SPARCS Frequently Asked Questions (FAQs)

IMPORTANT CONTACT INFORMATION
        SPARCS Administrative Unit - for all SPARCS questions        

Phone: (518) 473-8144 or (800) 638-3808
Fax: (518) 486-3518
E-mail: sparcs@health.state.ny.us		    Commerce Account Management Unit (CAMU) - for Health Commerce Accounts   

Phone: (866) 529-1890
HCS Website: https://commerce.health.state.ny.us
CAMU Help: NYSDOH-Commerce-Help@health.state.ny.us

Categories
Categories Menu Audit/Enforcement Process
Q - # Topic Questions & Answers Posted
AP-001 Enforcement Q: I just received a letter from SPARCS regarding missing data from last year's submissions – what happens now?

A: If the missing data mentioned in the letter is submitted by the following month, then no further actions will be taken. If the data is not received by the following month, and you have not received an exception, we will notify your CEO of possible impending enforcement actions which may include a Statement of Deficiencies (SOD), fines or a Medicaid rate reduction.

 12/22/2008
Categories Menu Contacts
Q - # Topic Questions & Answers Effective
C-001 Contact Q: How can I change my SPARCS Coordinator?

A: There are 3 ways: 1) send an e-mail with your changes to sparcs@health.state.ny.us, or 2) call SPARCS Administrative Unit at (518) 473-8144 or (800) 638-3808, or 3) complete the SPARCS Update Contact Information Form. The forms are available by calling or e-mailing the SPARCS Administrative Unit.

 12/22/2008
C-002 Contact Q: What level of access do SPARCS Coordinators have?

A: SPARCS Coordinators have SPARCS Upload Access, along with permission to view patient level data for their facility. They also have basic HCS account access which allows them to view information on the HCS not restricted by specific program areas.

 12/22/2008
C-003 Contact Q: Can our facility have more than one SPARCS Contact/Coordinator?

A: Each facility can have as many contacts as they wish; however, there is only one SPARCS Coordinator and Backup Coordinator per facility. Any correspondences generated by SPARCS relative to the data collection process will be sent to the Coordinator.

 12/22/2008
C-004 Contact Q: I contract with a vendor to submit files to SPARCS on our behalf – can I list the vendor as my SPARCS Coordinator?

A: While vendors may be listed as "Other" contacts for your facility, they cannot be assigned to either the SPARCS Coordinator or Backup Coordinator role.

 12/22/2008
C-005 Contact Q: How do I get e-mail notifications of SPARCS changes?

A: There are two ways - SPARCS Coordinators automatically receive all electronic and paper correspondences. In addition, any contact we list for your facility may opt to receive e-mails from SPARCS. Just call us to request to be added to our e-mail list. We also distribute information to interested parties via our listserv, SPARCS-L. To subscribe to SPARCS-L, go to SPARCS-L and follow the instructions.

 12/22/2008
Categories Menu Coding Issues
Q - # Topic Questions & Answers Effective
CI-001 NTE01 Q: The Inpatient versus Outpatient Addendum has different information as to what is to be reported in the NTE01?

A: The addenda is correct, the file layout is different for the inpatient and outpatient files.

 12/22/2008
CI-002 Other Diagnosis POA Indicator, Inpatient Addendum Section 5.44 Q: The Inpatient Addendum indicates the HI01-9 should be either a "Y", "N", "U" or "W" and the SPARCS Inpatient Output Data Dictionary indicates the valid codes are "1", "2", or "9". What is correct?

A: The correct values for 837 submission are "Y", "N", "U", "W", "1", or " " (blank).

 12/22/2008
CI-003 QTY Segment (Loop 2300, Claim Quantity), Inpatient Addendum Section 5.51 Q: The QTY segment is for reporting the Covered Days and Non-Covered Days quantities. The SPARCS Inpatient Addendum indicates at least two loops are required – one for Covered and one for Non-Covered. If a claim has no Non-Covered Days, what should I report?

A: The Non-Covered Days QTY segment is not required for claims with zero Non-Covered Days.

 12/22/2008
CI-004 QTY Segment (Loop 2300, Claim Quantity), Inpatient Addendum Section 5.51 Q: The UDS version allowed for Covered and Non-Covered Day quantities to be reported multiple times, once for each payer. Has this changed in the 837?

A: Yes. Covered days are reported only once and apply to the entire claim. The QTY segment can repeat up to 4 times to report Covered, Co-Insured, Life-Time Reserved or Non-Covered days. There is no longer a way to associate Covered and Non-Covered Days for a specific payer.

