Crosswalk: HSD Instructions

HSD4. Health Service Delivery Table Upload Instructions for CY 2018 Applications
This document contains information needed to complete the HSD tables required for the online
application process (you will not need to complete HSD tables if you are applying for an
employer-only SAE). It also contains frequently asked questions (FAQ) regarding HSD
submission and processing, guidance on developing valid addresses and field edits for the MA
Provider and MA Facility tables. Please note that this document may be revised. Applicants
should download the latest version directly from HPMS in the Submit Application Data section
of Basic Contract Management. The document is part of the zipped file called MA Download
Templates.

Contents
SPECIALTY CODE FOR MA PROVIDER TABLE.................................................... 2
SPECIALTY CODE FOR MA FACILITY TABLE ..................................................... 2
HSD TABLE INSTRUCTIONS ....................................................................................... 3
MA PROVIDER TABLE ................................................................................................ 3
MA FACILITY TABLE ..................................................................................................6
APPENDIX A-CY 2018 HSD SUBMISSION FREQUENTLY ASKED QUESTIONS ......... 8
APPENDIX B- GUIDANCE ON DEVELOPING VALID ADDRESSES ................. 17
APPENDIX C-FIELD EDITS FOR THE MA PROVIDER AND FACILITY TABLES .... 19

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PUBLIC REPORTING BURDEN: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless
it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0935 (Expires: TBD). The time required to
complete this information collection is estimated to average 50 hours per response, including the time to review instructions, search existing data resources, and
gather the data needed, and complete and review the information collection. If you have any comments, concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to CMS, Attn: Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
Expiration: TBD

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SPECIALTY CODES

CMS has created specific specialty codes for each of the physician/provider and facility types.
Applicants must use the codes when completing HSD tables (MA Provider and MA Facility
tables).

Specialty Codes for the MA Provider Table
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001 – General Practice
002 – Family Practice
003 – Internal Medicine
004 – Geriatrics
005 – Primary Care – Physician Assistants
006 – Primary Care – Nurse Practitioners
007 – Allergy and Immunology
008 – Cardiology
010 - Chiropractor
011 – Dermatology
012 – Endocrinology
013 – ENT/Otolaryngology
014 – Gastroenterology
015 – General Surgery
016 – Gynecology, OB/GYN
017 – Infectious Diseases
018 - Nephrology
019 - Neurology
020 - Neurosurgery
021 - Oncology - Medical, Surgical
022 - Oncology - Radiation/Radiation Oncology
023 – Ophthalmology
025 - Orthopedic Surgery
026 - Physiatry, Rehabilitative Medicine
027 - Plastic Surgery
028 - Podiatry
029 - Psychiatry
030 - Pulmonology
031 - Rheumatology
033 - Urology
034 - Vascular Surgery
035 – Cardiothoracic Surgery

Specialty Codes for the MA Facility Table
 040 – Acute Inpatient Hospitals
 041 - Cardiac Surgery Program

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042 - Cardiac Catheterization Services
043 - Critical Care Services – Intensive Care Units (ICU)
044 - Outpatient Dialysis
045 - Surgical Services (Outpatient or ASC)
046 - Skilled Nursing Facilities
047 - Diagnostic Radiology

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048 - Mammography
049 - Physical Therapy
050 - Occupational Therapy
051 - Speech Therapy
052 - Inpatient Psychiatric Facility Services
053 – NOT IN USE
054 - Orthotics and Prosthetics
055 - Home Health
056 - Durable Medical Equipment
057 - Outpatient Infusion/Chemotherapy
058 - NOT IN USE
059 – NOT IN USE
060 – NOT IN USE
061 - Heart Transplant Program
062 - Heart/Lung Transplant Program
063 – NOT IN USE
064 - Kidney Transplant Program
065 - Liver Transplant Program
066 - Lung Transplant Program
067 - Pancreas Transplant Program

Additional information related to these MA Provider and Facility specialty types is available
in the HSD Guidance and Methodology document located on CMS’s MA Applications
website at: https://www.cms.gov/Medicare/MedicareAdvantage/MedicareAdvantageApps/index.html?redirect=/MedicareAdvantageApps/.

