel Workbook
If the Provider Data is in a Microsoft Excel workbook, each data value should display in its
respective data cell that coordinates with the column header, as shown in Figure 10.
Figure 10: Example of Provider Data Microsoft Excel Workbook
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, the data cells should be empty. Figure 10
shows the first few data records in a data file. Note that some data elements are optional. An
entry may remain blank if there is no content for these data elements.
3.4 Excluded Providers
As a reminder, states are required under 42 CFR 455.436 to determine the exclusion status of
providers through routine checks of Federal databases, such as the List of Excluded
Individuals/Entities (LEIE). Excluded providers should not appear in dental provider lists that are
submitted to IKN. If a provider is added to the LEIE or another applicable database, states should
edit their IKN provider lists to remove these providers as soon as possible, no later than by the
next quarterly submission. Contact [email protected] for assistance.
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4. Strategies for Submitting The Provider Data File
Two 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
(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.
4.1 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’ from the quick links 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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4.2 Edit Provider Data Feature
Users also have the option of editing existing data directly by selecting the ‘Edit Provider
the quick links on the IKN Data Management website home page, 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
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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.
5.1 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.
•
5.2 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 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.
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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 + HealthPlan Name = Coverage Plan Name (website display name)
Table 4 represents the Program Type, Program Name, and HealthPlan 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
(Program_Name)
Health Plan Name
(Health_Plan_Name)
Coverage Plan Name (Website display
name)
Medicaid
Healthy Kids
Aetna
Healthy Kids Aetna
Medicaid
Medicaid
CHIP
Healthy Smiles
Delta Dental
Healthy Smiles Delta Dental
Both
Healthy Smiles
Health Net
Healthy Smiles Health Net
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
(Program_Name)
Medicaid Healthy Kids
Health Plan Name
(Health_Plan_Name)
Rows
Accepted/Rejected
Reason for rejection
Aetna
Accepted
N/A
Accepted
N/A
Medicaid Medicaid
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
(Program_Name)
Health Plan Name
(Health_Plan_Name)
Rows
Accepted/Rejected
Reason for rejection
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.
5.3 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 automatically replace the data listed in this table. If a State
Administrator wishes to delete a Health Plan (for example, when a Health Plan is no
longer active in the State), they have the option to delete data from this table by
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using the ‘Delete’ feature in the first column, titled ‘Action,’ of Table 2. Upon
clicking the ‘Delete’ icon, the website will prompt the user to confirm their
selections. Any Program/Health Plan name combinations the user selected for
deletion will be removed from the Insure Kids Now website within 24 hours. Figure
13 pictures the 'Delete' feature.
Figure 13: Delete Health Plan Feature
5.4 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 from the navigation bar on the IKN Data Management
website Home Page. Figure 14 pictures the 'Certify Provider Data' feature.
Figure 14: 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. Fora 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 (*only applicable for Text file formats)
6.1 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 15. 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 15: Data File Submission and Validation Receipt
6.2 Geophone Report
The email containing the submission receipt includes instructions for how to retrieve the
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 orb) 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 16) 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 ahigh
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 16: Geophone Report: Summary Tab
•
Raw Results: The raw results tab (shown in Figure 17) 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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Provider Data Submission Technical Information
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Figure 17: 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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6.3 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.
7. Updating the Summary of Benefits
State Administrators must update the description of dental benefits, or summary of benefits by
February 4th every year through the ‘Summary of Benefits’ feature. Only active state upload
administrators have the permission to update the Summary of Benefits information. All
upload administrators must be state employees.
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 every state is February
4th.
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 from the navigation baron 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 18.
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Figure 18: Summary of Benefits Feature (Landing Page)
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 19. The form
is pre-populated based on the last update, if the update was made within the last 24
months, 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 non- editable (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
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Figure 19: Summary of Benefits Feature (Benefits Form)
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.
Once the submission window has closed, users will not be able to upload their Summary of
Benefits data. If you have questions about filling in this template, adding a new state upload
administrator, or requesting a change in any current user’s permissions, please contact the
IKN Technical Team at [email protected].
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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Provider Data Submission Technical Information
Appendix B: Text Data File Submission Fields and Information
Table 7: Text Data File Submission Fields and Information
Data Element Name Description
Provider_ID
Unique
Provider
Identifier
Required
Comments
Test / Validation Plan
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.)
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.
•
•
Format: Does the data conform to
the format for an NPI? (See
https://www.cms.gov/regulations-andguidance/administrativesimplification/nationalprovidentstand/d
ownloads/npifinalrule.pdf). Failure to
meet this standard triggers a
manual scrutiny of the data.
•
Column name must be present in
file header.
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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Provider Data Submission Technical Information
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 overtime.
•
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)
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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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Provider Data Submission Technical Information
Data Element Name Description
Middle_Nm
Last_Nm
Provider
Middle Name
Provider Last
Name
Required
Comments
Test / Validation Plan
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.
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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•
•
If missing, either
Grp_Prac_Nmor 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.