 12/22/2008
CI-005 E-Codes Q: Are E-Codes required?

A: Yes. E-Codes are required for both inpatient and outpatient submission in the HI segment. (Note: the E must be an Uppercase letter "E" and all digits entered exactly as shown in the ICD-9-CM coding reference.)

 12/22/2008
CI-006 Value Codes Q: Is the value code I entered returned to me on the edit report?

A: Yes. The value code is displayed in the "Value" Column of the edit report.

 12/22/2008
Categories Menu Data Elements
Q - # Topic Questions & Answers Effective
DE-001a NPI Q: What National Provider Identifications (NPIs) are SPARCS collecting?

A: SPARCS is collecting the facility's NPI. (Note: Not the individual Practitioner's NPI.)

 12/22/2008
DE-001b NPI Q: My facility has multiple NPI's. Which one should I report?

A: Any one of the NPI's issued to your facility.

 12/22/2008
DE-001c NPI Q: I don't have the NPI? What would I report?

A: Report the PFI with the XX qualifier, or report the Employer's Identification Number with 24 as the qualifier. The NPI is entered in the NM1 Service Provider Name (Loop 2010AA) in segment NM109 for both inpatient and outpatient submission.

12/22/2008
DE-002a Type of Bill Q: How do I report the Type of Bill?

A: This is a composite element, the first 2 positions are for the type of facility and the bill classification. The letter "A" is used as a separator, and the third position designates the type of transaction.

Example of Type of Bill=131 (new claim from a hospital for outpatient services):
CLM*PCNTEST*100.00***13:A:1~

 12/22/2008
DE-003a Patient Race Q: The SPARCS Input Data Dictionary indicates that Patient Race is reported in the NTE segment of the 2300 Loop and in the DMG segments of the 2010BA or 2010CA Loops. Does this have to be reported in both the NTE segment and the DMG segment?

A: No. Reporting Patient Race is dependent on what version of the 837 you are reporting. If you are reporting in 4010, Patient Race is placed in the NTE segment. In 4050, it is submitted in the DMG segment.

12/22/2008
DE-004a License Number Q: The first two positions of the Physicians License Number indicate the category of license held by the health care professional. Is this really necessary to report?

A: Yes. The two-digit code is required for reporting Physician License Numbers. Records will error out if this information is not provided.

 12/22/2008
DE-004b License Number Q: I have a physician ID with a letter "A" in front, how should I submit it?

A: Drop the letter and remember to add the 2 digit type code from Appendix J.

 12/22/2008
DE-005a Source of Payment Typology Q: When is the new Source of Payment Typology required?

A: The SPARCS system will be able to accept these new data elements on July 1, 2009. You should start reporting the new payment typology in July 2009. You must submit a production file by December 31, 2009 containing the new source of payment typology I, II and III. Please refer to the October 1, 2008 letter.

 12/22/2008
DE-006a AMI Q: I have an AMI patient who was DOA and revived in the ER, there is no BP or Heart rate what should I report?

A: Report the values as '000'. The patient was dead on arrival, and thus there was no recordable BP or Heart Rate. The treatment you provided helped revive the patient

12/22/2008
DE-007a POA Q: Does my outpatient facility have to report Present on Admission?

A: No. It is only required for inpatient. It is not required for outpatient.

 12/22/2008
DE-007b POA Q: Can I use an E in my POA indicator?

A: No. SPARCS does not accept the value of E in POA. The valid values are Y, N, U, W, 1 or " " (blank).

 12/22/2008
DE-008a Payer ID Q: Where can I find the Payer ID numbers?

A: Located in Appendix K and Appendix L.

 12/22/2008
DE-009a Diagnosis Codes Q: I am not sure of the diagnosis code for a patient can SPARCS help me?

A: While SPARCS edits for valid Diagnosis and Procedure codes, we do not make determinations as to which codes accurately reflect a patient's particular diagnosis or procedure. We suggest you contact NYHIMA with any questions regarding coding.

 12/22/2008
DE-010a Patient Discharge Status Q: Do you have general guidelines for reporting Patient Discharge Status?

A: Yes. We are recommending using the references distributed by the National Uniform Billing Committee (NUBC) — Official UB-04 Data Specifications Manual. Please use the following link to read the complete Patient Discharge Status FAQs from NUBC. In addition, please refer to Appendix C for the codes and values associated with this data element.

 03/04/2009
Categories Menu Health Commerce System (HCS) Accounts
Q - # Topic Questions & Answers Effective
HCS-001 Account Q: How many months until an HCS account is locked due to inactivity?