. HSD Table Instructions
The tables should reflect the applicants’ executedNote: Detailed Technical instructions are
outlined in the HPMS User Guides
Organizations must demonstrate that they have an adequate contracted provider network on the
date of submission.that is sufficient to provide access to covered services, as required by 42
CFR 417.414, 42 CFR 417.416, 42 CFR 422.112(a)(1)(i) and 42 CFR 422.114(a)(3)(ii).
Organizations are able to demonstrate network adequacy through the submission of Provider
and Facility Health Service Delivery (HSD) Tables. Organizations shall only list providers
and facilities with which the organization has fully executed contracts on the HSD Tables.
CMS considers a contract fully executed when both parties have signed. Applicants should
only list providers with whom they have a fully executed updated contract. These contracts
and should be executed on or prior to applicationthe HSD submission deadline. The HSD
Tables templates are available in Appendix H and Appendix J and in the MA Download file in
HPMS.
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4.1 Populating the HSD Tables
4.1.1 Provider HSD Table
The Provider HSD Table is where you will list every contracted provider in your network.
The Provider HSD Table template has several fields to record the state/county code for the
county that the provider will be serving, the provider’s name, National Provider Identifier
Number (NPI), specialty, specialty code, contract type, provider service address, if accepts new
patients, medical group affiliation and if uses CMS MA contract amendment (see Appendix I
for the Provider HSD Table field definitions). CMS has created specific specialty codes for
each provider specialty type. Organizations must use these codes when completing the
Provider HSD Table (see Appendix D for a complete list of Provider Type specialty codes). If
a provider serves beneficiaries from multiple counties in the service area, list the provider
multiple times on the Provider HSD Table in the appropriate state/county code to account for
each county. Providers may serve enrollees residing in a different county/or state than their
office locations. However, organizations should not list contracted provider in state/county
codes where enrollees could not reasonably access services and that are outside the pattern of
care (e.g. listing a primary care provider practicing in California for a county in
Massachusetts). Such extraneous listing of provider affects CMS’ ability to quickly and
efficiently assess provider networks against the network adequacy criteria.
Organizations must ensure that the Provider HSD Table meets the conditions described below.
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Providers must not have opted out of Medicare.
Providers are not currently sanctioned by a federal program or relevant state licensing
boards.
Physicians and specialists must not be pediatric providers, as they do not routinely
provide services to the aged Medicare population.
Mid-level practitioners, such as physician assistants and nurse practitioners, must not be
used to satisfy the network adequacy criteria for specialties other than the Primary Care
Providers (see the HSD Reference File for additional conditions related to physician
assistants and nurse practitioners).

Organizations are responsible for ensuring contracted providers meet state and federal
licensing requirements as well as the organization’s credentialing requirements for the
specialty type prior to including them on the Provider HSD Table. Verification of credentialing
documentation may be requested at any time. Including providers that are not qualified to
provide the full range of specialty services listed in the Provider HSD Table will result in
inaccurate ACC results and possible network deficiencies.
In order for the automated network review tool to appropriately process this information,
applicantsMAOs must submit Provider and Facility names and addresses exactly the same way
each time they are entered, including spelling, abbreviations, etc. Any errors will result in
problems with processing of submitted data and may result in findings of network deficiencies.
CMS expects all applicantsorganizations to fully utilize the opportunities for pre-checksNMM
to check their networks and to fully review the Automated Criteria Check (ACC) reports to
ensure that their HSD tables are accurate and complete.
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MA Provider 4.1.2 Facility HSD Table

This table captures information on the specific physicians/providers in the applicant’sThe
Facility HSD Table is where you will list every contracted facility in your network. If a
provider serves beneficiaries residing in multiple counties in the service area, list the
provider multiple times with the appropriate state/county code to account for each county
served. Do NOT list Only list the facilities that are contracted providers in state/county
codes

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where the Medicare beneficiary could not reasonably access
services and that are outside the pattern of care.
Such extraneous listing of providers affects CMS’ ability to quickly and efficiently assess
provider networks against network criteria. You must ensure that the MA Provider Table
meets the following conditions:
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Providers must not have opted out of Medicare;
Physicians and specialists must not be pediatric providers, as they do not
routinely provide services to the aged Medicare population;
Physiatry/Rehabilitation Medicine must only be provided by a licensed
physician; Physical Therapists are not qualified to provide the full range of
Physiatry services;
Psychiatrists must only be licensed physicians and no other type of practitioner;
Physician Assistant and Nurse Practitioner services are limited to primary care, as
they are not able to provide the full range of services independently as a licensed
physician.

You are responsible for ensuring contracted providers (physicians and other health
care practitioners) meet State and Federal licensing requirements and your
credentialing requirements for the specialty type prior to including them on the MA
Provider Table. Verification of credentialing documentation may be requested at any time.
Including physicians or other health care practitioners that are not qualified to provide the
full range of specialty services listed in the MA Provider Table will result in inaccurate ACC
measurements that may result in your application being denied.

Column Explanations
A. SSA State/County Code – Enter the SSA State/County code of the county which
the listed physician/provider will serve. The state/county code is a five digit number.
Please include any leading zeros (e.g., 01010). The state and county codes on the
HSD Criteria Reference Table are the codes you should use. Format the cell as “text”
to ensure that codes beginning with a “0” appear as five digits.
B. Name of Physician or Mid-Level Practitioner – Self-explanatory. Up to
150 characters.
C. National Provider Identifier (NPI) Number – The provider’s assigned NPI number
must be included in this column. Enter the provider’s individual NPI number
whether the provider is part of a medical group or not. The NPI is a ten digit numeric
field. Include leading zeros.
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D. Specialty – Name of specialty of listed physician/provider. This should be
copied directly off of the HSD Criteria Reference Table.
E. Specialty Code – Specialty codes are unique codes assigned by CMS to process
data. Enter the appropriate specialty code (001 – 034).

