PRV.005.078

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

PROV-IDENTIFIER-ISSUING-ENTITY-ID

Data Element

DE Number

PRV078

System DE Number

PRV.005.078

File Name

File Segment Number

File Segment Name

PROV-IDENTIFIERS

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

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

RULE ID	RULE Definition
RULE-2902	If the provider identifier issuing entity ID is populated on a provider identifiers segment from a PRV file, then the provider identifier issuing entity ID must not contain any pipe or asterisk characters.
RULE-2903	If provider identifier type is '1' on a provider identifiers segment from a PRV file, then the value for the provider identifer issuing entity id must be equal to the value populated for submitting state.
RULE-2904	If provider identifier type is '2' on a provider identifiers segment from a PRV file, then the value for the provider identifer issuing entity id must be equal 'NPI'.
RULE-2905	If provider identifier type is '3' on a provider identifiers segment from a PRV file, then the value for the provider identifer issuing entity id must be equal 'CMS'.
RULE-2906	If provider identifier type is '4' on a provider identifiers segment from a PRV file, then the value for the provider identifer issuing entity id must be equal 'NCPDP'.
RULE-2907	If provider identifier type is '5' on a provider identifiers segment from a PRV file, then the value for the provider identifer issuing entity id must be equal 'IRS'.
RULE-6342	If a segment is a provider identifiers segment from a PRV file, the provider identifier issuing entity id value reported must be compatible with the specified T-MSIS picture format: X(18).
RULE-7361	If SUBMITTING-STATE-PROV-ID is populated on a PROV-IDENTIFIERS segment from an PRV file, then PROV-IDENTIFIER-ISSUING-ENTITY-ID must be populated.

Measure ID	Measure Name
MIS-11-034-34	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: PROV-IDENTIFIER-ISSUING-ENTITY-ID (PRV00005)
RULE-7361	% of segments missing PROV-IDENTIFIER-ISSUING-ENTITY-ID (PRV00005)

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	PROV-IDENTIFIER-ISSUING-ENTITY-ID	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV078\|PROV-IDENTIFIER-ISSUING-ENTITY-ID\| A free text field to capture the identity of the entity that issued the provider identifier in the PROV-IDENTIFIER data element. For (State Tax ID), if associated Provider Identifier Type (DE) value is equal to 6, then value must be the name of the state's taxation division. For (Other), if associated Provider Identifier Type (DE) value is equal to 8, then value must be the name of the entity that issued the identifier.\|	\|DE No\|Data Element Name\|Definition\| \|PRV078\|PROV-IDENTIFIER-ISSUING-ENTITY-ID\| 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.\|