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{"sheet":"Network Information","index":0,"n_rows":30,"n_cols":2,"rows_kept":30,"cut":false,"hidden":false,"merged":[[0,0,0,1],[2,0,2,1]]}
["2027 Network Adequacy Review"]
[]
[" Enter data only in column B. See user manual for detailed instructions. "]
[]
["Plan and Network Questions","Enter Information"]
["Plan Name"]
["Network Name"]
["Network ID"]
["Service Area"]
["Is this a returning network?"]
["If returning network, did your service area change?"]
["If your service area changed, what changed?"]
["Plan Type"]
["On-Exchange or Off-Exchange"]
["If On-Exchange, select type"]
["Individual Plan"]
["Small Group Plan"]
["Large Group Plan"]
["ACO or Narrow"]
["Does this network offer pharmacy services?"]
["If yes, do you use a Pharmacy Benefit Manager (PBM)?"]
["If yes, PBM Entity Name"]
["If yes, PBM Network Name"]
["Provider File Contact Name"]
["Provider File Contact Phone"]
["Provider File Contact Email"]
["ECP Contact Name"]
["ECP Contact Phone"]
["ECP Contact Email"]
["By typing my name in the signature field, I understand that I am electronically signing this form. I understand that my electronic signature has the same legal effect and can be enforced in the same way as a handwritten signature. (MN Statutes, Chapter 325L.07) I also attest that the network data provided is representative of signed contracts in place, and that all data submitted is accurate and current as of the date of filing. ","Please type your name and the date here."]

{"sheet":"Provider File Template","index":1,"n_rows":2,"n_cols":35,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
[]
["NPI","Secondary NPI","Individual Provider Last Name","Individual Provider First Name","Individual Provider Middle Initial","Facility Name","Individual Provider Type","Individual Provider Code","Facility Type","Facility Code","Taxonomy","Services Children and Adolescents","ECP Designation","Chemical Dependency Services ECP","Family Planning ECP","Indian Health Care Service Provider ECP","Mental Health Services ECP","Primary Care Services ECP","Medical Services ECP ","Dental Care ECP ","Physical Rehab Services ECP ","Home Care Services ECP ","Birth Centers ECP ","Psychiatric Residential Treatment (under 21) ECP ","Offers Telehealth","Street Address 1","Street Address 2","City","County","State","Zip Code","Accepting New Patients","Medical Group / Health System","Hospital Admitting Privileges NPI","Provider Status"]

{"sheet":"Appointment Wait Times","index":2,"n_rows":15,"n_cols":3,"rows_kept":15,"cut":false,"hidden":false,"merged":[]}
["D.2","Health Plan Name",{"$f":"'Network Information'!B6","v":0}]
["D.3","Network Name  \n",{"$f":"'Network Information'!B7","v":0}]
["D.4","Network ID  \n",{"$f":"'Network Information'!B8","v":0}]
[null,"Appointment Wait Times","(If you only have %, please estimate numbers)"]
["Q.1","Total number of network enrollees in Minnesota as of April 1, 2026"]
["Q.2","Number of enrollees with in-person behavioral health care appointments available within 10 business days"]
["Q.3","Number of enrollees with telehealth behavioral health care appointments available within 10 business days"]
["Q.4","Number of enrollees with in-person primary care (routine/preventive) appointments available within 15 business days"]
["Q.5","Number of enrollees with telehealth primary care (routine/preventive) appointments available within 15 business days"]
["Q.6","Number of enrollees with in-person specialty care appointments available within 30 business days"]
["Q.7","Number of enrollees with telehealth specialty care appointments available within 30 business days"]
[null,"Secret Shopper Surveys"]
["Q.11","How often do you administer secret shopper surveys to evaluate appointment wait times? (Dropdown)"]
["Q.10","Are secret shopper surveys network specific or across all networks? (Dropdown)"]
["Q.9","If you do not administer secret shopper surveys, what process do you use to determine appointment wait times?"]

