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TMSIS Dataguide Medicaid.gov
Version 3.27.0

PRV - PROVIDER

File

File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
PRV00001 FILE-HEADER-RECORD-PROVIDER A record containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
PRV00002 PROV-ATTRIBUTES-MAIN A record to capture basic, generally static information about each provider. A provider is an individual person (medical or non-medical), a group of individuals, or an organization (e.g. institution, facility, agency, hospital, nursing facility, home health agency, school, or transportation organization) that delivers or facilitates health-related treatments, health care services, or living supports.
PRV00003 PROV-LOCATION-AND-CONTACT-INFO A record to capture addresses, phone numbers, and email addresses of the provider.Each PROV-LOCATION-AND-CONTACT-INFO record segment represents the set of contact information for a single provider location.The state can enter as many sets of contact information (i.e., multiple PROV-LOCATION-AND-CONTACT-INFO record segments) as it considers necessary. The value selected for the ADDR-TYPE field describes the type of contact information on that particular record (e.g., provider service location, provider billing address, etc.).The PROV-LOCATION-ID differentiates one PROV-LOCATION-AND-CONTACT-INFO record segment from another when the ADDR-TYPE value on both records is the same.
PRV00004 PROV-LICENSING-INFO A record to capture licensing and accreditation information relevant to the provider.
PRV00005 PROV-IDENTIFIERS A record to capture the identifiers assigned to the provider entity by various governmental, professional, and payer entities.
PRV00006 PROV-TAXONOMY-CLASSIFICATION A record to classify the provider into areas of specialty, as well as the authorized categories of service for which the provider entity has been authorized by the state to render to Medicaid/CHIP eligibles.
PRV00007 PROV-MEDICAID-ENROLLMENT A record to capture the provider's periods of participation in the state's Medicaid/CHIP programs, and the reason for a change in enrollment status.
PRV00008 PROV-AFFILIATED-GROUPS A record to capture a provider's relationship(s) with other provider(s).
PRV00009 PROV-AFFILIATED-PROGRAMS A record to capture the Medicaid/CHIP health plans, waivers, health home entities, etc. that the provider entity is associated with.
PRV00010 PROV-BED-TYPE-INFO A record to capture the number of beds available for various categories of bed at provider entities that are facilities.
Definition
New file of provider enrollment with Medicaid and MCOs including demographics and characteristics data.

Overview

Diagram 6: Provider File – Provider Record Segment Relationships

prv_overview

Description of Diagram 6:

Each provider in T-MSIS (regardless of whether the provider is a single individual, a group of practitioners, a facility, or a group of facilities) must have a record in the T-MSIS providers file. Each provider record is comprised of up to nine different types of record segments. The PROV-ATTRIBUTES-MAIN (PRV00002) segment is the parent segment to five segments: PROV-TAXONOMY-CLASSIFICATION (PRV00006), PROV-MEDICAID-ENROLLMENT (PRV00007), PROV-AFFILIATED-GROUPS (PRV00008), PROV-AFFILIATED-PROGRAMS (PRV00009), and PROV-LOCATION-AND-CONTACT-INFO (PRV00003), all of which join to PROV-ATTRIBUTES-MAIN on the following two data elements:

1. SUBMITTING-STATE
2. SUBMITTING-STATE-PROV-ID

In addition, the PROV-LOCATION-AND-CONTACT-INFO (PRV00003) segment is a parent segment in its own right to three additional subordinate segments: PROV-IDENTIFIERS (PRV00005), PROV-LICENSING-INFO (PRV00004), PROV-BED-TYPE-INFO (PRV00010). These three segments join to the PROV-LOCATION-AND-CONTACT-INFO segment on:

1. SUBMITTING-STATE
2. SUBMITTING-STATE-PROV-ID
3. PROV-LOCATION-ID