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.
Data Element
PRV078
PRV.005.078
Definition | A free text field to capture the identity of the entity that issued the provider identifier in the Provider Identifier (PRV.005.081) data element. For (State Tax ID), if associated Provider Identifier Type (PRV.005.077) value is equal to 6, then value must be the name of the state's taxation division. For (Other), if associated Provider Identifier Type (PRV.005.077) value is equal to 8, then value must be the name of the entity that issued the identifier. |
---|---|
Size | X(18) |
FLF Start Position | 58 |
FLF Stop Position | 75 |
Segment Key Field Identifier | 5 |
Coding Requirements | 1. Value must not contain a pipe or asterisk symbol 2. (State-specific Medicaid Provider) if associated Provider Identifier Type (PRV.005.077) value is equal to 1, then value must equal (PRV.005.073) Submitting State 3. (NPI) if associated Provider Identifier Type (PRV.005.077) value is equal to 2, then value must equal 'NPI' 4. (Medicare) if associated Provider Identifier Type (PRV.005.077) value is equal to 3, then value must equal 'CMS' 5. (NCPDP) if associated Provider Identifier Type (PRV.005.077) value is equal to 4, then value must equal 'NCPDP' 6. (Federal Tax ID) if associated Provider Identifier Type (PRV.005.077) value is equal to 5, then value must equal 'IRS' 7. (SSN) if associated Provider Identifier Type (PRV.005.077) value is equal to 7, then value must be equal to 'SSA' 8. Value must be 18 characters or less 9. 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 |
---|