A: Five months, at which time you will need to call the Commerce Accounts Management Unit (CAMU) at (866) 529-1890 to activate your account.

 12/22/2008
HCS-002 Account Q: Who do I need to contact to get an HCS Account?

A: Your Facility's HCS Coordinator. If you do not know who your HCS Coordinator is, you can call (518) 473-8144 or (800) 638-3808 or e-mail the SPARCS at sparcs@health.state.ny.us.

 12/22/2008
HCS-003 Commerce Account Q: A new staff person has just been added to our organization. Should they be given access to the Health Commerce System?

A: There are many applications and uses on the HCS within the Department of Health. SPARCS is only one of the many program areas using the HCS. Each program area grants individual permission to their application on the HCS. Once an individual has an HCS account, they will need to contact the SPARCS Administrative Unit to obtain the appropriate SPARCS applications.

 12/22/2008
HCS-004 Commerce Account Q: A member of our staff who had an HCS access has left. Does this affect the Health Commerce System in any way?

A: Yes. It is important that this person's user ID is disabled in the system, since it is no longer appropriate that they access the Health Commerce System. Even if the person left on amicable terms, or transferred to another organization, it is important to protect the security of the Commerce Network and inform the Commerce Accounts Management Unit (CAMU) to have the person's user ID deactivated.

 12/22/2008
Categories Menu Obtain SPARCS Data
Q - # Topic Questions & Answers Effective
DATA-001
                		 Data Requests Q: Can requests for SPARCS Data be made?

A: Yes. Requests for SPARCS Data should be directed to:

Bureau of Biometrics and Health Statistics
New York State Department of Health
800 North Pearl Street, Albany, NY 12204
Phone: (518) 474-3189
Fax: (518) 402-1193
E-mail: bio-info@health.state.ny.us
12/22/2008
Categories Menu Reports
Q - # Topic Questions & Answers Effective
RPT-001 Quality Reports Q: How do I get Access to my facility's Quality Reports?

A: You must contact your SPARCS coordinator or SPARCS backup coordinator who can access the data for you. If you do not know who your SPARCS Coordinator is, you can contact the SPARCS Administrative Unit.

 12/22/2008
RPT-002 Performance Metrics Q: How do I get permission to view my facility's Performance Metrics?

A: You need an HCS Account with granted access to your facility.

 12/22/2008
Categories Menu Security
Q - # Topic Questions & Answers Effective
SEC-001 Security Q: I need help with my SPARCS File format. Can I e-mail the file to SPARCS for help?

A: Absolutely Not. E-mail is not a secure way of sending confidential data. Please contact the SPARCS Administrative Unit to get information regarding the acceptable method for sending confidential data to us.

12/22/2008
SEC-002 Security Q: If I forget or get locked out of my HCS account, is it okay if I use my co-worker's account to sign on until I get my account reactivated?

A: Absolutely not. Never share user IDs or passwords, even if it only temporary. That would be in violation to the User Agreement you and your organization signed. If you experience any problems with your user ID or password immediately call the Commerce Accounts Management Unit (CAMU). A staff member will assign a new password for you. Use of another's account can result in permanent termination of your HCS account privileges.

 12/22/2008
SEC-003 Password Q: What do I do if I have forgotten my username or password?

A: Contact the Commerce Accounts Management Unit (CAMU).

 12/22/2008
SEC-004 Password Q: I have just logged on to the HCS and it says my password is expired, what's going on?

A: Every HCS user, is required to change their password every 60 days. The system automatically prompts you to change your password every 60 days. For no reason should anyone ever know your password. Should you ever feel that the anonymity of your password has been compromised, immediately change the password on your own. (Change password now option at logon.)

 12/22/2008
Categories Menu SPARCS 837 PC Application
Q - # Topic Questions & Answers Effective
PC-001 Download Q: Does SPARCS provide a PC application to help me submit my SPARCS Data?

A: Yes. The SPARCS-837 PC Application is currently available for use. It is available free of charge for download on the HCS. Please see SPARCS Software/Documentation Download page for information on downloading the PC application.

 12/22/2008
PC-002 Errors Q: Can I correct my errors using the PC application?

A: Yes, you can import your SPARCS error files into the application and make corrections. You can then export the file and submit it to SPARCS via the HCS upload process.

 12/22/2008
PC-003 Edits Q: Does the PC application have the same edits as the submission system?

