| PRV072 |
PRV.005.072
|
RECORD-ID |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a
given row of data should be interpreted depending on which segment type the Record ID represents. Each type of
segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify
the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g.,
00001, 00002, 00003, etc.). |
PRV072 Values
|
| PRV073 |
PRV.005.073
|
SUBMITTING-STATE |
A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. |
PRV073 Values
|
| PRV074 |
PRV.005.074
|
RECORD-NUMBER |
A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file. |
N/A
|
| PRV075 |
PRV.005.075
|
SUBMITTING-STATE-PROV-ID |
The State-specific Medicaid Provider Identifier is a state-assigned unique identifier that states should report with all individual providers, practice groups, facilities, and other entities. This should be the identifier that is used in the state's Medicaid Management Information System. |
N/A
|
| PRV076 |
PRV.005.076
|
PROV-LOCATION-ID |
A code to uniquely identify the geographic location where the provider's services were performed. The Provider Location Identifier values reported on Inpatient, Long-Term Care, Other, and Pharmacy Claim Header Segments must correspond to an active Provider Location Identifier
value on a Provider Location and Contact Info (PRV.003) segment. If a particular license (e.g., a physician's medical license) or provider identifier (e.g., an individual provider's NPI or SSN) is applicable to all of their servicing locations, value "000" (a string of exactly three zeros) can
be used in the PRV.004 or PRV.005, respectively, to represent all locations, however that location identifier must not be attributed to claims or provider bed type info. |
N/A
|
| PRV077 |
PRV.005.077
|
PROV-IDENTIFIER-TYPE |
A code to identify the kind of provider identifier that is captured in the Provider Identifier data element. The state should
submit updates to T-MSIS whenever an identifier is retired or issued. see Provider Identifier Type List (VVL.146) |
PRV077 Values
|
| PRV078 |
PRV.005.078
|
PROV-IDENTIFIER-ISSUING-ENTITY-ID |
A free text field to capture the identity of the entity that issued the provider identifier in the Provider Identifier (PRV.005.081) data element. For (State Tax ID), if associated Provider Identifier Type (PRV.005.077) value is equal to 6, then value must be the name of the state's taxation
division. For (Other), if associated Provider Identifier Type (PRV.005.077) value is equal to 8, then value must be the name of the entity that issued the identifier. |
N/A
|
| PRV079 |
PRV.005.079
|
PROV-IDENTIFIER-EFF-DATE |
The first calendar day on which all of the other data elements in the same segment were effective. |
N/A
|
| PRV080 |
PRV.005.080
|
PROV-IDENTIFIER-END-DATE |
The last calendar day on which all of the other data elements in the same segment were effective. |
N/A
|
| PRV081 |
PRV.005.081
|
PROV-IDENTIFIER |
A data element to capture the various ways used to distinguish providers from one another on claims and other interactions between providers and other entities. The specific type of identifier is defined in the corresponding value in the Provider Identifier Type data element. |
N/A
|
| PRV082 |
PRV.005.082
|
STATE-NOTATION |
A free text field for the submitting state to enter whatever information it chooses. |
N/A
|
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