PRV.009.120

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

AFFILIATED-PROGRAM-ID

Data Element

DE Number

PRV120

System DE Number

PRV.009.120

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 data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates.
Size	X(50)
FLF Start Position	53
FLF Stop Position	102
Segment Key Field Identifier	4
Coding Requirements	1. Value must be 50 characters or less 2. Value must not contain a pipe or asterisk symbols 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-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-2991	If a provider affiliated programs segment affiliated program type is populated, then the affiliated program ID must be populated.
RULE-2992	If the affiliated program id is populated on the provider affiliated programs file, then the affiliated program id reported must not contain any pipe or asterisk characters.
RULE-6541	If a segment is a provider affiliated programs segment from a PRV file, then the affliated program identification value reported must be compatible with the specified T-MSIS picture format: X(50).
RULE-7174	If the provider affiliated programs segment has an affiliated program type of health home entity and the affiliated program ID is populated, then there must be a record of type provider attributes main that matches on the join keys.

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-11-051-51	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: AFFILIATED-PROGRAM-ID (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
06/14/2023	3.9.0	PRV.009.120	UPDATE	Definition	A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates. If Affiliated Program Type = 2 (Health Plan State-assigned health plan ID), then the value in Affiliated Program ID is the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. If Affiliated Program Type = 3 (Waiver), then the value in Affiliated Program ID is the core Federal Waiver ID in which a provider is allowed to deliver services to eligible beneficiaries. If Affiliated Program Type = 4 (Health Home Entity), then the value in Affiliated Program ID is the name of a health home in which a provider is participating. If Affiliated Program Type = 5 (Other), then the value in Affiliated Program ID is an identifier for something other than a health plan, waiver, or health home entity.	A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates.
06/23/2023	3.9.0	PRV120	UPDATE	Data Dictionary	DE NO\|\|DATA ELEMENT NAME COMPUTING\|\|\|DEFINITION PRV120\|AFFILIATED-PROGRAM-ID\|\|\|A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates.If Affiliated Program Type = 2 (Health Plan State-assigned health plan ID), then the value in Affiliated Program ID is the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. If Affiliated Program Type = 3 (Waiver), then the value in Affiliated Program ID is the core Federal Waiver ID in which a provider isallowed to deliver services to eligible beneficiaries. If Affiliated Program Type = 4 (Health Home Entity), then the value in Affiliated Program ID is the name of a health home in which a provider is participating. If Affiliated Program Type = 5 (Other), then the value in Affiliated Program ID is an identifier for something other than a health plan, waiver, or health home entity.	DE NO\|\|DATA ELEMENT NAME COMPUTING\|\|\|DEFINITION PRV120\|AFFILIATED-PROGRAM-ID\|\|\|A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates.
06/24/2022	3.0.0	AFFILIATED-PROGRAM-ID	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV120\|AFFILIATED-PROGRAM-ID A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates. (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\| \|PRV120\|AFFILIATED-PROGRAM-ID A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates. If Affiliated Program Type = 2 (Health Plan State-assigned health plan ID), then the value in Affiliated Program ID is the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. If Affiliated Program Type = 3 (Waiver), then the value in Affiliated Program ID is the core Federal Waiver ID in which a provider is allowed to deliver services to eligible beneficiaries. If Affiliated Program Type = 4 (Health Home Entity), then the value in Affiliated Program ID is the name of a health home in which a provider is participating. If Affiliated Program Type = 5 (Other), then the value in Affiliated Program ID is an identifier for something other than a health plan, waiver, or health home entity.