New Jersey DOBI - Provider Data Requirements
State of New Jersey - Department of Banking & Insurance
The purpose of this notice is to advise health maintenance organizations, insurers, health service corporations, medical service corporations and organized delivery systems of a change in the process used by the Department of Banking and Insurance to evaluate and monitor the adequacy of provider networks.
New Jersey's Health Care Quality Act (HCQA), codified at N.J.S.A. 26-S-1 et seq., and rules implementing the law, provide patient protections by requiring carriers to meet minimum standards, including provider network access and adequacy standards.
The Department recently entered into a contract with Quest Analytics to develop an automated process for evaluating and monitoring the adequacy of all provider networks and is requiring the next electronic submission for selected provider networks by Friday, April 11, 2025.
Questions regarding the Department's evaluation of provider network adequacy should be directed to Barbara Hanlon, Chief, Office of Managed Care at barbara.hanlon@dobi.nj.gov.
Technical questions concerning the submission of data through Quest Analytics should be directed to
njdobi@questanalytics.com.
The tabs above provide detailed instructions for each issuer to complete the required network data uploads.
Further instructions are available for download here.
PROVIDERS - click on the tab above to download the Excel template and for a detailed data dictionary.
FACILITIES - click on the tab above to download the Excel template and for a detailed data dictionary.
To obtain credentials to your secure upload account, please contact Quest Analytics at:
njdobi@questanalytics.com
920.739.4552
To submit provider data to the State of New Jersey - Department of Banking & Insurance, please click on the button below to download the provider template spreadsheet.
Download Provider TemplateThe data entered into the spreadsheet template must be in the following record granularity:
1 row per provider / address / specialty where an individual can make an appointment with the provider at this location
The following data dictionary describes each of the columns in the provider template spreadsheet and the content expected in each. All columns are required unless otherwise noted below.
Data Dictionary
| Field | Required | Description |
|---|---|---|
| IssuerId | Your 7-character Issuer Identifier (ie. DOBI099), repeated on each row. If you do not know your Issuer Id, please contact njdobi@questanalytics.com. | |
| NPI | The National Provider Identifier issued to the individual provider. | |
| FirstName | The provider's first name. | |
| MiddleName | [Supply if available]The provider's middle name. | |
| LastName | The provider's last name. | |
| Suffix | [Supply if available]Any additional piece of information for the provider's name (such as Sr., Jr., III, etc.). | |
| Credentials | [Supply if available]Comma-separated list of the provider's academic credentials (such as MD, DO, etc.). | |
| Phone | The phone number associated with this practice location (10-digits with no spaces or punctuation). | |
| Address | The physical street address of the provider's practice location. | |
| Address2 | [Supply if available] Secondary information for the provider's practice location (such as suite, building, etc.). | |
| City | The city name of the provider's practice location. | |
| State | The 2-character state abbreviation of the provider's practice location. | |
| Zip | The 5-digit ZIP code of the provider's practice location. [Fomatted as text with leading zeroes] | |
| SpecialtyCode | The provider's specialty code. [See list of specialty codes & descriptions below] | |
| SpecialtyDescription | The provider's specialty description. [See list of specialty codes & descriptions below] | |
| PCPAcceptingNew | Enter Y if the provider is accepting new patients, otherwise enter N. | |
| Tier1 | Enter Y if the provider is a Tier One provider, otherwise enter N. | |
| SubmittedClaimWithin12MonthsForThisLocation_Specialty(Y/N) |
Enter Y if claim submitted within 12 months for this provider and specialty at this location, otherwise enter N.
