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TMSIS Dataguide Medicaid.gov
Version 3.27.0

PROV-LOCATION-AND-CONTACT-INFO

File Segment

File Segment Number

PRV00003

File Name

PRV - PROVIDER

Last updated

No Updates

Data Elements Reference
DE Number System DE Number Data Element Definition Valid Values
PRV039 PRV.003.039 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.). PRV039 Values
PRV040 PRV.003.040 SUBMITTING-STATE A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. PRV040 Values
PRV041 PRV.003.041 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
PRV042 PRV.003.042 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
PRV043 PRV.003.043 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
PRV044 PRV.003.044 PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE The first calendar day on which all of the other data elements in the same segment were effective. N/A
PRV045 PRV.003.045 PROV-LOCATION-AND-CONTACT-INFO-END-DATE The last calendar day on which all of the other data elements in the same segment were effective. N/A
PRV046 PRV.003.046 ADDR-TYPE The type of address and contact information for the provider submitted in the record segment. PRV046 Values
PRV047 PRV.003.047 ADDR-LN1

The first line of a potentially multi-line physical street or mailing address for a given entity (e.g. person, organization, agency, etc.).

 N/A
PRV048 PRV.003.048 ADDR-LN2

The second line of a multi-line physical street or mailing address for a given entity (e.g. person, organization, agency, etc.).

 N/A
PRV049 PRV.003.049 ADDR-LN3

The third line of a multi-line physical street or mailing address for a given entity (e.g. person, organization, agency, etc.).

 N/A
PRV050 PRV.003.050 ADDR-CITY The city component of an address associated with a given entity (e.g. person, organization, agency, etc.). N/A
PRV051 PRV.003.051 ADDR-STATE The ANSI numeric state code component of an address associated with a given entity (e.g. person, organization, agency, etc.) PRV051 Values
PRV052 PRV.003.052 ADDR-ZIP-CODE

U.S. ZIP Code component of an address associated with a given entity (e.g. person, organization, agency, etc.)

 PRV052 Values
PRV053 PRV.003.053 ADDR-TELEPHONE

Phone number for a given entity (e.g. person, organization, agency).

 N/A
PRV054 PRV.003.054 ADDR-EMAIL

The email address of the provider for the location being captured on this record

 N/A
PRV055 PRV.003.055 ADDR-FAX-NUM The fax number of the provider for the location being captured on this record. N/A
PRV056 PRV.003.056 ADDR-BORDER-STATE-IND A code identify an out of state provider enrolled with the state (The provider location is out of state, but for payment purposes the provider is treated as an in-state provider.) PRV056 Values
PRV057 PRV.003.057 ADDR-COUNTY Standard ANSI code used to identify a specific U.S. County. PRV057 Values
PRV058 PRV.003.058 STATE-NOTATION

A free text field for the submitting state to enter whatever information it chooses.

 N/A
Definition
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.

File Segment Length
1100