A: No. The PC application does not contain all the edits that occur during Mainframe processing. Only when you submit your file through the HCS upload process (either in Test or Production mode) do you get a complete and accurate listing of all edit results.

 12/22/2008
PC-004 Format Conversion Q: My vendors system still outputs in the UDS version 6 format, can the PC application convert my file?

A: Yes. The application can convert your file from UDS version 5 or 6 to the new 837 format.

 12/22/2008
PC-005 Installation Q: Can the application be networked?

A: No. The application cannot be networked. Each valid HCS account user should download their own copy of the PC application using only their HCS user account.

 12/22/2008
PC-006 Data Replacement Q: Can the application help me to replace my data?

A: Yes. The application can convert the bill type to deletion, replacement or new claim for a batch of records. The application is recommended for batches of 4000 and less.

 12/22/2008
PC-007 New Data Element Q: My Vendor system still does not have the new source of payment typology can the application help me?

A: Yes the application can be used to enter the values on your claims.

 12/22/2008
PC-008 Installation Q: When I started the application for the first time it opened a screen requiring my collector number, I do not know it, what should I do?

A: The collector number is on every edit report at the top on the left side next to Data Collector. If you cannot find it call SPARCS Administrative Unit.

 12/22/2008
PC-009 Errors Q: Can I correct all my errors listed on my edit report using the SPARCS 837 PC application?

A: Yes the PC application can correct all edit errors listed on your edit report. Please note your corrections should be made to your internal system also.

 12/22/2008
PC-010 Procedure Time Q: My vendors system still outputs procedure time as a value code 83, but I am in the 837 format, can the PC application help me?

A: Yes. In the application menu bar select "Tools", "Convert Value Code 83 to NTE Procedure Time". Then select the range of records you wish to convert, then press "Continue". At the prompt, say yes to complete the conversion. You can now export your file ready for upload to SPARCS.

 12/22/2008
PC-011 Patient or Subscriber Failed Q: How do I correct the error message "Patient/Subscriber Failed" using the PC program?

A: In the X12-837 input format the data is formatted in a hierarchy of Subscriber->Patient->Claim "loops". When an error is encountered in the subscriber or patient loop, then any claims associated with the patient/subscriber will also fail. The edit report will show one or several errors for the patient or subscriber, followed by the message "Patient Failed" or "Subscriber Failed" for each claim that was associated with the failed subscriber/patient. To correct the error in the PC program, use the search menu, select find claim and search by Patient control number to find the claim. When the claim is highlighted in the claims list, click either the Patient or Subscriber button on the tool bar to navigate to the patient or subscriber associated with that claim, then update the patient or subscriber to be changed.

In this example, the Claim failed (error code 2300CLM0000) because the associated patient had an invalid County Code (error code 2010N46000):

Error Code Patient Control Number Loop HL Index Element Value
2010N46000 N/A 2010 514 N406
2300CLM0000 XXXXXXXXXX 2300 514 *PAT* PATIENT FAILED

4/9/2009
Categories Menu Submission Process
Q - # Topic Questions & Answers Effective
SP-001 Late Submission Q: What do I do if I can't submit my file on time?

A: You may request an extension by contacting SPARCS via phone or e-mail. Include your PFI, file type (IP/AS/ED) and reason. The request must be made from the SPARCS Primary or Backup Coordinator.

 12/22/2008
SP-002 Late Submission Q: What happens if I cannot submit my file on time and don't request an extension?

A: SPARCS will send you a notification via e-mail if your submission is below "target" and you did not request an extension. If you continue to submit late or under target and do not request extensions, the SPARCS Coordinator and your CEO will be notified by letter of impending enforcement actions which may include a Statement of Deficiencies (SOD), a fine, or a Medicaid rate reduction.

 12/22/2008
SP-003 Delete Records Q: I accidentally submitted the same records twice to SPARCS this month – can I delete them before they get processed?

A: Yes. The SPARCS Coordinator, backup coordinator, or authorized vendor must call or send an e-mail to sparcs@health.state.ny.us with the log number, file type (IP or OP), and your PFI requesting that the submission be deleted. Requests must be received before the last day of the month.

 12/22/2008
SP-004 Data Submission Q: Where do I go to submit my data?

A: You submit your data by going to the SPARCS submission page for your facility on the HCS, browsing to your file and uploading it through the secure web page.

 12/22/2008
SP-005 Test Submission Q: Can I test my submission?

A: Yes. We encourage all submitters to upload a test file to identify any errors. After making your corrections, submit your corrected file as a production submission.