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F. Contract Type – Enter the type of contract the Applicant holds with listed
provider by using a “DC” - Direct Contract or “DS” - Downstream Contract. Use
“DC” for direct contract between the applicant and provider.
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A "DC" - direct contract provider, requires the applicant to complete Col. L Medical Group Affiliation with a "DC".
A "DS" - downstream contract is between the first tier entity and other
providers (such as individual physicians).
An Independent Practice Association (IPA) with downstream contracts with
physicians must complete – Col F Contract Type with a “DS”, Col L Medical
Group Affiliation – Enter IPA Name.
Medical Group with downstream contracted physicians complete – Col F
Contract Type with a “DS”, Col L Medical Group Affiliation – Enter Medical
Group Name.
Medical Group with employed providers must complete – Col F Contract Type
with a “DS”, Col L Medical Group Affiliation – Enter Medical Group Name.

Provider Service Address Columns- Enter the address (i.e., street, city, state and zip
code) of the location at which the provider sees patients. Do not list P.O. Box, house,
apartment, building or suite numbers, or street intersections.

G. Provider Service Address: Street Address – up to 250 characters
H. Provider Service Address: City – up to 150 characters

I. Provider Service Address: State – 2 characters
J. Provider Service Address: Zip Code – up to 10 characters
K. If PCP Accepts New Patients? – Indicate if provider is accepting new patients by
entering a "Y" or "N" response.
L. Medical Group Affiliation – Provide name of affiliated Medical Group/Individual
Practice Association MG/IPA) or if applicant has direct contract with provider enter
“DC”.
M. Model Contract Amendment – Indicate if contract uses CMS Model MA Contract
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Amendment by entering “Y” for yes or “N” for no.

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. MA Facility Table
Only list the providers that are contracted Medicare-certified providers. Please do not list any
additional providersfacilities or services except those included in the list of facility specialty codes.
(see Appendix E for a complete list of Facility Type specialty codes). The Facility HSD Table
template has several fields to record the state/county code for the county that the facility will be
serving, facility or service type, NPI number, number of staffed/Medicare-certified beds, facility
name, provider service address, and if uses CMS MA contract amendment (see Appendix K for the
Facility HSD Table field definitions).
Additionally, do
Facilities may serve enrollees residing in a different county and/or state than their office location.
However, organizations should NOT list contracted facilities in state/county codes where the
Medicare beneficiaryenrollee could not reasonably access services and that are outside the pattern
of care. Such extraneous listing of providersfacilities affects CMS’ ability to quickly and
efficiently assess providerfacility networks against the network adequacy criteria.
If athe facility offers more than one of the defined services and/or provides services in multiple
counties, the facility should be listed multiple times with the appropriate “SSA State/County Code”
and “Specialty Code” for each service.

Column Explanations:

A. SSA State/County Code – Enter the SSA State/County code of the county for which the
listed facility will serve. The county code should be a five digit number. Please include any
leading zeros (e.g., 01010). The state and county codes on the HSD Criteria Reference Table
are the codes that applicants should use. Format the cell as “text” to ensure that codes
beginning with a “0” appear as five digits.
Facility or Service Type – Name4.2 Organization-Initiated Testing of Contracted

Networks
B. Organizations that received a contract ID number from CMS, either through the Notice
of facility/service type of listed facility. This should be copied directly off of the HSD
Criteria Reference Table.
C. Specialty Code – Specialty codes are unique 3 digit numeric codes assigned by CMS to
Intent to Apply process data. Enter the Specialty Code that best describes the services
offered by each facility or service. Include leading zeros.
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D. National Provider Identifier (NPI) Number – Enter the provider’s assigned NPI
number in this column. The NPI is a ten digit numeric field. Include leading zeros.

E. Number of Staffed, Medicare-Certified Beds – For Acute Inpatient Hospitals, Critical Care
Services – Intensive Care Units (ICU)s, Skilled Nursing Facilities, and Inpatient Psychiatric
Facility Services, enter the number of Medicare-certified beds for which the Applicant has or
receipt of a signed contract, have the opportunity to test their contracted networks’
compliance with network adequacy criteria at any time throughout the year via the Network
Management Module (NMM) in HPMS. To test networks, organizations may access for
Medicare Advantage enrollees. This number should not include Neo- Natal Intensive Care
Unit (NICU) beds. The the following facilities must include this field on the submitted
Facility Table: Acute Inpatient Hospital (040), Critical Care Services - ICU (043), Skilled
Nursing Facilities (046), and Inpatient Psychiatric Facility (052).
F. Facility Name – Enter the name of the facility. Field Length is 150 characters.
Provider Service Address Columns- Enter the address (i.e., street, city, state and zip code)
from which the provider serves patients. Do not list P.O. Box, house, apartment, building
or suite numbers, or street intersections. For Home Health and Durable Medical
Equipment, indicate the business address where one can contact these vendors.

