FAQ Data Descriptions Providers 

Provider information in Data Set I recipient table includes the Primary Care Provider (PCP) for each recipient. In addition Data Set II includes a provider table which provides information concerning each provider, PCP or otherwise, that served any recipient in the recipient table over the course of the experience period.

As providers are a non-protected group under Health Insurance Portability and Accountability Act (HIPAA), HFS is able to release providers’ names, zip code and county, and National Provider Identifier (NPI) (or, if this is not available, a randomized “Key ID”). Additional information on specialty, Primary Care Case Management (PCCM) enrollment, Critical Access status, and reimbursement type is also included.

In Data Set II, claims-level data will include information on the providers utilized for each healthcare event.

No. If you find the totals for total recipients, costs, service events, or units of service vary between the recipient and provider files, contact Healthcare and Family Services (HFS) using the contact information included with your data sets.

Provider types are included in the data sets two ways. First, they are a data point that can be viewed directly in the provider portion of the data sets. Second, they are one of two components that are most often used to define Types of Service; information as to which provider type occurs in which Type of Service can be found in the data dictionary.

Nursing Facilities in Illinois often change ownership. This causes them to change provider IDs. Therefore, Healthcare and Family Serives (HFS) maintains a building ID code that is used for tracking Nursing Facilities across ownership changes. This information is not included in the data sets. As the experience period is only one year, we expect that ownership changes will not have a significant impact on the data. We might add this as a supplement to provider number for future releases, and we invite your feedback on this point.