CurrentPennsylvania Insurance DepartmentPolicy P3N Policy #8 Reporting Policy v.5
P3N Reporting Policy
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Establishes minimum standards and requirements for quarterly reporting of usage and exchange metrics by all Certified Participants (CPs) in the Pennsylvania Patient and Provider Network (P3N). Applies to all CPs in the P3N and to PA eHealth processes that use the reports.
Policy Summary
PayerPennsylvania Insurance Department
PolicyP3N Reporting Policy
Policy CodePolicy P3N Policy #8 Reporting Policy v.5
Change TypeRoutine update — no material coverage changes
Effective DateJan 1, 2026
Last ReviewAug 6, 2025
Next Review Date
Key ActionCertified Participants must submit quarterly reports to PA eHealth and grant PA Navigate access where applicable.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
quarterlyreporting frequency required of CPs
last day following quarterreport due date
120 daysPA eHealth decision timeframe
6 monthsmax variance duration
annualMO data refresh minimum
Reporting Requirements
inv-01: Reporting requirements
Required report contents and submission rules for Certified Participants (CPs):
CPs shall submit quarterly reports to PA eHealth.
Reports are due on the last day of the month following each calendar quarter (Jan–Mar; Apr–Jun; Jul–Sep; Oct–Dec).
Exception: A CP must submit a report by the last day of the first full month in which it is connected to the P3N; PA eHealth will use this report for prorated billing and may or may not integrate it into network activity reporting depending on timing.
CPs participating in the PA Navigate consortium shall grant PA Navigate reporting access to authorized PA eHealth and Commonwealth staff.
Reported data elements must include: number of organizations participating with the CP by provider type (regardless of whether entities pull, contribute, or engage in P3N activity); number of active users and organizations during the three months prior to the report (by provider type); transaction volumes by users during the three months prior to the report (by provider type); total number of unique patients whose data is exchanged via the CPs during the three months prior to the report; and a list of member organizations by name and type.
Definition: 'Active' means an organization or user completed at least one transaction (send or receive) with the CP during the reporting period, whether or not those transactions involve the P3N.
MO-sourced information included in reports must be refreshed at least annually; PA eHealth may require more frequent refreshes for other elements as the reporting landscape evolves.
PA eHealth will provide specified reports and information to outlets or entities (including an annual report to the Governor and legislative leaders, HIETCC, and the Pennsylvania Department of Human Services) according to designated timeframes.
Report Categories, Line-items, and Definitions
Quarterly HIO Report categoriesmixed
| Active | Active |
| Transactions | Transactions |
| Payers | Payers |
| Organizations | Organizations |
| Covered lives for which HIE is accessible | Covered lives for which HIE is accessible |
Hospital line-itemsmixed
| Critical Access Hospitals | Critical Access Hospitals |
| Small Hospitals (<150 beds) | Small Hospitals (<150 beds) |
| Medium Hospitals (150-300 beds) | Medium Hospitals (150-300 beds) |
| Large Hospitals (>300 beds) | Large Hospitals (>300 beds) |
| Total Hospitals | Total Hospitals |
Practice line-itemsmixed
| Community Clinic/FQHC/Safety Net Providers | Community Clinic/FQHC/Safety Net Providers |
| Primary Care Physician Practices | Primary Care Physician Practices |
| Specialist Physician Practices | Specialist Physician Practices |
| Multi-Specialty Practices | Multi-Specialty Practices |
| Total Practices | Total Practices |
Other provider line-itemsmixed
| Ambulance/EMS Services | Ambulance/EMS Services (per organization) |
| Ambulatory Surgery Centers | Ambulatory Surgery Centers (per location) |
| Home Health Agencies | Home Health Agencies (per organization) |
| Independent Imaging Centers | Independent Imaging Centers |
| Independent Pharmacies | Independent Pharmacies |
| Independent Reference Laboratories | Independent Reference Laboratories |
| Long-Term/Post-Acute Care Facilities | Long-Term/Post-Acute Care Facilities |
| Mental Health/Substance Abuse Facilities | Mental Health/Substance Abuse Facilities |
| Outpatient Cancer Treatment Centers | Outpatient Cancer Treatment Centers (per location) |
| Physical Therapy/Occupational Therapy Practices | Physical Therapy/Occupational Therapy Practices (per location) |
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Active user/organization definition
DefinitionCompleting at least one transaction (send or receive) with the Certified Participant (CP) during the reporting period.
ScopeApplies to organizations and individual users reported by the CP for the three months prior to the month of the report (e.g., Jan–Mar for the April report).
Transaction types includedAny send or receive transaction with the CP, whether or not those transactions involve the P3N.
Counting ruleCounts are by provider type and apply regardless of whether entities pull, contribute, or engage in P3N activity.
Use in reportingUsed to populate the ‘number of active users and organizations’ line-item in quarterly reports to PA eHealth.
Submission, Access, and Operational Requirements
Documentation Required
Submit quarterly reports to PA eHealth and grant PA Navigate access
Certified Participants (CPs) must submit quarterly reports to PA eHealth and—if participating in the PA Navigate consortium—grant PA Navigate reporting access to authorized PA eHealth and Commonwealth staff. These reports are used to determine, invoice for, and collect CP fees under the HIO Fee Model and Schedule and to track and communicate HIE activity across Pennsylvania.
- Submit quarterly reports to PA eHealth via PA eHealth's resource account based on calendar-year quarters (Jan–Mar; Apr–Jun; Jul–Sep; Oct–Dec).
- Reports are due on the last day of the month following each quarter; exception: submit by the last day of the first full month connected to the P3N for initial connection reporting (used for prorated billing).
- Grant PA Navigate reporting access to authorized PA eHealth and Commonwealth staff if participating in PA Navigate.
Key Definitions
Active (short definition)
Short definitionActive = organization or user completing at least one transaction (send or receive) with the CP during the reporting period.
Reporting windowMeasured over the three months prior to the month of the report.
Inclusion regardless of P3N involvementTransactions are counted whether or not they involve the P3N.
Reporting granularityReported by provider type as part of the CP’s quarterly submission.
Reporting variance — definition and rules
DefinitionAgreement by PA eHealth and the CP to vary from adopted reporting requirements based on the CP’s current capabilities.
Maximum agreed durationAgreed variances are limited to six (6) months in duration.
Request processCPs anticipating variances longer than six months must submit a request to PA eHealth stating reason and anticipated duration (e.g., incompatible data collection processes).
PA eHealth decision timeframePA eHealth will communicate a decision within 120 calendar days of receipt of the variance request.
If rejectedIf PA eHealth rejects the request, the CP has six (6) months from notification of rejection to comply with reporting requirements.
Policy Summary
PayerPennsylvania Insurance Department
PolicyP3N Reporting Policy
Policy CodePolicy P3N Policy #8 Reporting Policy v.5
Change TypeRoutine update — no material coverage changes
Effective DateJan 1, 2026
Last ReviewAug 6, 2025
Next Review Date
Key ActionCertified Participants must submit quarterly reports to PA eHealth and grant PA Navigate access where applicable.
SourceLink
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