Network Manager

This tool is available only to users that have Security Official Access.

To access the Network Manager go to the Admin tab in the upper right hand corner of your screen and choose 'Network Manager' from the drop down menu.

Step 1 - TIN Setup (Optional)

During this step you will create your TIN and NPI relationships.

Users should review their TINs and NPIs with each HALR and QALR import to ensure all of your TIN and NPI data is current and accurate.

1) Select the effective period you want to work with from the drop down.

2) Download Current TIN Configuration (will match the effective period selected). Clicking this button will download an Excel file containing existing TIN and NPI relationship data in the selected effective period. This file is used when a provider or practice needs to be added or removed while keeping most of the configuration the same.

3) Download TIN Template, clicking this button will download an Excel file with the required headers that may be filled in with TIN/NPI relationships. This file is used to set initial relationships or completely reconfigure TIN/NPI mappings.

4) Toggle TIN Grid, Shows a list of all TINs that have been received from the assignment file. Use this to verify all TINs are accounted for on the template before uploading.

5) Click Choose File, to select your configured file from your computer for upload.

6) Click Upload TIN Data, when you are ready to continue to the review page. Make sure you are in the correct effective period before uploading your file.

7) In the History section the Download button generates an Excel file that contains TIN/NPI relationship data at the indicated date and time. This configuration entry is made to show settings before an import file was uploaded.

8) If you do not have any changes to make to the TIN/NPI configurations, click the Skip button to move past the TIN setup page and on to the next step.

9) The Skip to Review All button allows you to move to the review page for all patients in your database.

Step 1 - TIN Setup

Notes: As imports are made to sections of the Network Manager system, the History section will expand to show previous entries based on date. You may download a copy of historical imports as required.

When creating a file for upload, the following columns are required:

1) TIN Name - The name of the TIN as it appears in the HPMS or most recent assignment file

2) TIN Number - The TIN number associated to the TIN. New TINs can be added that are not present within the most recent assignment file but will not be utilized by the patient assignment algorithm.

3) Primary Care Practice or Specialist - This column allows a P, S, or Blank. P will designate a TIN as being a primary care practice, and S will designate a TIN as being a specialist, and a Blank, will skip a TIN in the patient assignment algorithm but utilize the TIN in the in-network configuration.

4) Associated NPI - The NPI number that is billing through the associated TIN. A Physician NPI can be associated to more than one TIN while a Facility NPI can only be associated to one TIN.

5) Facility NPI - This column allows a Yes or NO to indicate an NPI as being a facility. If YES is used, the next column must be left blank for this TIN/NPI relationship and the NPI cannot be used in any other TIN relationships.

6) Primary Care Provider or Specialist - This column allows a P, S, or Blank. The P will designate an NPI as being a primary care provider, and S will designate an NPI as being a specialist, and a Blank will skip and NPI in the patient assignment algorithm but utilize the NPI in the in-network configuration.

Notes: To remove an NPI from a TIN, simply remove the row that assigns that specific NPI to a TIN. If a patient is part of this TIN/NPI relationship, they will be unassigned from the NPI but remain assigned to the TIN. If the TIN is fully removed the patient will be unassigned in both fields. Please keep in mind, all TINs and NPIs that are part of your organization's most recent assignment file MUST be included in the template in order for the import to work correctly. You will receive an error if any TINs from the assignment file are missing from the import.

Step 2 - CCN Setup (Optional)

The TIN Review page gives you the ability to review and correct the data you just uploaded before making the updates final.

1) If one or more of the TINs being imported encounter a ERROR, a red error message is displayed near the top of the page. You must fix the error(s) by clicking Back and uploading a new file with corrections made before moving to the next step.

2) If one or more of the TINs being imported encounter a WARNING, 2 yellow warning messages will be displayed near the top of the page, but you may still continue with your configuration by clicking Submit. We recommend that the warnings be reviewed carefully before choosing to submit the data. If you find some of the data needs to be corrected, click the Back button and upload a corrected file.

3) If none of the TINs being imported encounter an Error or WARNING, the message below will still appear, but no action is required. To continue with your configuration click the Submit button.

TIN Review Page

During this step you have the option to import CMS Certification Numbers, or CCNs. CCNs are similar to NPIs in that they may be associated with specific TINs. If your organization uses CCNs that have not been mapped to TINs in the system, this step will appear as Mandatory instead of optional. You will not be able to move forward from this step until missing CCNs are mapped.

