PRV.004.067

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide

Medicaid.gov

Version 3.27.0

LICENSE-TYPE

Data Element

DE Number

PRV067

System DE Number

PRV.004.067

File Name

File Segment Number

File Segment Name

PROV-LICENSING-INFO

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to identify the kind of license or accreditation number that is captured in the License or Accreditation Number data element.
Size	X(1)
FLF Start Position	73
FLF Stop Position	73
Segment Key Field Identifier	4
Coding Requirements	1. Value must be in License Type List (VVL) 2. Value must be 1 character 3. 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-2884	If the license type is populated on a provider licensing information file, then the license type reported must be found in the list of valid values.
RULE-6533	If a segment is a provider licensing information segment from an ELG file, then the licensing type value reported must be compatible with the specified T-MSIS picture format: X(1).

Measure ID	Measure Name
MIS-11-026-26	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: LICENSE-TYPE (PRV00004)

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
06/24/2022	3.0.0	LICENSE-TYPE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV067\|LICENSE-TYPE\|A code to identify the kind of license or accreditation number that is captured in the LICENSE-OR-ACCREDITATION-NUMBER data element.\|	\|DE No\|Data Element Name\|Definition\| \|PRV067\|LICENSE-TYPE\|A code to identify the kind of license or accreditation number that is captured in the License or Accreditation Number data element.\|