Pursuant to N.J.A.C. 11:24C-4.6 carriers shall confirm the participation of any provider who has not submitted a claim for a period of 12 months. |
|
| ContractedHospitalNPI1 | [Leave blank if no contracted hospitals] The National Provider Identifier issued to the contracted hospital. | |
| ContractedHospitalName1 | [Leave blank if no contracted hospitals] The name of a contracted hospital. | |
| ContractedHospitalNPI2 | [Leave blank if no additional contracted hospitals] The National Provider Identifier issued to the contracted hospital. | |
| ContractedHospitalName2 | [Leave blank if no additional contracted hospitals] The name of a contracted hospital. | |
| ContractedHospitalNPI3 | [Leave blank if no additional contracted hospitals] The National Provider Identifier issued to the contracted hospital. | |
| ContractedHospitalName3 | [Leave blank if no additional contracted hospitals] The name of a contracted hospital. | |
| ContractedHospitalNPI4 | [Leave blank if no additional contracted hospitals] The National Provider Identifier issued to the contracted hospital. | |
| ContractedHospitalName4 | [Leave blank if no additional contracted hospitals] The name of a contracted hospital. |
Specialty Codes & Descriptions
| Specialty Code | Description | # Providers | Miles | Minutes | Access |
|---|---|---|---|---|---|
| 001 | General Practice | 2* | 10 | 30 | 90% |
| 002 | Family Practice | 2* | 10 | 30 | 90% |
| 003 | Internal Medicine | 2* | 10 | 30 | 90% |
| 007 | Allergist/Immunologist | 2 | 45 | 60 | 90% |
| 008 | Cardiologist | 2 | 45 | 60 | 90% |
| 010 | Chiropractors | 1 | 45 | 60 | 90% |
| 011 | Dermatologist | 2 | 45 | 60 | 90% |
| 012 | Endocrinologist | 2 | 45 | 60 | 90% |
| 013 | Otolaryngologist | 2 | 45 | 60 | 90% |
| 014 | Gastroenterologist | 2 | 45 | 60 | 90% |
| 015 | General Surgeon | 2 | 45 | 60 | 90% |
| 016G | Gynecologist | 2 | 45 | 60 | 90% |
| 016O | Obstetrician | 2 | 45 | 60 | 90% |
| 017 | Infectious Disease Specialist | 2 | 45 | 60 | 90% |
| 018 | Nephrologist | 2 | 45 | 60 | 90% |
| 019 | Neurologist | 2 | 45 | 60 | 90% |
| 021 | Oncologist/Hematologist | 2 | 45 | 60 | 90% |
| 023 | Ophthalmologist | 2 | 45 | 60 | 90% |
| 024 | Oral Surgeon | 2 | 45 | 60 | 90% |
| 025 | Orthopedist | 2 | 45 | 60 | 90% |
| 026 | Physiatrist | 2 | 45 | 60 | 90% |
| 028 | Podiatry | 1 | 45 | 60 | 90% |
| 029 | Psychiatrist | 2 | 45 | 60 | 90% |
| 030 | Pulmonologist | 2 | 45 | 60 | 90% |
| 033 | Urologist | 2 | 45 | 60 | 90% |
| 034 | Vascular Surgery | 2 | 45 | 60 | 90% |
| 035 | Cardio Thoracic Surgery | 2 | 45 | 60 | 90% |
| 036 | Anesthesiology | 1 | 45 | 60 | 90% |
| 100 | Board Certified Behavior Analyst (BCBA) | 1 | 20 | 30 | 90% |
| 101 | Pediatrics | 2 | 10 | 30 | 90% |
| 102 | Social Worker (LCSW, LSW, CSW) | 1 | 20 | 30 | 90% |
| 103 | Psychologists | 1 | 20 | 30 | 90% |
| 104 | Certified Alcohol and Drug Counselor (CADC) | 1 | 20 | 30 | 90% |
| 105 | Licensed Clinical Alcohol/Drug Counselor (LCADC) | 1 | 20 | 30 | 90% |
| 106 | Psychiatric - Mental Health Nurse (PMHN) | 1 | 20 | 30 | 90% |
| 198 | Audiology | 1 | 45 | 60 | 90% |
| 200 | Optometrist | 1 | 45 | 60 | 90% |
| 201 | General Dentist | 1 | 10 | 30 | 90% |
| 202 | Orthodontist | 1 | 45 | 60 | 90% |
| 203 | Periodontist | 1 | 45 | 60 | 90% |
| 204 | Endodontist | 1 | 45 | 60 | 90% |
| 205 | Pedodontist | 1 | 45 | 60 | 90% |
| 206 | Prosthodontist | 1 | 45 | 60 | 90% |
| 517 | Acupuncture | 1 | 45 | 60 | 90% |
| 518 | Interventional Pain | 1 | 45 | 60 | 90% |
| 519 | Massage Therapy | 1 | 45 | 60 | 90% |
| 521 | Naturopathy | 1 | 45 | 60 | 90% |
| 523 | Joint & Spinal Surgical | 1 | 45 | 60 | 90% |
| FFC | Fertility | 1 | 45 | 60 | 90% |
To submit facilty data to the State of New Jersey - Department of Banking & Insurance, please click on the button below to download the facility template spreadsheet.
Download Facility TemplateThe data entered into the spreadsheet template must be in the following record granularity:
1 row per facility / address / specialty
The following data dictionary describes each of the columns in the facility template spreadsheet and the content expected in each. All columns are required unless otherwise noted below.