To view missing CCNs click on the 'Toggle missing CCNs Grid +/-' button.

Once you click on this button you will see a grid of your Unmapped CCNs. To update your CCNs follow the steps below.

1) Click Download Current Configuration to view the current CCN data configurations.

2) Click Download CCN Template to download a blank spreadsheet for initial CCN configurations.

3) Click Choose File, to select your configured file from your computer for upload.

4) Click Upload CCN Data, when you are ready to continue to the review page.

5) Click Back to go back and review the previous step.

6) If you do not have any changes to make to CCN configurations, click the Skip button to move past the CCN setup page and on to the next step.

7) In the History section the Download button generates an Excel file that contains CCN configuration data at the indicated date and time. This configuration entry is made to show settings before an import file was uploaded.

When creating a file for upload, the following columns are required:

Step 2 - CCN Setup

TIN Number - The exact TIN number as it appears in HPMS or the most recent patient assignment file.

CCN - The exact CCN that should be associated with the TIN in the left column

Step 3 - Division Setup (Optional)

During this step you have the ability to setup Divisions. Divisions are groups of TINs that can be utilized when filtering data throughout Health Endeavors. Divisions are used to group multiple TINs into a region or organization.

For example, one layout of divisions could be 10 TINs represent service area 1, while 8 other TINs represent service area 2 and their associated data would need to be broken apart to look at each service area independently.

If you are not using Divisions, you may click on the Skip button to move onto the next step.

1) Select the effective period you want to work with from the drop down.

2) Click Download Current Configuration to view the current Division data configurations.

3) Click Download Division Template to download a blank spreadsheet for Division configurations.

4) Click Choose File, to select your configured file from your computer for upload.

5) Click Upload Division Data, when you are ready to continue to the review page.

6) Click Back to go back and review the previous step.

7) If you do not have any changes to make to Division configurations, click the Skip button to move past the Division setup page and on to the next step.

7) In the History section the Download button generates an Excel file that contains Division configuration data at the indicated date and time. This configuration entry is made to show settings before an import file was uploaded.

Step 3 - Division Setup

Division Name - This is the naming convention that will be given to a division. Health Endeavors recommends using a unique name for each division.

TIN Number - The exact TIN number as it appears in HPMS or the most recent patient assignment file.

*If you would like a division to have multiple TINs, use a new row for each unique TIN Number belonging to that division.

When creating a file for upload, the following columns are required:

Step 4 - Subgroup Setup (Optional)

During this step you have the ability to setup Subgroups. Subgroups are groups of NPIs within a TIN that can be utilized when filtering data throughout Health Endeavors. Subgroups are typically used to group multiple NPIs into a practice that may be part of TIN. If your organization chooses to use Subgroups/Sub-TINs, configuring this area will create assignable permissions in My Team for users under a TIN/practice that has one or more subgroups associated with it.

An example of a Subgroup could be 10 NPIs that represent a primary care practice, while 8 other NPIs represent a cardiology office and their associated data would need to be broken apart to look at each practice independently.

If you are not using Subgroups, you may click on the Skip button to move on to the next step.

1) Select the effective period you want to work with from the drop down.

2) Click Download Current Configuration to view the current Subgroup data configurations.

3) Click Download Subgroup Template to download a blank spreadsheet for Subgroup configurations.

4) Click Delete All Subgroups to remove all subgroups from the selected effective period.

5) Click Choose File, to select your configured file from your computer for upload.

6) Click Upload Subgroup Data, when you are ready to continue to the review page.

7) Click Back to go back and review the previous step.

8) If you do not have any changes to make to Subgroup configurations, click the Skip button to move past the Subgroup setup page and on to the next step.

9) In the History section the Download button generates an Excel file that contains Subgroup configuration data at the indicated date and time. This configuration entry is made to show settings before an import file was uploaded.

Step 4 - Subgroup Setup

When creating a file for upload, the following columns are required:

Subgroup Name - This is the naming convention that will be given to a Subgroup. Health Endeavors recommends using a unique name for each Subgroup.

Associated Individual and Facility NPIs - The exact NPI numbers that are to be part of a Subgroup. Multiple NPIs may be associated to a single Subgroup by separating each with a semicolon(;) in this column

TIN Number - The exact TIN number as it appears in HPMS or your most recent patient assignment file.

