PRV.002.026

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

FACILITY-GROUP-INDIVIDUAL-CODE

Data Element

DE Number

PRV026

System DE Number

PRV.002.026

File Name

File Segment Number

File Segment Name

PROV-ATTRIBUTES-MAIN

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to identify whether the Submitting State Provider Identifier is assigned to an individual, group, or a facility.
Size	X(2)
FLF Start Position	428
FLF Stop Position	429
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Facility Group Individual Code List (VVL) 2. Value must be 2 characters 3. Mandatory 4. (individual) if value equals "03", then Provider First Name (PRV.002.028) must be populated 5. (organization) if value does not equal "03", then Provider Middle Initial (PRV.002.029) must not be populated 6. (individual) if value equals "03", then Provider Last Name (PRV.002.030) must be populated 7. (individual) if value equals "03", then Provider Sex (PRV.002.031) must be populated 8. (individual) if value equals "03", then Provider Date of Birth (PRV.002.034) must be populated 9. (organization) if value is in [01,02], then Provider Date of Death (PRV.002.035) must not be populated 10. (individual) if value equals "03", then there must be one Provider Identifier (PRV.005.081) populated with an associated Provider Identifier Type (PRV.005.077) equal to "2" (NPI)

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-2803	If facility group individual code is populated on a provider attributes main segment from a PRV file, then the facility group individual code value reported must be in the list of valid values for facility group individual code.
RULE-6923	If a segment is a provider attributes main segment from a PRV file, the facility group individual code value reported must be compatible with the specified T-MSIS picture format: X(2).
RULE-7358	If SUBMITTING-STATE-PROV-ID is populated on a PROV-ATTRIBUTES-MAIN segment from an PRV file, then FACILITY-GROUP-INDIVIDUAL-CODE must be populated.
RULE-7587	If submitting state provider ID is populated on a provider attributes main segment from an PRV file, and facility group individual code is equal to '01' (facility) or '02' (group), and the provider identifier type = '2' and the submitting state provider ID is a valid NPI in the NPPES file, then the entity type code is equal to '2' (organization) in the NPPES NPI data file.
RULE-7589	If submitting state provider ID is populated on a provider attributes main segment from an PRV file, and facility group individual code is equal to '03' (individual), and the provider identifier type = '2' and the submitting state provider ID is a valid NPI in the NPPES file, then the entity type code is equal to '1' (individual) in the NPPES NPI data file.

Measure ID	Measure Name
MIS-11-003-3	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: FACILITY-GROUP-INDIVIDUAL-CODE (PRV00002)
PRV-2-010-10	% of Submitting State Provider IDs (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with more than one NPI (PROV-IDENTIFIER-TYPE = 2) (across all time)
PRV-6-001-1	% of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 01, 02 (facility or group) that do not have a Provider Classification Code that indicates a facility or group
PRV-6-002-2	% of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 03 (individual) that do not have a Provider Classification Code that indicates an individual
PRV-6-003-3	% of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 01, 02 (facility or group) that are missing Provider Classification Code
PRV-6-004-4	% of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 03 (individual) that are missing Provider Classification Code
RULE-2806	% of PRV00002 segments for individuals (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with missing or invalid Provider First Name
RULE-2809	% of PRV00002 segments for non-individuals (FACILITY-GROUP-INDIVIDUAL-CODE <> 03) with non-missing Provider Middle Name
RULE-2810	% of PRV00002 segments for individuals (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with missing or invalid Provider Last Name
RULE-2813	% of PRV00002 segments for individuals (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with missing or invalid Sex
RULE-7569	% of Provider Attributes Main segments for individual providers (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with more than one NPI (PROV-IDENTIFIER-TYPE = 2) (across all time)
RULE-7728	% of individual providers where Provider Last Name is missing
MIS-11-010_10-58	% distinct SUBMITTING-STATE-PROV-IDs where FACILITY-GROUP-INDIVIDUAL-CODE <> 03 with only missing values in any active segment: PROV-ORGANIZATION-NAME (PRV00002)
RULE-7358	% of segments missing FACILITY-GROUP-INDIVIDUAL-CODE (PRV00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	PRV.002.026	UPDATE	Coding requirement	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals '03', then Provider First Name (PRV.002.028) must be populated5. (organization) if value does not equal '03', then Provider Middle Initial (PRV.002.029) must not be populated6. (individual) if value equals '03', then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals '03', then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals '03', then Provider Date of Birth (PRV.002.034) must be populated9. (organization) if value equals '01' or '02', then Provider Date of Death (PRV.002.035) must not be populated10. (individual) if value equals '03', then there must be one Provider Identifier (PRV.005.081) populated with an associated Provider Identifier Type (PRV.005.077) equal to ‘2’ (NPI)	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals "03", then Provider First Name (PRV.002.028) must be populated5. (organization) if value does not equal "03", then Provider Middle Initial (PRV.002.029) must not be populated6. (individual) if value equals "03", then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals "03", then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals "03", then Provider Date of Birth (PRV.002.034) must be populated9. (organization) if value is in [01,02], then Provider Date of Death (PRV.002.035) must not be populated10. (individual) if value equals "03", then there must be one Provider Identifier (PRV.005.081) populated with an associated Provider Identifier Type (PRV.005.077) equal to "2" (NPI)
08/28/2023	3.12.0	PRV.002.026	UPDATE	Coding requirement	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals '03', then Provider First Name (PRV.002.028) must be populated5. (organization) if value does not equal '03', then Provider Middle Initial (PRV.002.029) must not be populated6. (individual) if value equals '03', then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals '03', then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals '03', then Provider Date of Birth (PRV.002.034) must be populated9. (organization) if value equals '01' or '02', then Provider Date of Death (PRV.002.035) must not be populated	1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals '03', then Provider First Name (PRV.002.028) must be populated5. (organization) if value does not equal '03', then Provider Middle Initial (PRV.002.029) must not be populated6. (individual) if value equals '03', then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals '03', then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals '03', then Provider Date of Birth (PRV.002.034) must be populated9. (organization) if value equals '01' or '02', then Provider Date of Death (PRV.002.035) must not be populated10. (individual) if value equals '03', then there must be one Provider Identifier (PRV.005.081) populated with an associated Provider Identifier Type (PRV.005.077) equal to ‘2’ (NPI)