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G. Provider Service Address: Street Address – up to 250 characters
H. Provider Service Address: City – up to 150 characters
I. Provider Service Address: State – 2 characters
J. Provider Service Address: Zip Code – up to 10 characters
K. Model Contract Amendment – Indicate if contract uses CMS Model MA Contract
Amendment by entering “Y” for yes or “N” for no.

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. Appendix A - CY 2018 HSD
Submission Frequently Asked
Questions
CMS has developed a series of frequently asked questions (FAQ) regarding the HSD table
submission process. These FAQs provide additional technical guidance on the following topics:

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Requirements for participating in the HSD pre-checks
Understanding the HSD submission statuses
Reviewing the HSD Status Report and ACC Report
Informational messages versus errors
MA Provider and MA Facility table formats and edit checks
Address Information Report statuses (duplicate address, invalid address)
Zip –Distributive Process

Please contact Greg Buglio at either gregory.buglio@cms.hhs.gov or 410-786-6562 for technical
questions regarding the CY 2018 HSD submission. Please contact the DMAO web portal for
questions related to policy: https://dmao.lmi.org

1. What is the schedule for HSD pre-checks?

Response: Applicants, and all organizations, may utilize the Network Management Module
– Organization Initiated Upload process to check networks against current CMS criteria. The
NMM Organization Initiated Upload functionality may be accessed at thisnavigation path: HPMS
Home Page>Monitoring>Network Management. The Quick Reference User Guide, under the
Documentation link, explains how to perform an >Organization Initiated Upload. Once an
organization uploads their HSD tables through the Organization Initiated Upload and how to
check the ACC results (see section 2 and section 7 of the NMM Quick Reference User Guide).
NOTE: CMS may not access the uploaded tables or the ACC results affiliated with an
Organization Initiated Upload, HPMS will automatically review the contracted network against
CMS network adequacy criteria for each required provider and facility type in each county.
2. How can I participate in the HSD pre-check process?
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Response: All organizations, including applicants, may check their networks via the Network
Management Module – Organization Initiated Upload at any time throughout the year. See
answer to Question 1.

3. Where and when can I view my final application HSD processing results?

Response: The results of the online application HSD processingtables review will be available
inthrough the HSD Automated Criteria Check (ACC) report. An in HPMS. The ACC reports may
be accessed at the following navigation path: HPMS Home Page>Monitoring>Network
Management>ACC Extracts.
The ACC report displays the results of the automated email will be sent when the ACC results are
available (typically three to five days after the submission window closes). You may access this
report at the following link: HPMS Home Page>Contractnetwork assessment for each provider
and facility. The results are displayed as either “PASS” or “FAIL”. Results displayed as “PASS”
means that the specific provider or facility met the CMS network adequacy criteria. Results
displayed as “FAIL” means that the specific provider or facility did not meet the criteria. In
addition, HPMS has available the HSD Zip Code Report that indicates the areas in which enrollees
do not have adequate access. The ACC reports may be accessed at the following navigation path:
HPMS Home Page>Monitoring>Network Management>ACC Extracts. Organizations should
use the feedback received during the network self-checks to revise HSD tables and formally
submit them by the application initial submission date.
Specific instructions on how to submit each table and access the ACC reports will be outlined in
the NMM Organization Quick Reference Guide. The NMM Reference Guide may be accessed at
the following navigation path: HPMS Home Page>Monitoring>Network Management>User
Guide>NMM Org Quick Reference User Guide.

4.3 CMS Network Adequacy Reviews
As discussed in section 1, several events trigger CMS’s review of an organization’s contracted
network. The type of triggering event dictates where CMS requires an organization to upload their
HSD tables, as shown in Table 4-1.
Table 4-1: HPMS Module for CMS Network Adequacy Reviews

Triggering Event
Application
Provider-Specific Plan
Provider/Facility Contract
Termination

Application Module
X

X
X
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Network Management
Module

Triggering Event
Change of Ownership
Network Access Complaint
Organization-Disclosed Network
Deficiency

Application Module

Network Management
Module

X
X
X

As reflected in Table 4-1, the NMM supports network reviews of existing, operational contracts
only. The Application Module supports networks reviewed as part of the application review
process that qualifies an entity to offer Medicare Advantage plans in a service area pursuant to 42
CFR 422 Subpart K. The sections below provide instructions for uploading HSD tables in the
HPMS.
4.3.1 HPMS Application Module
By the application initial submission date, organizations will formally submit HSD tables via the
HPMS Online Application module. The Online Application upload requirements are completed in
the following navigation path: HPMS Home Page> Contract Management>Basic Contract
Management>Select Contract Number>Submit Application Data>HSD Submission
Reports>Contract Management Start Page>Online Application>Upload Files>HSD Tables.
Organizations applying for a Service Area Expansion (SAE) must upload HSD tables for the
entire network not just the counties targeted in the SAE application.
HSD tables will be automatically reviewed against CMS network adequacy criteria for each
required provider and facility type in each county. After each submission, the results of the
HSD tables review will be available through the HSD Automated Criteria Check (ACC)
Report.
Note: More information about using the ACC report, and all HSD reports, is available in the
Online Application User’s Manual, located under “Documentation” on the Basic Contract
Management screen. An email notification will be emailed to the Part C Application Contact
and to the email affiliated with the user ID of the person who uploaded the HSD tables when
the ACC reports are available.