Provider Data Submission Technical Information
Data Element Name Description
Grp_Prac_Nm
Group Practice
Name
Required
Comments
Test / Validation Plan
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.
(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 a sa
hospital, school, or community health center.
(Must be
present in
file header;
may be
blank on
individual
data lines)
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•
•
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.
Provider Data Submission Technical Information
Data Element Name Description
Lang_Spoken
Specialty
Languages
Spoken
Provider
Specialty
Required
Comments
Test / Validation Plan
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.
Required
Select one or more from the following list:
• Endodontics
•
•
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.
• General Dentistry
• Oral and Maxillofacial Surgery
• Orthodontics and Dentofacial Orthopedics
• Pediatric Dentistry
NOTE: Use a comma (,) to separate multiple entries.
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Provider Data Submission Technical Information
Data Element Name Description
Required
Comments
Test / Validation Plan
Website
Optional
Provider’s website, if any.
•
Column name must be present in file
header.
Sites will be checked to ensure the URL is associated
with a functioning site and that the site includes
content related to dentistry.
•
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.)
Select from:
•
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.
Program_Type
December 2023
Website
address
of
provider
Type of
Program
Required
•
CHIP (i.e., CHIP Standalone/Separate)
•
Medicaid (i.e., Medicaid or Medicaid Expansion)
•
Both
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Provider Data Submission Technical Information
Data Element Name Description
Required
Comments
Test / Validation Plan
Program_Name
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.
Name of
Program
(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”.
December 2023
-42-
Provider Data Submission Technical Information
Data Element Name Description
Health_Plan_Name
Name of entity
providing
coverage
Required
Comments
Test / Validation Plan
Required, if The name of a Health Plan, if any, that is operated
•
applicable 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
(Must be
beneficiaries might be enrolled. The Program Name
present in plus Health Plan Name combined is the Coverage Plan
file header; which families use to search for providers on the
•
may be
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.
blank on
individual
data
lines)
•
Data may be blank on individual
data lines.
•
Avoid using the same name for both the
Program Name and the Health Plan
Name.
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”.
Column name must be present in
file header
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
Physical location (i.e., street address) where services •
are provided. Please include Floor Number and Room
Number, where applicable.
•
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.
December 2023
-43-
Should be the actual practice location,
not a billing office.
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
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.
State_Abbr
Provider State
Required
Two-character postal abbreviation.
•
•
December 2023
-44-
Column name must be present in
file header.
Provider Data Submission Technical Information
Data Element Name Description
Required
Comments
Test / Validation Plan
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:
ZIP
(see
NOTE
following
table)
(Must be
present in
file header;
may be
blank on
individual
data
lines)
or
Letter-number-letter number-letter-number for
Canadian Postal Codes (e.g., X0X 0X0)
•
December 2023
-45-
o
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.
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 Canada Post’s website for a
description of the format and
validation.)
Provider Data Submission Technical Information
Data Element Name Description
Phone_Num
FAX_Num
December 2023
Required
Phone Number Required
FAX Number
Optional
Comments
Test / Validation Plan
999-999-9999x999(extension optional)
•
Phone number must be in service.
Contains only digits and, optionally,
Standard telephone number punctuation/
formatting.
•
Phone number verification will be checked using
geophone system.
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.
999-999-9999x999 (extension optional)
-46-
•
•
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.
Provider Data Submission Technical Information
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.
Enter Y, N, or U.
•
Column name must be present in
file header.
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'.
•
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
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.
•
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
Active_Ind
Can
Accommodate
Special
Needs
Required
Active Status
Required
(Must be
present in
file header;
may be
blank on
individual
data
lines)
December 2023
Note: If a given provider will remain inactive for the
entire reporting cycle, they do not need to be
included.
-46-
Provider Data Submission Technical Information
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.
•
'Y', 'N', or 'U' are valid values.
Dental License
Number
Optional
•
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.
•
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.
Column name must be present in
file header.
•
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
License_Num
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.
Data must be entered as text.
(However,
Must be unique to a specific provider.
states must
submit data
either in this
field OR in
the
Provider_ID
field)
Services_Mobility
December 2023
Facility Can
Provide
Services for
Children
with
Mobility
Limitations
Optional
-46-
Provider Data Submission Technical Information
Data Element Name Description
Required
Comments
Test / Validation Plan
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.
•
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
Services_Intellectual Facility Can
_Disability
Provide
Services for
Children Who
May Have
Optional
•
Column name must be present in file
header.
•
'Y' for yes, 'N' for no, or 'U' for unknown
are valid values.
Sedation
Difficulty
Communicating
or
Cooperating
Such as Those
With Autism,
Mental
Retardation, or
Intellectual
Disability
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.
Enter Y, N, or U.
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.
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.
December 2023
-48-
Provider Data Submission Technical Information
| File Type | application/pdf |
| File Title | Insure Kids Now Technical Guidance_Jun2023_v3.11 |
| Subject | Dental Provider Data Submission Technical Information |
| Author | Insure Kids Now |
| File Modified | 2024-04-25 |
| File Created | 2024-04-25 |