PRV.006.089

PROV-CLASSIFICATION-CODE

Data Element

DE Number

PRV089

System DE Number

PRV.006.089

File Name

PRV - PROVIDER

File Segment Number

PRV00006

File Segment Name

PROV-TAXONOMY-CLASSIFICATION

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The code values from the categorization schema identified in the Provider Classification Type data element. Note: States should apply these classification schemas consistently across all providers.
Size	X(20)
FLF Start Position	53
FLF Stop Position	72
Segment Key Field Identifier	4
Coding Requirements	1. If associated Provider Classification Type equals "1", value must be in Provider Taxonomy List (VVL) 2. If associated Provider Classification Type equals 2, value must be in Provider Specialty List (VVL) 3. If associated Provider Classification Type equals "3", value must be in Provider Type Code List (VVL) 4. If associated Provider Classification Type equals "4", value must be in Provider Authorized Category of Service Code List (VVL) 5. Value must be 20 characters or less 6. Mandatory

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

*Valid values for PROV-CLASSIFICATION-CODE depend on the value submitted for PROV-CLASSIFICATION-TYPE. All four valid value sets are shown here below.

If PROV-CLASSIFICATION-TYPE = 1 then refer to the Provider Taxonomy Code List

If PROV-CLASSIFICATION-TYPE = 2 then you should submit a valid value from the PROV-SPECIALTY valid value set.

If PROV-CLASSIFICATION-TYPE = 3 then you should submit a valid value from the PROV-TYPE valid value set.

If PROV-CLASSIFICATION-TYPE = 4 then you should submit a valid value from the PROV-CLASSIFICATION-CODE-TYPE-4 valid value set.

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
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-6863	If a segment is a provider taxonomy classification segment from a PRV file, the provider classification code value reported must be compatible with the specified T-MSIS picture format: X(20).
RULE-7363	If SUBMITTING-STATE-PROV-ID is populated on a PROV-TAXONOMY-CLASSIFICATION segment from an PRV file, then PROV-CLASSIFICATION-CODE must be populated.

Measure ID	Measure Name
MIS-11-038-38	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: PROV-CLASSIFICATION-CODE (PRV00006)
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
PRV-6-003-3	% of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 01, 02 (facility or group) that are missing Provider Classification Code
PRV-6-004-4	% of Submitting State Provider IDs with FACILITY-GROUP-INDIVIDUAL-CODE = 03 (individual) that are missing Provider Classification Code
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-7363	% of segments missing PROV-CLASSIFICATION-CODE (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
09/12/2024	3.29.0	PRV.006.089	UPDATE	Coding requirement	1. If associated Provider Classification Type equals 1, value must be in Provider Taxonomy List (VVL)2. If associated Provider Classification Type equals 2, value must be in Provider Specialty List (VVL)3. If associated Provider Classification Type equals 3, value must be in Provider Type Code List (VVL)4. If associated Provider Classification Type equals 4, value must be in Provider Authorized Category of Service Code List (VVL)5. Value must be 20 characters or less6. Mandatory	1. If associated Provider Classification Type equals "1", value must be in Provider Taxonomy List (VVL)2. If associated Provider Classification Type equals 2, value must be in Provider Specialty List (VVL)3. If associated Provider Classification Type equals "3", value must be in Provider Type Code List (VVL)4. If associated Provider Classification Type equals "4", value must be in Provider Authorized Category of Service Code List (VVL)5. Value must be 20 characters or less6. Mandatory
09/21/2023	3.13.0	PRV.006.089	UPDATE	Segment key field identifier	Not Applicable	4
01/03/2023	3.2.0	PRV.006.089	UPDATE	Medicaid valid value info	*Valid values for PROV-CLASSIFICATION-CODE depend on the value submitted for PROV-CLASSIFICATION-TYPE. All four valid value sets are shown here below.If PROV-CLASSIFICATION-TYPE = 1 then you should submit a valid value from the PROV-CLASSIFICATION-CODE-TYPE-1 valid value set.If PROV-CLASSIFICATION-TYPE = 2 then you should submit a valid value from the PROV-SPECIALTY valid value set.If PROV-CLASSIFICATION-TYPE = 3 then you should submit a valid value from the PROV-TYPE valid value set.If PROV-CLASSIFICATION-TYPE = 4 then you should submit a valid value from the PROV-CLASSIFICATION-CODE-TYPE-4 valid value set.	*Valid values for PROV-CLASSIFICATION-CODE depend on the value submitted for PROV-CLASSIFICATION-TYPE. All four valid value sets are shown here below.If PROV-CLASSIFICATION-TYPE = 1 then refer to the Provider Taxonomy Code ListIf PROV-CLASSIFICATION-TYPE = 2 then you should submit a valid value from the PROV-SPECIALTY valid value set.If PROV-CLASSIFICATION-TYPE = 3 then you should submit a valid value from the PROV-TYPE valid value set.If PROV-CLASSIFICATION-TYPE = 4 then you should submit a valid value from the PROV-CLASSIFICATION-CODE-TYPE-4 valid value set.
03/15/2024	3.21.0	PROV-CLASSIFICATION-CODE-TYPE-1	Update	Data Dictionary - Valid Values	reference files containing provider taxonomy are out of sync	Valid Values updated
09/11/2020	2.4.0	PROV-CLASSIFICATION-CODE	UPDATE	Data Dictionary - Valid Values	\|Code\|Current DDv2.3 definition\| \|62\|Psychologist, Clinical\| \|68\|Psychologist, Clinical\|	\|Code\|definition\| \|62\|Psychologist (Billing Independently)\| \|68\|Clinical Psychologist\|
09/11/2020	2.4.0	PROV-CLASSIFICATION-CODE	UPDATE	Data Dictionary - Valid Values	\|Code\|Definition\| \|62\|Psychologist, Clinical\| \|68\|Psychologist, Clinical\|	\|Code\|Definition\| \|62\|Psychologist (Billing Independently)\| \|68\|Clinical Psychologist\|