PRV.009.119

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

AFFILIATED-PROGRAM-TYPE

Data Element

DE Number

PRV119

System DE Number

PRV.009.119

File Name

File Segment Number

File Segment Name

PROV-AFFILIATED-PROGRAMS

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to identify the category of program that the provider is affiliated.
Size	X(1)
FLF Start Position	52
FLF Stop Position	52
Segment Key Field Identifier	3
Coding Requirements	1. Value must be in Affiliated Program 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-2989	If the affiliated program type is populated on a provider affiliated programs file, then the affiliated program type reported must be found in the list of valid values.
RULE-2990	If the affiliated program type is equal to '2' (health plan (state assigned health plan ID)) on a provider affiliated programs PRV file segment and the provider affiliated programs prov affiliated program end date is greater than the states tmsis cutover date then the effective and end dates on the provider affiliated programs segment must fall with the effective and end dates of one or more continuous mangaged care main segments.
RULE-6735	If a segment is a provider affiliated programs segment from a TPL file, the affiliated program type value reported must be compatible with the specified T-MSIS picture format: X(1).

Measure ID	Measure Name
EL-13-001-1	% of MC enrollments with a plan ID that does not link to a health plan affiliated with any provider in the provider file
MIS-11-052-52	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: AFFILIATED-PROGRAM-TYPE (PRV00009)

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
06/02/2023	3.8.0	PRV119	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION AFFILIATED-PROGRAM-TYPE\|00010101\|99991231\|7\|Fee-For-Service - (This value is used to identify providers that are affiliated directly with the state’s Medicaid or CHIP agency (or their fiscal intermediary) and reimbursed by the Medicaid or CHIP agency on a FFS basis. The value in the AFFILIATED-PROGRAM-ID data element contains the ANSI state code of the state in which the provider is enrolled to provide services including through the state plan and a waiver.)
07/10/2020	2.4.0	AFFILIATED-PROGRAM-TYPE (PRV119)	UPDATE	Data Dictionary - Valid Values	\|Data Element Name\|Valid Value\|Description\|Effective Date\|End Date\| \|AFFILIATED-PROGRAM-TYPE\|1\|Health Plan (NHP-ID) – The value in the AFFILIATED-PROGRAM-ID data element contains the National Health Plan Identifier of health plan in which the provider is enrolled to provide services including through the state plan and a waiver.\|01/01/0001\|12/31/9999\|	N/A
06/24/2022	3.0.0	AFFILIATED-PROGRAM-TYPE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV119\|AFFILIATED-PROGRAM-TYPE\| A code to identify the category of program that the provider is affiliated. see Affiliated Program Type List (VVL.004) (health plan federal assigned) if associated Affiliated Program Type (DE) value is 1, then value must be the federal-assigned plan ID of the health plan in which a provider is enrolled to provide services. (health plan state assigned) if associated Affiliated Program Type (DE) value is 2, then value must be the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. (waiver) if associated Affiliated Program Type (DE) value is 3, then value must be the core Federal Waiver ID in which a provider is allowed to deliver services to eligible beneficiaries. (health home entity) if associated Affiliated Program Type (DE) value is 4, then value must be the name of a health home in which a provider is participating. (other) if associated Affiliated Program Type (DE) value is 5, then value must be an identifier for something other than a health plan, waiver, or health home entity.\|	\|DE No\|Data Element Name\|Definition\| \|PRV119\|AFFILIATED-PROGRAM-TYPE\|A code to identify the category of program that the provider is affiliated.\|