{"sheet":"General Waivers","index":3,"n_rows":501,"n_cols":7,"rows_kept":501,"cut":false,"hidden":false,"merged":[]}
["Plan Name","Network Name","Network ID","Provider Type","County","Reason","In 2-3 sentences, please justify why you selected this code."]
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{"sheet":"ECP Waivers","index":4,"n_rows":495,"n_cols":7,"rows_kept":495,"cut":false,"hidden":false,"merged":[]}
["Plan Name","Network Name","Network ID","ECP Category","County","Reason Code","Please explain, in 2-3 sentences, why you are requesting an ECP waiver."]
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{"sheet":"Lookup","index":5,"n_rows":300,"n_cols":18,"rows_kept":300,"cut":false,"hidden":false,"merged":[]}
["Individual Provider Types","Individual Provider Code","Facility Types","Facility Code","NUCC Taxonomy Code","County Name","State Code","ECP Designation","Services Children and Adolescents","<select a county>","<select an ECP type>","<select a reason>","Accepting New Patients","Provider Status","Offers Telehealth","<select one>","<select one>","valid address"]
["General Practice","001","Acute Inpatient Hospitals (Must have Emergency services available 24/7)","040","171100000X","Statewide","AL","State","Yes","Aitkin","Chemical Dependency Services ECP","1. provider does not meet carrier's data requirements, utilization review, and quality assurance requirements","Yes","active","Yes","Acupuncture","1. no providers physically present","E101 4th Street"]
["Family Medicine","002","Cardiac Surgery Program","041","207K00000X","Aitkin","AK","QHP","No","Anoka","Family Planning ECP","2. plan has made a good faith effort to contract with provider (s) that has not been successful","No","inactive","No","Allergy and Immunology ","2. provider did not meet plan's credentialing requirements","N14 W24200 West Tower Place"]
["Internal Medicine","003","Cardiac Catheterization Services","042","207KA0200X","Anoka","AZ","Both",null,"Becker","Indian Health Care Service Provider ECP",null,null,null,null,"Anesthesiology Physicians and Certified Registered Nurse Anesthetist","3. after good faith attempt, provider refused contract","S68W15500 Janesville Road"]
["Geriatrics","004","Critical Care Services - Intensive Care Units (ICU)","043","207KI0005X","Becker","AR","No",null,"Beltrami","Mental Health Services ECP",null,null,null,null,"Cardiology","4. network is an Accountable Care Organization (ACO) or Narrow Network","N15W28300 Golf Road"]
["Primary Care - Physician Assistant","005","Surgical Services (Ambulatory Surgical Centers and Outpatient Hospital)","045","207RA0201X","Beltrami","CA",null,null,"Benton","Primary Care Services ECP",null,null,null,null,"Cardiothoracic Surgery ",null,"N21W23340 Ridgeview Parkway West"]
["Primary Care - Advanced Registered Nurse Practitioner","006","Skilled Nursing Facilities","046","207RI0001X","Benton","CO",null,null,"Big Stone","Medical Services ECP",null,null,null,null,"Chiropractic Services "]
["Allergy and Immunology","007","Diagnostic Radiology (Free-standing; hospital outpatient; ambulatory health facilities with Dx Radiology)","047","2080P0201X","Big Stone","CT",null,null,"Blue Earth","Dental Care ECP",null,null,null,null,"Colon and Rectal"]
["Cardiology","008","Mammography","048","207L00000X","Blue Earth","DE",null,null,"Brown","Physical Rehab Services ECP",null,null,null,null,"Dental - General"]
