Provider Network Status Report (PNSR)
Last updated: January 10, 2012.
About the report
What is the Provider Network Status Report (PNSR) and why is it needed?
The PNSR is a downloadable data set containing information about providers' L&I medical provider network (MPN) status. Self-insured employers (SIEs), third-party administrators (TPAs) and bill processing firms may import this report into their information management systems, to efficiently and appropriately pay bills when the new medical provider network goes into effect on January 1, 2013.
In 2011, the Washington legislature passed a number of workers' compensation reforms in Substitute Senate Bill 5801. One of those called for the Department of Labor & Industries (L&I) to create a medical provider network, wherein only network providers could provide ongoing care (beyond emergency care or the initial visit) to injured workers. Workers covered by Washington's State Fund workers' compensation program, as well as those covered by self-insured employers, will need to see network providers for ongoing care.
- What provider types are included in the PNSR?
Only the following provider types practicing in Washington will be required to enroll in the network at this time, so the PNSR will only contain information for these types:
- Physicians*.
- Osteopathic Physicians*.
- Chiropractors.
- Naturopathic Physicians.
- Podiatric Physicians & Surgeons.
- Advanced Registered Nurse Practitioners.
- Physician Assistants.
- Dentists.
- Optometrists.
*There are some specialties (within provider type) that will not be required to be in the network. These include:
- Pathologists.
- Emergency Room Providers.
- Hospitalists.
- Consulting Radiologists in a Hospital Radiology Dept.
- Anesthesiologist (or CRNA not in a pain mgmt program).
- What are the main differences between the PNSR and L&I's FindADoc online provider directory?
Item PNSR FindADoc Electronic report for downloading Yes No Provider network status history Yes No Providers who can only treat for initial visit Yes No Providers who have applied, but network status is pending Yes No Provider individual NPI Yes Yes L&I Provider ID Yes Yes Provider types other than the 9 currently being credentialed into network
(e.g. out of state/country, OT, PT, hospitals, labs, etc.)No Yes Provider practice location addresses and contact information No Yes Easy search for providers by location, type and specialty No Yes Mapping and driving directions to provider practice location No Yes - Where can I find L&I's FindADoc online provider directory?
- What are the PNSR file formats?
Identical data is available in 3 different report formats. Download the format that best meets your needs.
- EXCEL for occasional viewing.
- Tab-delimited and XML for importing.
- How can self-insured employers retrieve the PNSR?
Files are available at PNSR. Customers can manually download the files or write scripts to import them.
- Will a special login and password be needed to access the PNSR?
No.
- What is the approximate file size?
The tab-delimited and Microsoft Excel versions of the report will start out about 4MB. The XML version will be closer to 16MB. File size will grow over time, due to the inclusion of status history. If file size impedes easy downloading in the future, L&I will explore options for archiving historical information.
- How often is the PNSR updated?
Every day by 7 a.m.
- Does each new PSNR include only changes since the previous report or is it a complete replacement report?
Each PNSR extract is a complete replacement file. This lowers the risk of information gaps, should importation fail or if network status data is completely lost.
About data contained in the PNSR
- Does the PNSR contain historical network status information?
Yes. It also contains history of providers' status related to special programs, such as COHE.
- What is the key element in each provider's record?
Individual National Provider Identifier (NPI). All provider records contained in the PNSR will have an NPI.
- Does the PNSR contain provider address and Tax Identification Number (TIN)?
No. To minimize file complexity and make the file available without extensive security measures, these items are not included. Practice location is available in L&I's Find A Doctor online provider directory.
- Does the PNSR contain providers' status information and effective dates for special programs like Centers for Occupational Health & Education (COHE), the Orthopedic-Neurological Surgical Pilot Project and the network's Top Tier?
Yes. Historical status information is included. Please note that self-insured participation in COHE and the Ortho-Neuro Pilot project is voluntary and requires enrollment by the employer.
- Are billing codes and fees related to special programs included in the PNSR?
No. COHE and Ortho-Neuro codes and fees are available through other documentation for those projects. Top-tier codes and fees, when developed, will most likely be incorporated into L&I's Medical Aid Rules and Fee Schedules (MARFS).
- Does the PNSR contain providers' L&I Provider ID?
Yes. Please note that some providers have multiple L&I Provider IDs, if they are associated with multiple organizational NPIs and Tax Identification Numbers (TIN).
- Is the provider's network status tied to any specific L&I Provider ID?
No. Network status is tied to the provider's individual NPI.
- Does the PNSR contain names of providers who have applied to the MPN, but whose network status has not yet been determined?
Yes. See the Definitions Look-Up Table (100412) (29 KB MS Excel) for descriptions of all Network Codes, which includes status codes for providers whose applications are in-process.
About Provider Types and Specialty Codes
- Why aren't there more specialties available in the data for Advanced Registered Nurse Practitioners (ARNP)?
Currently L&I is only using 3 specialty codes for ARNPs: N1 (NURSE ARNP), N3 (NURSE ANESTHETIST, CERTIFIED REGISTERED) and 36 (PSYCHIATRIC). Only one specialty code is being used for Physician Assistants: 01 (General Practice). L&I is only using these specialties, due to difficulty in verification for these provider types.
- Where does L&I obtain its taxonomy for specialty codes?
Our taxonomy is updated twice a year, based on information from Washington Publishing Company (wpc-edi.com), which uses taxonomy derived from the National Uniform Claim Committee.