 12/22/2008
SP-006 Submission Process Q: When I submit my file what happens next?

A: You will receive an upload confirmation page acknowledging your submission. It will contain the name of the file, the submission log number and the type - test or production of the submission. You should print and file this page for future reference.

 12/22/2008
SP-007 Submission Results Page Q: I got my confirmation page, now what?

A: You will check your submission results page and look for the edit report containing a matching submission log number. It is usually the last log number in the dropdown list.

 12/22/2008
SP-008 Errors Q: I have errors on my edit report, now what?

A: You should return to your facility's computer system, make corrections to the errors and resubmit the file.

 12/22/2008
SP-009 Production Submission Q: My report does not have any errors, I submitted in test, am I finished?

A: No. Once you have the errors corrected you need to submit the file in production mode for the claims to make it into the SPARCS master file.

 12/22/2008
SP-010 Vendor Submission Q: My vendor does my submission, do I have to do anything?

A: You need to check for the edit report to verify that your claims are 100 percent accepted. It is the facility's responsibility to make sure the claims are submitted and accurate.

 12/22/2008
SP-011 Audit Report Q: When will I see the records reflected in the Audit and Submission History Reports?

A: The files are processed at the beginning of every month. Typically, the Audit Report is completed within 7 to 10 days of the following month.

 12/22/2008
SP-012 No Confirmation Page Q: I submitted my file but did not get the confirmation page, is something wrong?

A: Yes. Contact the SPARCS Administrative Unit.

 12/22/2008
SP-013 Missing Edit Report Q: I submitted my file and got the confirmation page but the edit report is not there, what should I do?

A: If you submit in the morning, the report should be there by the afternoon, but if you submit in the afternoon it should be there the next day. Remember to check for a failure notice on the submission results page, if it is not there contact the SPARCS Administrative Unit.

 12/22/2008
SP-014 SPARCS ID Q: Where can I find my SPARCS ID?

A: It is a five digit code consisting of the pfi and a check digit. It is at the top of your edit report on the right - Labeled "SPARCS Facility Identifier".

 12/22/2008
SP-015 Debugging Edit Report Errors Q: I do not understand an error on my report what should I do?

A: First click on the error code to read the description of the error. Then click the description of the error to go to the page for the element in the data dictionary. Look at the value for the error in the value column of the report and read the requirements in the data dictionary. If you still cannot understand then contact the SPARCS Administrative Unit.

 12/22/2008
SP-016 Revenue Code Q: I submitted an ED claim and got an error for procedure time.

A: Check to be sure there is a 450 revenue code indicating it is an ED claim on the file.

 12/22/2008
Categories Menu Submission Schedule
Q - # Topic Questions & Answers Effective
SS-001 Data Submission Q: When is my Data due to SPARCS?

A: Data is due into SPARCS 60 days following the month of patient discharge.

 12/22/2008
Categories Menu Vendor Submission
Q - # Topic Questions & Answers Effective
V-001 Vendor Submission Q: What is required of a vendor who wants to submit SPARCS data for a facility?

A: Representatives from both the facility and vendor must complete and sign the SPARCS Data Agreement Notification Form (DOH-4388) and mail the original back to the SPARCS Administrative Unit (mailing address is on the form).

 01/16/2009
V-002 Vendor Submission Q: Do facilities need to have an HCS account even if they are using a vendor to submit SPARCS data for them?

A: Yes. All facilities should have an HCS account, as well as a designated SPARCS Coordinator and a backup SPARCS Coordinator.

 01/23/2009
V-003 Vendor Submission Q: Do you have a list of vendors?

A: Yes. Please see the Results of our 2008 SPARCS Vendor Survey.

 01/23/2009
Categories Menu Edit Program Errors
Q - # Topic Questions & Answers Effective
E-001 Patient/Subscriber Failed Q: What does the error message "Patient/Subscriber Failed" mean?

A: In the X12-837 input format the data is formatted in a hierarchy of Subscriber->Patient->Claim "loops". When an error is encountered in the subscriber or patient loop, then any claims associated with the patient/subscriber will also fail. The edit report will show one or several errors for the patient or subscriber, followed by the message "Patient Failed" or "Subscriber Failed" for each claim that was associated with the failed subscriber/patient. This same line will display the patient control number of the claim so the subscriber or patient can be corrected.