["Chiropractor","010","Inpatient Psychiatric (Free-standing inpatient behavioral health facility and behavioral health beds within an Acute Care Hospital)","052","367500000X","Brown","DC",null,null,"Carlton","Home Care Services ECP",null,null,null,null,"Dermatology"]
["Dermatology","011","Outpatient Infusion/Chemotherapy","057","207LP3000X","Carlton","FL",null,null,"Carver","Birth Centers ECP",null,null,null,null,"Emergency Medicine "]
["Endocrinology","012","Substance Use Disorder Rehabilitation Facility (Hospital unit and residential treatment facility)","072","367H00000X","Carver","GA",null,null,"Cass","Psychiatric Residential Treatment (under 21) ECP",null,null,null,null,"Endocrinology"]
["ENT/Otolaryngology","013","Mental Health Residential Treatment Facility (Mental Illness; Psychiatric)","076","207LC0200X","Cass","HI",null,null,"Chippewa",null,null,null,null,null,"ENT/Otolaryngology "]
["Gastroenterology","014","Urgent Care","080","207LP2900X","Chippewa","ID",null,null,"Chisago",null,null,null,null,null,"Gastroenterology"]
["General Surgery","015","Home Healthcare Agency","60","207LH0002X","Chisago","IL",null,null,"Clay",null,null,null,null,null,"General Surgery "]
["Gynecology (OB/GYN)","016","Substance Use Disorder (Outpatient)","CD2F","207RA0001X","Clay","IN",null,null,"Clearwater",null,null,null,null,null,"Gynecology OB/GYN "]
["Infectious Diseases","017","Children's Substance Use Disorder Rehabilitation Facility","P072","207RA0002X","Clearwater","IA",null,null,"Cook",null,null,null,null,null,"Infectious Disease "]
["Nephrology","018","Children's Residential Treatment Facility (Mental Illness; Psychiatric)","P076","207RC0000X","Cook","KS",null,null,"Cottonwood",null,null,null,null,null,"Mental Health Providers (outpatient therapy) "]
["Neurology","019","Birthing Center","BC","207RI0011X","Cottonwood","KY",null,null,"Crow Wing",null,null,null,null,null,"Mental Health Provider Prescribers "]
["Neurosurgery","020","Pediatric Specialty Hospital","PH","2080P0202X","Crow Wing","LA",null,null,"Dakota",null,null,null,null,null,"Nephrology"]
["Oncology - Medical & Surgical","021","Psychiatric Residential Treatment Facility (DHS PRTF)","PR","208G00000X","Dakota","ME",null,null,"Dodge",null,null,null,null,null,"Neurology"]
["Oncology - Radiation","022","Residential Treatment Facility","RT","111N00000X","Dodge","MD",null,null,"Douglas",null,null,null,null,null,"Neurosurgery"]
["Ophthalmology","023","Organ Transplant Center","TC","111NI0900X","Douglas","MA",null,null,"Faribault",null,null,null,null,null,"Occupational Therapy "]
["Orthopedic Surgery","025","Essential Community Provider","ECP","111NN0400X","Faribault","MI",null,null,"Fillmore",null,null,null,null,null,"Oncology-Medical and Surgical "]
["Physical Medicine, Rehabilitation, and Occupational Medicine","026",null,null,"111NN1001X","Fillmore","MN",null,null,"Freeborn",null,null,null,null,null,"Oncology-Radiation "]
["Plastic Surgery","027",null,null,"111NP0017X","Freeborn","MS",null,null,"Goodhue",null,null,null,null,null,"Ophthalmology"]
["Podiatry","028",null,null,"111NR0200X","Goodhue","MO",null,null,"Grant",null,null,null,null,null,"Orthopedic Surgery "]
["Psychiatry","029",null,null,"111NR0400X","Grant","MT",null,null,"Hennepin",null,null,null,null,null,"Physical Medicine, Rehabilitation and Occupational Medicine "]
["Pulmonology","030",null,null,"111NS0005X","Hennepin","NE",null,null,"Houston",null,null,null,null,null,"Physical Therapy "]
