PRV.003.042

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

SUBMITTING-STATE-PROV-ID

Data Element

DE Number

PRV042

System DE Number

PRV.003.042

File Name

File Segment Number

File Segment Name

PROV-LOCATION-AND-CONTACT-INFO

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

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	22
FLF Stop Position	51
Segment Key Field Identifier	2
Coding Requirements	1. Value must be 30 characters or less 2. Mandatory

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

RULE ID	RULE Definition
RULE-6568	If a segment is a provider location and contact information segment from a PRV file, then the submitting state provider identification value reported must be compatible with the specified T-MSIS picture format: X(30).
RULE-2834	All prov location and contact info segments must have a corresponding prov attributes main segment where the prov location and contact info effective and end dates are within the prov attributes main effective and end dates. Note: Prov attributes main dates can be consecutive or overlapping.

Measure ID	Measure Name
PRV-1-010-9	LT - % of billing providers with all PROV-LOCATION-IDs represented in the practice and service locations in the Provider file
RULE-7735	% of providers without a corresponding Provider Location and Contact Information segment
RULE-7729	% of Provider Location and Contact Info segments with a missing Address Line 1
PRV-1-016-6	RX - % of unique combinations of billing providers and PROV-LOCATION-IDs that are found in the provider record's practice and service locations
PRV-1-015-3	OT - % of unique combinations of billing providers and PROV-LOCATION-IDs that are found in the provider record's practice and service locations
PRV-1-014-5	LT - % of unique combinations of billing providers and PROV-LOCATION-IDs that are found in the provider record's practice and service locations
PRV-1-013-4	IP - % of unique combinations of billing providers and PROV-LOCATION-IDs that are found in the provider record's practice and service locations
PRV-1-012-10	RX - % of billing providers with all PROV-LOCATION-IDs represented in the practice and service locations in the Provider file
PRV-1-011-7	OT - % of billing providers with all PROV-LOCATION-IDs represented in the practice and service locations in the Provider file
PRV-1-001-12	Average # of PROV-ADDR-TYPE = 1 (Provider Billing) per Provider
PRV-1-009-8	IP - % of billing providers with all PROV-LOCATION-IDs represented in the practice and service locations in the Provider file
PRV-1-008-2	% of unique combinations of SUBMITTING-STATE-PROV-ID and PROV-LOCATION-ID for practice and service locations (provider records) that are represented in claims files
PRV-1-007-1	% of provider records that have all practice and service locations (PROV-LOCATION-IDs) represented in the claims files
PRV-1-006-15	% of records with PROV-ADDR-TYPE = 4 (Service Location)
PRV-1-005-16	Average # of PROV-ADDR-TYPE = 4 (Service Location) per Provider
PRV-1-004-13	% of records with PROV-ADDR-TYPE = 3 (Provider Practice)
PRV-1-003-14	Average # of PROV-ADDR-TYPE = 3 (Provider Practice) per Provider
PRV-1-002-11	% of records with PROV-ADDR-TYPE = 1 (Provider Billing)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
PRV019	PRV.002.019	SUBMITTING-STATE-PROV-ID	PRV00002	PROV-ATTRIBUTES-MAIN
PRV063	PRV.004.063	SUBMITTING-STATE-PROV-ID	PRV00004	PROV-LICENSING-INFO
PRV075	PRV.005.075	SUBMITTING-STATE-PROV-ID	PRV00005	PROV-IDENTIFIERS
PRV087	PRV.006.087	SUBMITTING-STATE-PROV-ID	PRV00006	PROV-TAXONOMY-CLASSIFICATION
PRV097	PRV.007.097	SUBMITTING-STATE-PROV-ID	PRV00007	PROV-MEDICAID-ENROLLMENT
PRV109	PRV.008.109	SUBMITTING-STATE-PROV-ID	PRV00008	PROV-AFFILIATED-GROUPS
PRV118	PRV.009.118	SUBMITTING-STATE-PROV-ID	PRV00009	PROV-AFFILIATED-PROGRAMS
PRV128	PRV.010.128	SUBMITTING-STATE-PROV-ID	PRV00010	PROV-BED-TYPE-INFO

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/21/2023	3.13.0	PRV.003.042	UPDATE	Segment key field identifier	Not Applicable	2