CAQH ProView™
Extract Guidelines
for
Participating Organizations
Please note this is a draft document. Changes may be made to these
extract specifications since the CAQH ProView system is still in
development. CAQH will distribute the final version of this document
as soon as it is available.
© 2014 CAQH, All Rights Reserved.
CONTENTS
1 INTRODUCTION
1.1
1.2
1.3
3
OVERVIEW
PURPOSE
TARGET AUDIENCE
3
3
3
2 EXTRACT SUBMISSION
2.1
2.2
3
USING PARTICIPATING ORGANIZATION USER INTERFACE
USING EXTRACT SERVICES
3
3
3 EXTRACT RETRIEVAL
4
4 EXTRACT TYPES
4
4.1
4.2
STANDARD EXTRACT
CUSTOM EXTRACT
4
4
5 EXTRACT CONTENT
5.1
5.2
5.3
5.4
5.4.1
5.4.2
5.5
5.5.1
5.5.2
5.5.3
5.6
5.6.1
4
EXTRACT QUALIFYING CRITERIA
AFFILIATED / NON-AFFILIATED PROVIDERS
DELEGATED PROVIDERS
XML EXTRACT PACKAGE CONTENTS
XML EXTRACT FILE LAYOUT
XML EXTRACT DATA SUMMARY LAYOUT
ASCII EXTRACT PACKAGE CONTENTS
ASCII EXTRACT SECTION NAMES
ASCII EXTRACT DATA FILE LAYOUT
ASCII EXTRACT DATA SUMMARY LAYOUT
REPLICA/PDF EXTRACT PACKAGE CONTENTS
REPLICA/PDF EXTRACT DATA SUMMARY LAYOUT
4
5
5
5
6
6
6
7
8
8
9
9
6 SANCTIONS EXTRACT
6.1
6.2
6.3
6.4
6.5
9
SANCTIONS STANDARD EXTRACT
SANCTIONS CUSTOM EXTRACT
SANCTIONS EXTRACT FORMAT
SANCTIONS EXTRACT DATA FILE LAYOUT
SANCTIONS EXTRACT PACKAGE CONTENTS
9
10
10
10
10
7 BACKWARD COMPATIBILITY WITH CURRENT UPD EXTRACT
10
8 APPENDIX A – EXTRACT FIELDS FOR NON-AFFILIATED AND DELEGATED PROVIDERS
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1.1
Introduction
Overview
The Extract Guideline document is a compliation of instructions and documentation for Participating
Organizations to set up and retrieve extracts from the CAQH ProView system (formerly Universal Provider
Datasource, UPD). This document will explain multiple types of extract options including standard, custom
and sanctions.
An extract is a file that contains the latest attested data for every provider associated with a Participating
Organization. The data can be requested in various formats (e.g: ASCII, XML and Application Replica PDF).
The delivery of the data is based on the schedule set up by the Participating Organization in the system.
In addition to provider’s latest self-attested information, CAQH ProView also can provide sanctions data
associated with a provider to the Participating Organizations’ through the Sanctions Extract. This option is
available for an additional fee.
1.2
Purpose
This document is intended to serve as a reference for data layout, field definitions, naming standards and
all other information pertinent to the dissemination of provider information through various CAQH ProView
extracts.
1.3
Target Audience
This document is intended for developers, data stewards, operational and technical staff or any other user
involved in the exchange of data between CAQH ProView and its Participating Organizations.
2
Extract Submission
Extract requests can be established in CAQH ProView through the Participating Organization portal or by
using the extract web service.
2.1
Using Participating Organization User Interface
The Participating Organization user interface in CAQH ProView will have a screen to schedule extracts.
The extract submission screen will let the users define the extract contents, frequency and format.
2.2
Using Extract Services
The Participating Organization can also trigger custom extracts through the Custom Extract Generator
Service. Please refer to the CAQH ProView Webservices Specifications document for more details.
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Extract Retrieval
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Both standard and custom extracts can be retrieved from the Participating Organization’s “Outgoing” FTP
folder. The naming standards for each type of extract are outlined in the following sections.
Extract Types
4
4.1
Standard Extract
Standard Extracts contain the latest attested data for providers who have attested since the last extract
run. It also includes a file that highlights the changes since the last attestation and a list of data elements
that changed value along with their previous and current values.
Participating Organizations can create a standard extract by selecting the format of extract, extract
frequency, and the sections required in each extract. They can also choose to include supporting
documentation with their extracts. Supporting documentation will be a separate zip file that contains all
the supporting documentation associated with all providers in the extract. The naming convention for
these files will allow the Participating Organization to distinguish the supporting documents for each
provider. Standard extracts can be scheduled to run immediately, at a later time, or on a recurring
schedule.
4.2
Custom Extract
Custom extracts include the latest attested data for a provider, but allow Participating Organizations to
customize the sections required in each extract. Custom extracts also let users filter data by Plan Provider
IDs or CAQH Provider IDs. In CAQH ProView, custom extracts can also be scheduled to run immediately,
at a later time, or on a recurring schedule.
Extract Content
5
5.1
Extract Qualifying Criteria
The following criteria must be satisfied for a provider to be included in the extract:

Provider has attested and completed their profile/application (including supporting
documentation) or re-attested with no changes.

Provider in active status in the Participating Organizations roster.

Provider has authorized the Participating Organization to access their data.
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5.2
Affiliated / Non-Affiliated Providers
Based on a provider’s “Affiliation Flag” in the roster file, a Participating Organization can receive both
affiliated and non-affiliated providers in their extracts. However, only certain fields will be populated for
non-affiliated providers. The list of fields populated for non-affiliated providers are listed in Appendix A.
5.3
Delegated Providers
Based on a provider’s “Delegation Flag” in the roster file, a Participating Organization can receive
delegated providers in their extracts as well. The list of fields populated for delegated providers are listed
in Appendix A.
5.4
XML Extract Package Contents
The contents of the XML extract is as follows:
FileName: <POID>_<ExtractSubmitTimestamp>_XML.zip (POID is an identifier assigned by UPD for all
its Participating Organizations)
XML Extract Zip file will contain the following:

Separate XML files for each provider in the extract (Filename:
<ProviderID>_<ProviderAttestID>.xml)

One Extract Index File (Filename: ExtractIndex.xml)

One Data Summary File (Filename: DataSummary.txt)

One Provider Attachment Index file (Filename:ProviderAttachment.txt)

One ZIP file per provider with supporting documents (if requested) (Filename:
<ProviderID>_Attachments.zip)
o
All provider supporting documents (if requested) (Filename:
<ProviderID>_<DocumentType>.pdf)
Note: For large volume extracts that includes supporting documents, the supporting
documents will be delivered as a separate file
Filename: <POID>_<ExtractSubmitTimestamp>_XML_Attachments.zip
The separate file will contain the following:

One Provider Attachment Index file (Filename:ProviderAttachment.txt)

All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)
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5.5
5.4.1
XML Extract File Layout
5.4.2
XML Extract Data Summary Layout
ASCII Extract Package Contents
The contents of the ASCII extract is as follows:
FileName: <POID>_<ExtractSubmitTimestamp>_ASCII.zip (POID is an identifier assigned by UPD for
all its Participating Organizations)
ASCII Extract Zip file will contain the following:

One file for each provider section (Filename: Provider<SectionName>.text) See layout for
sections.

One Data Summary File (Filename: DataSummary.txt)

One Provider Attachment Index file (Filename:ProviderAttachment.txt)

One ZIP file per provider with supporting documents (if requested) (Filename:
<ProviderID>_Attachments.zip)
o
All provider supporting documents (if requested) (Filename:
<ProviderID>_<DocumentType>.pdf)
Note: For large volume extracts that includes supporting documents, the supporting
documents will delivered as a separate file
Filename: <POID>_<ExtractSubmitTimestamp>_ASCII_Attachments.zip
The separate file will contain the following:

One Provider Attachment Index file (Filename:ProviderAttachment.txt)