["Rheumatology","031",null,null,"111NT0100X","Houston","NV",null,null,"Hubbard",null,null,null,null,null,"Plastic Surgery"]
["Urology","033",null,null,"111NX0100X","Hubbard","NH",null,null,"Isanti",null,null,null,null,null,"Podiatry"]
["Vascular Surgery","034",null,null,"111NX0800X","Isanti","NJ",null,null,"Itasca",null,null,null,null,null,"Primary Care-Adult "]
["Cardiothoracic Surgery","035",null,null,"208C00000X","Itasca","NM",null,null,"Jackson",null,null,null,null,null,"Primary Care-Pediatric "]
["Emergency Medicine","037",null,null,"1223E0200X","Jackson","NY",null,null,"Kanabec",null,null,null,null,null,"Pediatric Specialty Care"]
["Physical Therapy","049",null,null,"122300000X","Kanabec","NC",null,null,"Kandiyohi",null,null,null,null,null,"Pulmonology"]
["Occupational Therapy","050",null,null,"1223G0001X","Kandiyohi","ND",null,null,"Kittson",null,null,null,null,null,"Rheumatology "]
["Speech Therapy","051",null,null,"1223X0400X","Kittson","OH",null,null,"Koochiching",null,null,null,null,null,"Speech Therapy "]
["Genetics","08",null,null,"1223P0221X","Koochiching","OK",null,null,"Lac Qui Parle",null,null,null,null,null,"Urology "]
["Anesthesiology Physicians and Certified Registered Nurse Anesthetists","41",null,null,"1223P0300X","Lac Qui Parle","OR",null,null,"Lake",null,null,null,null,null,"Vascular Surgery "]
["Colon and Rectal","50",null,null,"1223P0700X","Lake","PA",null,null,"Lake Of The Woods",null,null,null,null,null,"Acute Inpatient Hospitals (24/7 Emergency Services Required) "]
["Primary Care - Pediatric","101",null,null,"207N00000X","Lake of the Woods","RI",null,null,"Le Sueur",null,null,null,null,null,"Cardiac Catheterization Services "]
["Social Worker","102",null,null,"207ND0101X","Le Sueur","SC",null,null,"Lincoln",null,null,null,null,null,"Cardiac Surgery Program "]
["Psychologist","103",null,null,"207ND0900X","Lincoln","SD",null,null,"Lyon",null,null,null,null,null,"Critical Care Services – Intensive Care Units "]
["Marriage and Family Therapist","105",null,null,"207NI0002X","Lyon","TN",null,null,"Mahnomen",null,null,null,null,null,"Diagnostic Radiology"]
["Addiction (Substance Use Disorder) Counselor","106",null,null,"207NP0225X","McLeod","TX",null,null,"Marshall",null,null,null,null,null,"Inpatient or Residential Behavioral Health Facility Services "]
["Counselor (Mental Health and Professional)","107",null,null,"207NS0135X","Mahnomen","UT",null,null,"Martin",null,null,null,null,null,"Mammography"]
["Behavioral Health - Advanced Practice Registered Nurse","108",null,null,"207P00000X","Marshall","VT",null,null,"McLeod",null,null,null,null,null,"Outpatient Infusion/Chemotherapy "]
["Psychiatric Pharmacist","109",null,null,"207PE0005X","Martin","VA",null,null,"Meeker",null,null,null,null,null,"Psychiatric Residential Treatment Facility (PRTF) "]
["Dental - General","201",null,null,"207PH0002X","Meeker","WA",null,null,"Mille Lacs",null,null,null,null,null,"Skilled Nursing Facilities "]
["Dental - Orthodontist","202",null,null,"207PP0204X","Mille Lacs","WV",null,null,"Morrison",null,null,null,null,null,"Substance Use Disorder (Outpatient) "]
["Dental - Periodontist","203",null,null,"207PS0010X","Morrison","WI",null,null,"Mower",null,null,null,null,null,"Surgical Services (Outpatient or ASC)"]
["Dental - Endodontist","204",null,null,"207PT0002X","Mower","WY",null,null,"Murray",null,null,null,null,null,"Residential Treatment Facility "]