Data Dictionary
| Field | Required | Description |
|---|---|---|
| IssuerId | Your 7-character Issuer Identifier (ie. DOBI099), repeated on each row. If you do not know your Issuer Id, please contact njdobi@questanalytics.com. | |
| NPI | The National Provider Identifier issued to the facility. | |
| Name | The facility name. | |
| Phone | The phone number associated with this facility location (10-digits with no spaces or punctuation). | |
| Address | The physical street address of the facility. | |
| Address2 | [Supply if available] Secondary information for the facility location (such as suite, building, etc.). | |
| City | The city name of the facility. | |
| State | The 2-character state abbreviation of the facility. | |
| Zip | The 5-digit ZIP code of the facility. [Fomatted as text with leading zeroes] | |
| SpecialtyCode | The facility's specialty/service code. [See list of specialty/service codes & descriptions below] | |
| SpecialtyDescription | The facility's specialty/service description. [See list of specialty/service codes & descriptions below] | |
| Tier1 | Enter Y if the facility is a Tier One facility, otherwise enter N. | |
| SubmittedClaimWithin12MonthsForThisLocation_Specialty(Y/N) |
Enter Y if claim submitted within 12 months for the facility and specialty at this location, otherwise enter N.
Pursuant to N.J.A.C. 11:24C-4.6 carriers shall confirm the participation of any provider who has not submitted a claim for a period of 12 months. |
|
| GeneralAcuteCareHospitalLIC# | Must contain a valid license number for every general acute care hospital (Specialty Code = 040) listed on the Facilities tab. All valid license numbers are available on the AllGeneralAcuteCareHospitals tab. This list is also available at https://healthapps.state.nj.us/facilities/acSearch.aspx |
Specialty/Service Codes & Descriptions
| Specialty/Serivice Code | Description | # Providers | Miles | Minutes | Access |
|---|---|---|---|---|---|
| 028 | Podiatry | 1 | 45 | 60 | 90% |
| 040 | General Acute Care Hospital | 1 | 20 | 30 | 90% |
| L040 | Long Term Care Facility | 1 | 20 | 30 | 90% |
| 041 | Cardiac Surgery Program | 1 | 45 | 60 | 90% |
| 044 | Renal Dialysis Center | 1 | 20 | 30 | 90% |
| 045 | Ambulatory Surgical Facilities | 1 | 20 | 30 | 90% |
| 046 | Skilled Nursing Facility | 1 | 20 | 30 | 90% |
| 047C | Diagnostic Imaging - CAT Scan | 1 | 20 | 30 | 90% |
| 047M | Diagnostic Imaging - MRI | 1 | 20 | 30 | 90% |
| 047P | Diagnostic Imaging - PET Scan | 1 | 20 | 30 | 90% |
| 047X | Diagnostic Imaging - X-Ray | 1 | 20 | 30 | 90% |
| 049 | Physical Therapy | 1 | 45 | 60 | 90% |
| 050 | Occupational Therapy | 1 | 45 | 60 | 90% |
| 051 | Speech Therapy | 1 | 45 | 60 | 90% |
| 052 | Inpatient Adult Psychiatric Facility | 1 | 45 | 60 | 90% |
| 054 | Orthotics & Prosthetics | 1 | 45 | 60 | 90% |
| 055 | Home Health Agency | 1 | |||
| 056 | DME | 1 | 45 | 60 | 90% |
| 057 | Radiation Oncology Therapy Center | 1 | 20 | 30 | 90% |
| 058 | Laboratory | 1 | 45 | 60 | 90% |
| 060 | Outpatient Substance Abuse Treatment Facility | 1 | 45 | 60 | 90% |
| 070 | Inpatient Pediatric Psychiatric Facility | 1 | 45 | 60 | 90% |
| 071 | Inpatient Rehabilitation Facility | 1 | 45 | 60 | 90% |
| 072 | Inpatient Substance Abuse Treatment Facility | 1 | 45 | 60 | 90% |
| 074 | Residential Substance Abuse Treatment Center | 1 | 45 | 60 | 90% |
| 302 | Hearing Aid Centers | 1 | 45 | 60 | 90% |
| 401 | Hospitals with Obstetrics | 1 | 20 | 30 | 90% |
| 402 | Regional Perinatal Services | 1 | 45 | 60 | 90% |
| 550 | Home Infusion | 1 | |||
| 600 | Sleep Management | 1 | 45 | 60 | 90% |
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