PRV.006.088

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

PROV-CLASSIFICATION-TYPE

Data Element

DE Number

PRV088

System DE Number

PRV.006.088

File Name

File Segment Number

File Segment Name

PROV-TAXONOMY-CLASSIFICATION

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File" https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/98581 . A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.
Size	X(1)
FLF Start Position	52
FLF Stop Position	52
Segment Key Field Identifier	3
Coding Requirements	1. Value must be in Provider Classification 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-2927	If provider classification type is populated on a provider taxonomy classification segment from a PRV file, then the provider classification type value reported must be in the list of valid values for provider classification type.
RULE-2928	If provider classification type and provider classification code are populated on a provider taxonomy classification segment from a PRV file, then the provider classification code value reported must be in the list of valid values corresponding to the provider classification type on the date specified by the provider taxonomy classification effective date.
RULE-6666	If a segment is a provider taxonomy classification segment from a PRV file, the provider classification type value reported must be compatible with the specified T-MSIS picture format: X(1).
RULE-7364	If SUBMITTING-STATE-PROV-ID is populated on a PROV-TAXONOMY-CLASSIFICATION segment from an PRV file, then PROV-CLASSIFICATION-TYPE must be populated.

Measure ID	Measure Name
MIS-11-039-39	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: PROV-CLASSIFICATION-TYPE (PRV00006)
PRV-2-009-9	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 2 (NPI) that don't have any PROV-CLASSIFICATION-TYPE = 1 (taxonomy)
PRV-4-001-1	# of providers by Provider Classification Type
PRV-6-001-1	% of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 01, 02 (facility or group) that do not have a Provider Classification Code that indicates a facility or group
PRV-6-002-2	% of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 03 (individual) that do not have a Provider Classification Code that indicates an individual
RULE-2928	% of PRV00006 segments with invalid Provider Classification Code for Provider Classification Type
PRV-2-011-11	% of providers that require NPI (non-atypical) that are missing NPI (PROV-IDENTIFIER-TYPE=2)
RULE-7364	% of segments missing PROV-CLASSIFICATION-TYPE (PRV00006)

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
01/26/2023	3.2.0	PRV.006.088	UPDATE	Definition	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File" https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47562 A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.	A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File" https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/98581 . A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply.
12/03/2021	3.0.0	PROV-CLASSIFICATION-TYPE = 3 (Provider Type Code)	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|PROV-CLASSIFICATION-TYPE = 3 (Provider Type Code)\|00010101\|99991231\|58\|Institutions for Mental Disease\|
11/05/2021	3.0.0	PROV-CLASSIFICATION-TYPE = 4	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|89\|Disposable medical supplies\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|90\|Critical access hospital services - IP\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|91\|Skilled care - hospital residing\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|92\|Exceptional care - hospital residing\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|93\|Non-acute care - hospital residing\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|120\|Capitated payments for primary care case management (PCCM)\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|123\|Disproportionate share hospital (DSH) payments\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|127\|Indian Health Service (IHS) - Family Plan\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|132\|Supplemental payment - inpatient\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|133\|Supplemental payment - nursing\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|134\|Supplemental payment - outpatient\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|135\|EHR payments to provider\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|136\|In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|137\|COVID–19 testing-related services\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|138\|Per member per month (PMPM) payments for health home services\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|143\|Per member per month (PMPM) payments for other payments\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|144\|Payments to individuals for personal assistance services under 1915(j)\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|145\|Medication Assisted Treatment (MAT) services and drugs for evidenced-based treatment of Opioid Use Disorder (OUD) in accordance with section 1905(a)(29) of the Social Security Act\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|146\|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD)\| \|PROV-CLASSIFICATION-TYPE = 4 (Authorized Category of Service Code)\|00010101\|99991231\|147\|Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items and services for which medical assistance is available under the State plan to infants with the diagnosis of neonatal abstinence syndrome without any other significant medical risk factors.\|