CARES Act Provider Relief Fund - Medicaid Provider Distribution Minimum Data Set Specifications and Instructions
States are requested to submit the following set of data elements:
Provider Identifiers, consisting of:
a. Provider Name and associated addresses used for billing.
i. If reporting an Organization/Facility, use the field for LName.
b. TIN(s) for each, as well as any of the provider’s subsidiary organizations.
c. NPI(s) used for billing purposes.
i. If a Provider does not have a NPI, please enter the Unique ID the SMA used to direct the payment.
d. Total of all Medicaid paid amounts per NPI or TIN;
i. One total for payment in calendar Year 2018
ii. One total for payment in calendar Year 2019
e. Is the Provider a Retail Pharmacy?
States will be requested to submit the information in the encrypted form of either a Tab Delimited File or as a Comma Separated Value (CSV) file.
For definition:
LName=Provider Last Name; if submitting a Facility/Organization, enter that name here.
FName=Provider First Name
MI=Provider Middle Initial (if have one)
TEL=Provider Telephone Number
Address=Street Number and Name used as the Billing Address
Address2=Additional Location information, as needed
City, State and ZIP are as named
NPI=National Provider Identifier, one record per each; If no NPI exists, use the Unique ID the SMA used to direct the payment.
BA=Bank Account number
RT=Routing Number
TIN=Tax Identification Number