4. HPMS is showing a message that both of my tables have been “successfully uploaded” to the
system. Does this mean that my submission will automatically be processed during the next
pre-check or final submission processing?
Response: Not necessarily. Successfully uploading your tables is the first step. However, in
order to participate in the HSD pre-check process or to final submit your application, your
submission must also pass the “unload” validation edits. The automated HSD validation
process may take some time to complete, depending upon the size of your data tables and the
number of other organizations submitting data at the same time. Consequently, CMS
strongly urges applicants to submit your tables as soon as possible so that there is sufficient
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time to complete the unload validation process, retrieve your results, and resubmit your
tables if you encounter fatal unload errors.

5. What other HSD Upload status messages might appear?
Response: The following are the most common Upload messages you will see: “Upload
Started,” which means the tables are in the process of being uploaded; “Upload Ended,”
which means the tables are uploaded and waiting to go through the automated Unload edit
process. Question #6, #7, #8, #9, #10, and #11 address the automated HSD Unload edit
process and the most common Unload messages.

6. Will I be notified when the HSD tables unload successfully or unsuccessfully?
Response: HPMS will email the Application Contact (found on the Contact screen in
Contract Management) when the HSD tables have gone through the Unload edit process.
The email will indicate if the Unload was successful. If unsuccessful, the email will provide
details on the errors encountered and will list a File Confirmation ID. You may contact the
HPMS help desk for assistance in resolving Unload errors. Be sure to reference the File
Confirmation ID so the HPMS help desk is able to quickly find your files and reports. A
separate email will be sent for both the Provider Table and the Facility Table.

7. How can I verify if my submission passed the “unload” validation edits successfully?

Response: You must look at the HSD Status Report on the Online Application page.
Applicants must use the following navigation path to access this report:
in HPMS. The ACC reports may be accessed at the following navigation path: HPMS Home
Page > Contract Management > Basic Contract Management > Select Contract Number >
Submit Application Data > HSD Submission Reports.

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address affiliated with the user ID performing the HSD table uploads will also receive an
email when the unload process has completed; that email will indicate if the unload was
successful or if errors exist.

8. When I access the HSD Status Report, the report provides the following message:
“Currently, there is no HSD Status Report for this contract.” What does this mean?

Response: This message means that your HSD submission is still in the “unload” validation
process. If you encounter this message, CMS strongly recommends that you check the report
at a later time. Once your submission completes the “unload” validation process, you will
see a link for each of the files (MA Provider File and MA Facility File). Also, the
Application Contact will be emailed when the Unload Process has completed.

9. The HSD Status Report indicates that my MA Provider and/or MA Facility submissions
have a status of “Unload Started.” What does that mean?

Response: The status of “Unload Started” means that your table or tables are in the process
of going through the edit routine. Once they have completed Unload edit process, the status
will be updated to “Unloaded Successfully” or “Unload Failed,” and an email will be sent to
the Part C Application Contact and the person who completed the upload.

10. The HSD Status Report indicates that my MA Provider and MA Facility submissions
have been “Unloaded Successfully.” What does that mean?
Response: Achieving the “Unloaded Successfully” status indicates that your submission has
passed all of the validation edits. If both the MA Provider and MA Facility Tables unload
successfully, your submission will be processed in the HSD pre-check or the final submission
process.

11. The HSD Status Report indicates that one or both of the HSD tables has an “Unload
Failed” status. What does that mean?
Response: An “unsuccessful unload” means that validation errors are present on your
file(s) and that until the errors are corrected, your submission will not be included in the
next HSD pre-check or final submission process. You must review your error report, make
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the necessary corrections to your file(s), resubmit the file(s) to HPMS, and pass the
“unload” process.

12. In the HSD Status Report, some messages are marked as informational. What does
that mean?

Response: Messages marked as “informational” are intended to highlight certain data
scenarios. You should review all informational messages to determine if the data being
highlighted is correct or if it requires a change. For example, you will receive an
informational message if your file does not have a row assigned to a county for a required

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specialty. If you do have a provider of that specialty serving that county, you would update
your file to add the row. If you do not have a provider of that specialty serving the county,
and you intend to submit an exception request, then no updates are required to your file. It is
important to note that informational messages do NOT prevent a file from passing “unload”
validation and moving on to the pre-check.