["Dental - Oral Surgery","205",null,null,"1223S0112X","Murray",null,null,null,"Nicollet",null,null,null,null,null,"Urgent Care "]
["Dental - Prosthodontist","206",null,null,"2080P0204X","Nicollet",null,null,null,"Nobles"]
["Addiction Medicine Physician","800",null,null,"207RE0101X","Nobles",null,null,null,"Norman"]
["Behavioral Analyst","801",null,null,"163WD0400X","Norman",null,null,null,"Olmsted"]
["Pediatric Dental","P201",null,null,"2080P0205X","Olmsted",null,null,null,"Otter Tail"]
["Acupuncture","AP",null,null,"231H00000X","Otter Tail",null,null,null,"Pennington"]
["Lactation Counselor","LA",null,null,"207Y00000X","Pennington",null,null,null,"Pine"]
["Pediatric Specialty Care","PE",null,null,"207YP0228X","Pine",null,null,null,"Pipestone"]
["Pediatric Anesthesiology Physician","PE41",null,null,"207YS0012X","Pipestone",null,null,null,"Polk"]
["Pediatric Allergy/Immunology","PE007",null,null,"207YS0123X","Polk",null,null,null,"Pope"]
["Pediatric Cardiology","PE008",null,null,"207YX0007X","Pope",null,null,null,"Ramsey"]
["Pediatric Emergency Medicine Physician","PE037",null,null,"207YX0602X","Ramsey",null,null,null,"Red Lake"]
["Pediatric Endocrinology","PE012",null,null,"207YX0901X","Red Lake",null,null,null,"Redwood"]
["Pediatric Gastroenterology","PE014",null,null,"207YX0905X","Redwood",null,null,null,"Renville"]
["Pediatric Hematology/Oncology","PE021",null,null,"170100000X","Renville",null,null,null,"Rice"]
["Pediatric Infection Disease","PE017",null,null,"207ZP0007X","Rice",null,null,null,"Rock"]
["Pediatric Nephrology","PE018",null,null,"207SC0300X","Rock",null,null,null,"Roseau"]
["Pediatric Orthopedic Surgery Physician","PE025",null,null,"207SG0201X","Roseau",null,null,null,"St. Louis"]
["Pediatric Otolaryngology Physician","PE013",null,null,"207SG0202X","St. Louis",null,null,null,"Scott"]
["Pediatric Pulmonology","PE030",null,null,"207SG0203X","Scott",null,null,null,"Sherburne"]
["Pediatric Surgery","PE015",null,null,"207SM0001X","Sherburne",null,null,null,"Sibley"]
["Pediatric Neurodevelopmental Disabilities","PE019",null,null,"207SG0205X","Sibley",null,null,null,"Stearns"]
["Pediatric Dermatology","PE011",null,null,"207SG0207X","Stearns",null,null,null,"Steele"]
["Pediatric Ophthalmology and Strabismus Specialist","PE023",null,null,"170300000X","Steele",null,null,null,"Stevens"]
["Pediatric Urology","PE033",null,null,"207RG0100X","Stevens",null,null,null,"Swift"]
["Pediatric Rheumatology Physician","PE031",null,null,"2080P0206X","Swift",null,null,null,"Todd"]
[null,null,null,null,"204F00000X","Todd",null,null,null,"Traverse"]
[null,null,null,null,"208600000X","Traverse",null,null,null,"Wabasha"]
[null,null,null,null,"2086H0002X","Wabasha",null,null,null,"Wadena"]
[null,null,null,null,"2086S0102X","Wadena",null,null,null,"Waseca"]
[null,null,null,null,"2086S0120X","Waseca",null,null,null,"Washington"]
[null,null,null,null,"2086S0127X","Washington",null,null,null,"Watonwan"]
[null,null,null,null,"207V00000X","Watonwan",null,null,null,"Wilkin"]
[null,null,null,null,"207VB0002X","Wilkin",null,null,null,"Winona"]
[null,null,null,null,"207VC0200X","Winona",null,null,null,"Wright"]
[null,null,null,null,"207VE0102X","Wright",null,null,null,"Yellow Medicine"]
[null,null,null,null,"207VF0040X","Yellow Medicine"]
[null,null,null,null,"207VG0400X","Other"]
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