PRV.005.081

PROV-IDENTIFIER

Data Element

DE Number

PRV081

System DE Number

PRV.005.081

File Name

PRV - PROVIDER

File Segment Number

PRV00005

File Segment Name

PROV-IDENTIFIERS

Last updated

09/21/2023

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A data element to capture the various ways used to distinguish providers from one another on claims and other interactions between providers and other entities. The specific type of identifier is defined in the corresponding value in the Provider Identifier Type data element.
Size	X(30)
FLF Start Position	92
FLF Stop Position	121
Segment Key Field Identifier	6
Coding Requirements	1. Mandatory 2. Value must not contain a pipe or asterisk symbol 3. Value must have an associated Provider Identifier Type (PRV.005.077) 4. One record must have a Provider Identifier Type (PRV.005.077) equal to "1" 5. Value must be 30 characters or less

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date
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RULE ID	RULE Definition
RULE-2917	If the provider identifier is populated on a provider identifiers segment from a PRV file, then the provider identifier must not contain any pipe or asterisk characters.
RULE-2918	If the provider identifier type is populated on a provider identifiers segment from a PRV file, then provider identifier must also be populated.
RULE-6931	If a segment is a provider identifiers segment from a PRV file, the provider identifier value reported must be compatible with the specified T-MSIS picture format: X(30).
RULE-7170	If the provider identifier type is '2' on a provider identifiers segment from a PRV file, then the value for the provider identifer must be a valid NPI number.
RULE-7359	If SUBMITTING-STATE-PROV-ID is populated on a PROV-IDENTIFIERS segment from an PRV file, then PROV-IDENTIFIER must be populated.
RULE-7472	If the provider identifier is populated on a provider identifiers segment from a PRV file, and the PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE is '2' (NPI), then provider identifier is a valid NPI number that exists in the NPPES NPI data file.
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.

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Measure ID	Measure Name
ALL-4-001-1	% of billing and servicing provider numbers on claims that are not found in the provider file
ALL-4-002-2	% of billing and servicing provider numbers on claims that are not found in the provider file
ALL-4-003-3	% of billing and servicing provider numbers on claims that are not found in the provider file
ALL-4-004-4	% of billing and dispensing provider numbers on claims that are not found in the provider file
MIS-11-031-31	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: PROV-IDENTIFIER (PRV00005)
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-2-011-11	% of providers that require NPI (non-atypical) that are missing NPI (PROV-IDENTIFIER-TYPE=2)
RULE-1126	% of claim headers with a Billing Provider Number that is not found on the provider file during the dates of service
RULE-1246	% of claim headers with a Servicing Provider Number that is not found on the provider file during the dates of service
RULE-1540	% of claim headers with a Billing Provider Number that is not found on the provider file during the dates of service
RULE-1663	% of claim headers with a Servicing Provider Number that is not found on the provider file during the dates of service
RULE-1845	% of claim headers with a Billing Provider Number that is not found on the provider file on the Prescription Fill Date
RULE-1964	% of claim headers with a Dispensing Provider Number that is not found on the provider file on the Prescription Fill Date
RULE-689	% of claim headers with a Billing Provider Number that is not found on the provider file during the dates of service
RULE-7359	% of segments missing PROV-IDENTIFIER (PRV00005)
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-7921	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Admission Date
RULE-7922	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Beginning Date of Service
RULE-7923	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Beginning Date of Service
RULE-7924	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Prescription Fill Date
RULE-7929	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Admission Date
RULE-7930	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Beginning Date of Service
RULE-7931	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Beginning Date of Service
RULE-7932	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Prescription Fill Date
RULE-810	% of claim headers with a Servicing Provider Number that is not found on the provider file during the dates of service

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DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
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Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/21/2023	3.13.0	PRV.005.081	UPDATE	Segment key field identifier	Not Applicable	6
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.\|
06/24/2022	3.0.0	PROV-IDENTIFIER	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV081\|PROV-IDENTIFIER\|A data element to capture the various ways used to distinguish providers from one another on claims and other interactions between providers and other entities. The specific type of identifier is defined in the corresponding value in the PROVIDER-IDENTIFIER-TYPE data element.\|	\|DE No\|Data Element Name\|Definition\| \|PRV081\|PROV-IDENTIFIER\|A data element to capture the various ways used to distinguish providers from one another on claims and other interactions between providers and other entities. The specific type of identifier is defined in the corresponding value in the Provider Identifier Type data element.\|
06/24/2022	3.0.0	PRV081/ PROV-IDENTIFIER	Modify DE Width	Data Dictionary - Record Layout	SIZE X(12)	SIZE X(30)