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TMSIS Dataguide Medicaid.gov
Version 3.28.0

HEALTH-HOME-PROV-NUM

Data Element

DE Number

ELG120

System DE Number

ELG.007.120

File Name

ELG - ELIGIBLE

File Segment Number

ELG00007

File Segment Name

HEALTH-HOME-SPA-PROVIDERS

Last updated

No Updates

Definition The State-specific Medicaid Provider Identifier is a state-assigned unique identifier that states should report with all individual providers, practice groups, facilities, and other entities. This should be the identifier that is used in the state's Medicaid Management Information System.
Size X(30)
FLF Start Position 242
FLF Stop Position 271
Segment Key Field Identifier 5
Coding Requirements 1. Value must be 30 characters or less
2. Value must match Provider Identifier (PRV.005.081)
3. Mandatory
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name