13. Some of the error messages indicate that I am missing data from fields on the table, but when
I look at my upload file, those fields are populated. Why am I getting this message?
Response: If your submission contains any formatting errors, you should first correct the
formatting errors and then resubmit your file(s) to HPMS. Formatting errors will skew the
unload validation of the files and may result in errors reading the files. You may contact the
HPMS help desk for assistance with this by emailing them at hpms@cms.hhs.gov.

14. Do I need to include every ACTIVE and PENDING non-employer county on the MA
Provider and MA Facility tables?
Response: Yes.

15. Are we required to list at least one of every provider and facility type for each of our
ACTIVE and PENDING non-employer only counties?
Response: The requirements are as follows:
a. On the MA Provider Table, you must include at least one type of Primary Care
Physician (provider codes 001-006) for every ACTIVE and PENDING non-employer
county in your application.
b. On the MA Facility Table, you must include at least one Acute Inpatient Hospital
(facility code 040) for every ACTIVE and PENDING non-employer county in your
application.
c. You must complete all required fields on both of the tables.
d. You must adhere to the edit rules for both of the tables.
e. Please read the HSD Instructions, located above, to determine which fields are
required and which are optional.
f. Please note that the edit rules in Appendix C apply ONLY to data edits which
determine if an applicant may hit Final Submit. A field marked as “optional” may be
required (see the field descriptions above), but the absence of the field will not be a
fatal error. You will still be found deficient if you don’t submit all required data.
Why do we do this? We do this to permit applicants to hit Final Submit. If these
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were “fatal” errors, you would not be permitted to final submit the application. To
reiterate, these edit rules (in Appendix C) indicate which errors are fatal and which
are informational. Actual required fields are noted above.
Note: The HSD Status Report will continue to list every county where a provider or
facility code has not been provided. Other than the edits indicated in points a. and b.
above, these messages are informational and will not prevent your files from being
processed.

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16. Can we include placeholder or dummy data on the MA Provider and MA Facility tables for
the pre-check?
Response: No. The inclusion of placeholder of dummy data will skew the results you receive
in the ACC reports.

17. What format must we use to submit the MA Provider and MA Facility Tables?

Response: You should use the following steps to ensure you are using the correct format:

a. Download the templates for the MA Provider and MA Facility Tables in the MA
download section on the Application Start Page.
b. Complete your files in Excel.
c. Save the files as tab-delimited text files (.txt).
d. Zip the .txt files.
e. Upload each file on the HSD Upload page.
Note: These instructions are also available on the HSD Upload Page.

18. Can you explain what the meaning of the “actual time” and “actual distance” fields on the
ACC report?
Response: The “actual time” and “actual distance” values reflect the percentage of
beneficiaries with access to at least one provider/facility within the required time or distance
criteria.

19. Can you explain when a listed provider is included in the Minimum Number of Providers
calculation?
Response: A submitted provider is included in the Number of Providers calculation when
he/she is located within the prescribed time and/or distance of at least one sample beneficiary
listed on the Sample Beneficiary file.
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20. I have listed twenty different providers for a specific county/specialty combination, and I
meet the Minimum Number of Providers check. How is it possible that I failed the Time
and/or Distance check?
Response: When performing the Minimum Number of Providers check for a specific
county/specialty combination, HPMS starts with the Provider addresses and ensures that at
least one sample beneficiary is within the time and/or distance indicated in the criteria. The
Time and/or Distance checks start with each of the sample beneficiaries in the county and
determine that at least 90% of them have at least one of the measured providers within the
prescribed Time and/or Distance criteria.

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NOTE: If your network consists of five specialists who all practice from the same building,
and one sample beneficiary lives across the street from the practice, within the Time and/or
Distance criteria, then all five will be included in the Minimum Number of Providers check.
However, at least 90% of all beneficiaries must have at least one of these provider types
within the time and/or distance of their specific location to pass the time and/or distance
checks.

21. How is an address identified as a “duplicate” on the Address Information report?

Response:
Providers are considered duplicates when they have the:
a.
b.
c.
d.

Same state/county code
Same provider code
Same NPI number
Same address or different address (i.e., a different address is still considered a
duplicate for the provider).
Note: When a different address is listed with the same state/county code, provider code
and NPI number combination, we will include the address in the calculation for “actual
time” and “actual distance,” but we will only count the provider once in determining the
minimum number of provider’s calculation.

Facilities are considered duplicates when they have the:
a.
b.
c.
d.

Same state/county code
Same facility code
Same NPI number
Same address

Note: A different address for a facility, even with the same state/county code, facility
code, and NPI number, is not considered a “duplicate.”

22. If a provider or facility appears on the Address Information Report, are they still used in the
automated calculations for the minimum number of providers, time, and distance?
Response: There are four reasons why an address may be listed on the Address Information
Report, and depending on the status, the address may or may not be included in the
automated processing. The four statuses are:
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a. Zip-Distributive – when an address is listed on this report with a reason of ZipDistributive, it means that it was not located in our mapping software. As long as the
zip code is valid, the software will include it in the ACC process by providing a
randomly generated geo-code within the zip code based on population density. The
randomly generated geo-code will be the same for the address every time the ACC
process is invoked.