In this example, the Claim failed (error code 2300CLM0000) because the associated patient had an invalid County Code (error code 2010N46000):

Error Code Patient Control Number Loop HL Index Element Value
2010N46000 N/A 2010 514 N406
2300CLM0000 XXXXXXXXXX 2300 514 *PAT* PATIENT FAILED

4/9/2009
Categories Menu Source of Payment Typology
Q - # Topic Questions & Answers Effective
SOP-001 Source of Payment Typology Q: Who developed the Source of Payment Typology?

A: The Source of Payment Typology was developed by the Payer Subcommittee of the Standards Data Committee of the Public Health Data Standards Consortium (PHDSC). The PHDSC represents all 50 states from a public health / regulatory perspective. It was developed over the course of four years.

 07/01/2009
SOP-002 Source of Payment Typology Q: Is this a nationally recognized data element?

A: Yes. For those coding data under the HIPAA standards, the Payer Typology is referenced as an external code list in the ANSI X12 standards as a data element in the Subscriber Information Segment in the Subscriber and the Patient Loops. Because this change was made after the October 2003 version of the ANSI X12 was approved and published, this modification will be supported in post 5010 (October 2003) version of the Health Services Data Reporting Guide. It has been adopted by the National Uniform Billing Committee.

 07/01/2009
SOP-003 Source of Payment Typology Q: Are other States using this?

A: Yes. Georgia started in 2007. Oregon began in June, 2008. New York will start in July, 2009.

 07/01/2009
SOP-004 Source of Payment Typology Q: Who is maintaining this code set?

A: The Source of Payment Typology is maintained by the PHDSC . Any changes to the typology will be made annually in October.

 07/01/2009
SOP-005 Source of Payment Typology Q: Has PHDSC developed definition for these values / code set?

A: Yes. The PHDSC has created a 20 page "Users Guide for Source of Payment Typology" for reporting. The link is http://www.phdsc.org/about/committees/pdfs/SourceofPaymentTypologyUsersGuideOct2007.pdf

The PHDSC website is http://www.phdsc.org/.

 07/01/2009
SOP-006 Source of Payment Typology Q: When will SPARCS require this data element?

A: The SPARCS system will begin accepting these new data elements on July 1, 2009. All facilities are expected to completely transition to the new data elements by December 31, 2009.

 07/01/2009
SOP-007 Source of Payment Typology Q: Will SPARCS require a different X12-837 version for this data element?

A: No. At this time, the data element will be placed in the NTE segment and SPARCS will continue to accept the 4050 Reporting and the 4010A (1) Institutional versions. The future version that accepts the Source of Payment Typology data element is the 5010 Reporting version. SPARCS hopes to change to this version in the future.

07/01/2009
SOP-008 Source of Payment Typology Q: What will happen to the old payer data elements?

A: The old payer data elements listed will be removed on December 31, 2010:

 07/01/2009
SOP-009 Source of Payment Typology Q: Will the Source of Payment Code data element (aka Claim Filing Indicator) still be required?

A: Yes. This data element is required until December 31, 2010. Thus, in 2009 you will be reporting in essence, three types of payer data elements (the old NY payer fields called Expected Principal Reimbursement, the X12-837 field Source of Payment Code and the new NY -- adopted nationally depending on version of X12-837 -- payer field). In the 5050 version of the X12-837 the standards committee will allow both to be reported. When SPARCS moves to another version X12-837 we will consider removing the Source of Payment Code data elements so that you will only be reporting one type of payer data element to NYS (the new Source of Payment Typology).

 07/01/2009
SOP-010 Source of Payment Typology Q: Will there be a cross walk to the other payer types?

A: Yes. The PHDSC has developed a crosswalk with the Source of Payment/Claim Filing Indicator. NYS will provide a crosswalk with the Expected Principal Reimbursement payer type.

 07/01/2009
SOP-011 Source of Payment Typology Q: Will there be any edits on this data element?

A: Yes. Only the values defined in Appendix P - Source of Payment Typology Codes will be accepted. The Medicaid and Medicare values must have a minimum of two digits when reporting.

In addition, the Payer ID for managed care plans will have a cross-edit to the Source of Payment Typology. With assistance from the NYS Department of Health, Office of Managed Care, this information will be checked. For example, the managed care plan for Capital District Physician Health Plan (CDPHP) is only licensed to have the following products/Source of Payment Typology's:

Example: Capital District Physician Health Plan (CDPHP) -- NAIC #95491
11 = Medicare Managed Care
211 = Medicaid Managed Care
2111 = Family Health Plus
2112 = Healthy New York
23 = Child Health Plus
51 = Managed Care (Private)
Only these values will be accepted for the Payer ID - CDPHP.		 07/01/2009