Step 5 - Patient Assignment Setup

The Patient Assignment step is required. During this step you will designate how patients are assigned. There are two available options and you must choose one to move forward:

1) No - manual assign from file or 2) Yes - setup and run algorithm

1) No - Manual assign from file - If Chosen, the Patient Assignment Setup page will appear.

A) Choose the population you will working with from the drop down menu. The system will default to your Medicare population.

B) Choose the Effective Period you would like to work with from the drop down menu.

C) Click Download Current Configuration if you would like to make updates to current patient assignments.

D) Click Download Patient Assignment Template to download a blank template.

E) Click Choose File, to select your configured file from your computer for upload.

F) Click Upload Patient Assignment Data, when you are ready to continue to the review page.

G) Click Back to review the previous step

H) Click Skip to move to the Network Manager Review.

Note: You may assign patients to any TIN, real or fake, through this import. If the patient assignment algorithm cannot be used to assign the patient as needed, this import may be used instead.

Step 5 - Patient Assignmet Setup

Step 6a - Manual Assign

When creating a file for upload, the following columns are required:

MBI/Enrollment Number - This field would be considered the unique ID given to the beneficiary.

First Name - The given name of the beneficiary

Last Name - The family name of the beneficiary

DOB - The date of birth of the beneficiary. This field is to be formatted as a date in the MM/DD/YYYY format.

Gender - The sex of the beneficiary. This field is to be formatted as M for male and F for female.

TIN Number - The TIN associated to the patient for assignment purposes

MRN - The Medical Record Number associated with the beneficiary

Assigned NPI Number - The providers NPI associated to the beneficiary for assignment purposes.

2) Yes, Setup and run algorithm - If Chosen, the Algorithm Setup will need to be configured prior to running the algorithm itself.

A) Choose the population you will working with from the drop down menu. The system will default to your Medicare population.

B) Choose the Effective Period you would like to work with from the drop down menu.

C) Override manual keyed in Beneficiary Database or Uploaded file?

If YES is chosen any previously uploaded or manually entered assignments will be overridden.

If NO is chosen manually entered or uploaded assignments will NOT be overridden.

D) Process Type

Fully Process will apply to all patients using data from the most recent patient assignment file.

Partial Process will only attempt to assign newly attributed patients as well as patients who currently do not have a TIN/NPI assignment.

E) Choose the Claims look-back period (12 or 36 months) for the algorithm to use for patient assignments

F) Click Save Selections & Run Algorithm once you have completed your selections. After algorithm has run you will be brought to the Network Manager Review page.

G) Click Back to review the previous step

The algorithm runs off of the most recent HALR/QALR file provided to your organization. Based on the data within the file, patients are assigned to a TIN and NPI combination based on their most relevant and/or most frequent provider. For a patient to be assigned by the algorithm, some basic requirements need to be met:

The TIN and NPI assignment must be possible based on the current TIN configuration. If the TIN and NPI are not associated with each other, or if either/both are set to SKIP, the patient will be mapped to the next best selection or left unassigned if no other option is available.
If a patient has multiple entries in a HALR/QALR file, certain configuration factors determine where the patient is assigned. For example, if a patient has a HALR/QALR data with two TINs and/or NPIs, and one NPI is configured as a Primary Care Provider and the other as a Specialist, the patient will be assigned to the TIN/NPI that contains the Primary Care Provider.
If more than one entry is configured as in the chart specifications below, items highlighted in RED indicate the factor ethat will break a tie. For example, if a patient has HALR data with two primary TINs and /or NPIs, the entry with the highest number of visits will break the tie. If both visit counts are the same, the most recent visit will break the tie.
If a tie remains after all tie-breakers have been considered, the patient will not be assigned to and TIN/NPI. The patient may still be assigned manually.

NPI

Primary

Specialist

Identical

Skip (Or Facility NPI)

Primary

Specialist

Skip (Or Facility NPI)

TIN

Primary

Specialist

Primary

Specialist

Identical

Primary

Specialist

Skip

Visits

Most Visited NPI

N/A

Most Visited NPI

Identical

N/A

Most Recent Visit

N/A

Yes

Identical

N/A

Assignment Priority

Unassigned

Not assigned to this NPI

Not assigned to any NPI in this TIN

Step 6b - Run Algorithm