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b. Invalid Address – an address is considered invalid if it is not contained in the
mapping software and the zip code is not valid. The address is not included in any
automated processing.
c. Duplicate Record – Please see question 16 above for an explanation of Duplicate
addresses for Providers and Facilities.
d. Not Supported by ACC – identifies addresses affiliated with certain situations which
are not supported by the automated review process and require a manual review.
23. How can I avoid having addresses listed as “Invalid” or “Zip-Distributive” on the Address
Information Report?

Response: Please see Appendix B for guidance on developing valid addresses for the
purposes of the HSD automated review.

24. Can you explain the methodology CMS employs in determining the time and distance check
for providers and facilities?

Response: CMS will provide additional information on the methodology for determining
time and distance results in a separate communication.

25. What are all of the edit checks applied to the MA Provider Table and MA Facility Table?

Response: Please see Appendix C for a listing of the field edits on the MA Provider Table
and the MA Facility Table.

Please note that the edit rules in Appendix C apply ONLY to data edits which determine if an
applicant may hit Final Submit. A field marked as “optional” may be required (see the field
descriptions above), but the absence of the field will not be a fatal error. You will still be
found deficient if you don’t submit all required data. Why do we do this? We do this to
permit applicants to hit Final Submit. If these were “fatal” errors, you would not be
permitted to final submit the application. To reiterate, these edit rules (in Appendix C)
indicate which errors are fatal and which are informational. Actual required fields are noted
above.

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26. Can I list providers or facilities that are part of my network as serving a county other than
where their office is located?
Response: Yes. You should associate providers or facilities within a given county on your
table(s) based on whether they serve beneficiaries residing within the county, not whether
they are physically located in the county itself.

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27. If only one of the files is successfully submitted and unloaded, will that file go through the
pre-check or final-submit process?
Response: In order for a submission to go through the pre-check or final-submit process,
both the MA Provider and MA Facility tables must be uploaded and unloaded successfully
prior to the established deadline.

28. What do the various messages in the HSD Status Report mean and which of these messages
will prevent my submission from going through the pre-check process?
Response:
a. File Processing Error – These are errors in the format of the submitted file. These
errors may prevent the system from reading the file correctly. Your HSD
submission will not be included in the pre-check process until you correct the
errors and successfully resubmit the HSD file(s).
b. Record Invalid – A record contains a restricted character. Restricted characters
are the greater than symbol, the less than symbol and the semi-colon ( < > ;).
Your HSD submission will not be included in the pre-check process until you
correct the errors and successfully resubmit the HSD file(s).
c. SSA State/County Not in ACTIVE or PENDING Service Area – The state/county
code you provided is not part of your contract’s non-employer only ACTIVE or
PENDING Service Area. Your HSD submission will not be included in the precheck process until you correct the errors and successfully resubmit the HSD
file(s).
d. Invalid/Missing Provider/Specialty Code – You have either entered an invalid
specialty code or you have not entered a Primary Care Physician (provider codes
001-006) for every ACTIVE and PENDING non-employer only county in your
service area. Your HSD submission will not be included in the pre-check or final
application process until you correct the errors and successfully resubmit the HSD
file(s).
e. Invalid/Missing Facility Code – You have either entered an invalid specialty code
or you have not entered an Acute Inpatient Hospital (facility code 040) for every
ACTIVE and PENDING non-employer only county in your service area. Your
HSD submission will not be included in the pre-check or final application process
until you correct the errors and successfully resubmit the HSD file(s).
f. Invalid Data Type – There is a processing error in the record due to incorrect data
type (example – alpha character in a numeric-only field). Your HSD submission
will not be included in the pre-check process until you correct the errors and
successfully resubmit the HSD file(s).
g. Invalid Length – There is a processing error in the record due to an invalid length
in a field. Your HSD submission will not be included in the pre-check process
until you correct the errors and successfully resubmit the HSD file(s).
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h. Invalid Data - There is a processing error in the record due to invalid data. Your
HSD submission will not be included in the pre-check process until you correct
the errors and successfully resubmit the HSD file(s).

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i.

j.

Required Field Missing – A required field or fields is missing from the
record. Your HSD submission will not be included in the pre-check process
until you correct the errors and successfully resubmit the HSD file(s).
Informational Messages – These messages provide you with information
about your submission. If there are missing provider codes or facility codes
for a county or counties, they will be listed here. You will still be included in
the pre- check process.

29. For Service Area Expansion Applications, must I submit HSD tables for all ACTIVE
and PENDING non-employer only counties affiliated with my contract?
Response: Yes.

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. Appendix B - Guidance on
Developing Valid Addresses
The following list the most common errors encountered with listing addresses in the HSD
files.