All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)
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5.5.1
ASCII Extract Section names
ProviderPersonalInformation
ProviderOtherName
ProviderOtherQuestions
ProviderReference
ProviderSpecialty
ProviderSubstanceAbuse
ProviderTimeGap
ProviderWorkHistory
ProviderMedicaid
ProviderMedicalAssociation
ProviderMedicalCondition
ProviderMedicalConditionProvider
ProviderMedicalLicense
ProviderMedicare
ProviderMilitary
ProviderNon-PracticeAddress
ProviderOtherBusinessInterest
ProviderOtherInterest
ProviderInsuranceCoverage
ProviderLanguage
ProviderLiabilityAction
ProviderMalpracticeCaseStatus
ProviderMalpracticeHistory
ProviderDisclosure
ProviderEducation
ProviderHospitalAssociate
ProviderHospitalPrivilege
ProviderCDS
ProviderCertification
ProviderCriminalAction
ProviderDEA
ProviderDegree
PracticeService
PracticeSpecialty
PracticeTaxID
ProviderAdverseAction
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PracticeOtherQuestions
PracticeOtherTaxID
PracticePatientType
PracticePhoneCoverage
PracticeHours
PracticeInformation
PracticeLanguage
PracticeLimitation
PracticeOtherAddress
PracticeAccessibility
PracticeAssociate
PracticeAssociateOtherQuestions
PracticeAssociateSpecialty
PracticeBusinessArrangement
PracticeCertification
OwnershipDisclosure (new)
EntityOwnershipDetail (new)
MedicareMedicaidOwnershipDetail (new)
5.5.2
ASCII Extract Data File Layout
The extract layout for each data file in an ASCII Extract are as follows:
ProView ASCII
Extract Layout_PO.xlsx
5.5.3
ASCII Extract Data Summary Layout
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5.6
Replica/PDF Extract Package Contents
The contents of the ASCII extract is as follows:
FileName: <POID>_<ExtractSubmitTimestamp>_Replica.zip (POID is an identifier assigned by UPD
for all its Participating Organizations)
Replica Extract Zip file will contain the following:

One Data Summary File (Filename: DataSummary.txt)

One document for each replica file (Filename: ReplicaApp_<ProviderID>_<StateCode>.pdf)

One ZIP file per provider with supporting documents (if requested) (Filename:
<ProviderID>_Attachments.zip)
o
All provider supporting documents (if requested) (Filename:
<ProviderID>_<DocumentType>.pdf)
Note: For large volume extracts that includes supporting documents, the supporting
documents will delivered as a separate file
Filename: <POID>_<ExtractSubmitTimestamp>_Replica_Attachments.zip
The separate file will contain the following:

One Provider Attachment Index file (Filename:ProviderAttachment.txt)

All provider supporting documents (if requested) (Filename: <ProviderID>_<DocumentType>.pdf)
5.6.1
6
Replica/PDF Extract Data Summary Layout
Sanctions Extract
CAQH SanctionsTrak is a centralized data collection process of querying national and state boards for
sanctions data and loading this data to CAQH ProView. Sanctions are matched to unique providers
within CAQH ProView. Participating Organizations can request this sanctions data through the CAQH
ProView portal.
6.1
Sanctions Standard Extract
Sanctions Standard Extract can be scheduled to run on a recurring basis by the POs. The standard
extract will contain additions and updates to sanctions since the last standard extract. When new
sanctions are added or updates are made to existing sanctions for a provider, they will be reported on the
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next scheduled standard extract run for a Participating Organization (if the Participating Organization has
purchased the sanctions module of CAQH ProView)
6.2
Sanctions Custom Extract
Sanctions Custom Extracts are ad hoc reports based on the most current Sanction data CAQH ProView
has for a provider.The sanctions custom extract will be generated based on the criteria provided by a
Participating Organization (if the Participating Organization has purchased the sanctions module of
CAQH ProView).
6.3
Sanctions Extract Format
The sanctions extract will be delivered in a pipe-delimited text file. In addition, a PDF attachment will be
available for each sanction if supplied by the sanction vendor. The PDF file can be linked to the provider
in the pipe-delimited text file using the naming convention detailed below. In addition, the provider record
in the ASCII file will contain the name of the PDF file that corresponds to the provider’s sanction image.
6.4
Sanctions Extract Data File Layout
ProView Sanctions
ASCII Extract Layout.xlsx
6.5
Sanctions Extract Package Contents
FileName: <POID>_Sanctions_<ExtractDate>.zip
Sanctions ASCII extract zip file will contain the following:
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
One text file that contains all the providers in the extract (Filename: SanctionExtract.txt)

Sanction Image File for providers who have a sanctions image identified by the
“SanctionImageName” field in the ASCII file (Filename:
<ProviderID>_<SanctionDate>_<SequenceNumber>.pdf)
Backward Compatibility with Current UPD Extract
CAQH will support existing UPD extract formats for a limited time. This will provide additional time for
Participating Organizations to transition into the new layout. The existing UPD extract files and layout for
ASCII and XML will be honored.
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Appendix A – Extract fields for Non-Affiliated and
Delegated Providers
DelegatedandAffiliat
edExtract fields.xlsx
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