1. Do not put the Business Name in the address
line. Example:
Address
Dupage Obstetrics and
Gynecology

City

State

Zip

Amf Ohare

IL

60666

Reason
Address listed as Office
Name

2. Do not list an intersection as the
address. Example:
Address

City

State

Zip

E 65th St at Lake Michigan

Chicago

IL

60649

Reason
Intersection

3. Do not include a house, apartment, building or suite number in the
address. Example:
Address
306 US ROUTE ONE, BLDG
C-1
5900 B LK WRIGHT DR

City

State

Zip

Scarborough

ME

04074

Norfolk

VA

23502

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Reason
Should remove “BLDG
C-1”
Should remove “B”

4.

Enter the complete Street Number and Street Name in the address line.
Example:

Address
21 Cir Dr

City
Barrington

State

Zip

IL

60010

VA

23502

State

Zip

IL

60010

ME

04101

LK WRIGHT DR
Norfolk

Reason
Should enter “21
Circle Dr.”
Missing house
number

5. Do not enter extra words in the address line.
Example:
Address
450 W Hwy 22 Medical

City
Barrington

449 FOREST AVE PLZ
Portland

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Reason
Should remove
“Medical”
Should remove “PLZ”

6. Enter a valid Street Name.
Example:
Address

City

5900 LK Right DR

Norfolk

State

Zip

VA

23502

Reason
Correct name should
be “LK WRIGHT DR”

7. Enter correct Street Address and Zip Code combination in the address line.
Example:
Address
5900 LK WRIGHT DR

City
Norfolk

State

Zip

VA

21043

Reason
Should correct zip code
to be 23502

8. Enter the correct Street Number in the address line.
Example:
Address
12 LK WRIGHT DR

City
Norfolk

State

Zip

VA

23502

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Reason
12 is not a valid street
number.

.

Appendix C – Field Edits for the MA
Provider and Facility Tables

The following chart lists the SYSTEM edits for the MA Provider Table and the MA Facility Table. A
field marked as “not required” means the system will not reject the file if the field is blank. It does not
imply that the field should be blank. Please read the HSD Instructions, located above, to determine which
fields are required and which are optional.

MA Provider Table
Field

Description

SSA State/County Code
Name of Physician or MidLevel Practitioner
National Provider Identifier
(NPI) Number

VARCHAR2(5)

Specialty

VARCHAR2(150)

Provider Specialty Code
Contract Type
Provider Street Address
Provider City

VARCHAR2(3)
VARCHAR2(150)
VARCHAR2(250)
VARCHAR2(150)

Provider State Code
Provider Zip Code
If PCP, Accepts New
Patients

VARCHAR2(2)
VARCHAR2(10)
VARCHAR2(1)

Required (not null)
Required (not null) and validated against valid
values
Required (not null)
Required (not null)
Required (not null)
Required (not null). Validate the state code
against the valid list of state abbreviations
Required (not null)
Required only for provider types 001-006;
otherwise not required.

Medical Group Affiliation
Uses CMS MA Contract
Amendment

VARCHAR2(150)

Not Required

VARCHAR2(1)

Required (not null); Y for yes, N for no.

VARCHAR2(150)
VARCHAR2(10)

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Rule
Required (not null) and validated against valid
values (SSA County Code). Must be ACTIVE
or PENDING non-employer county attached to
contract.
Required (not null)
Required (not null) and validated that it is 10
digit numeric; May not be All Zeros.

Medicare Advantage Network Adequacy Criteria Guidance
(Last updated: January 10, 2017)

MA Facility Table
Field

Description

SSA State/County Code
Facility or Service Type

VARCHAR2(5)
VARCHAR2(150)

Facility Specialty Code
National Provider Identifier
(NPI) Number

VARCHAR2(3)
VARCHAR2(10)

# of Staffed, MedicareCertified Beds
Facility Name
Provider Street Address
Provider City

VARCHAR2(10)
VARCHAR2(150)
VARCHAR2(250)
VARCHAR(150)

Provider State Code

VARCHAR2(2)

Rule
Required (not null) and validated against valid
values (SSA County Code). Must be ACTIVE
or PENDING non-employer county attached to
contract.
Required (not null)
Required (not null) and validated against valid
values
Required (not null) and validated that is 10
digit numeric; May not be All Zeros.
Verify that entry is numeric since used in a
calculation. Required but only for the
following facility types: Acute Inpatient
Hospital (040), Critical Care Services - ICU
(043), Skilled Nursing Facilities (046), and
Inpatient Psychiatric Facility (052).
Required (not null)
Required (not null)
Required (not null)
Required (not null). Validate the state code
against the valid list of state abbreviations.

Provider Zip Code
VARCHAR2(10)
Required (not null)
Uses CMS MA Contract
Amendment
VARCHAR2(1)
Required (not null); Y for yes, N for no.
4.3.2 HPMS Network Management Module
The NMM, Org-Initiated Functionality, may be used to check Networks against the current
criteria. To Utilize the Org-Initiated Functionality, please reference the User Guide located at:
HPMS Home Page>Monitoring>Network Management>User Guide.

OMB Control Number: 0938-New (Expires: TBD)

pg. 13