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TMSIS Dataguide Medicaid.gov
Version 3.27.0

PROV-MEDICAID-ENROLLMENT

File Segment

File Segment Number

PRV00007

File Name

PRV - PROVIDER

Last updated

No Updates

Data Elements Reference
DE Number System DE Number Data Element Definition Valid Values
PRV094 PRV.007.094 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.). PRV094 Values
PRV095 PRV.007.095 SUBMITTING-STATE A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. PRV095 Values
PRV096 PRV.007.096 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
PRV097 PRV.007.097 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
PRV098 PRV.007.098 PROV-MEDICAID-EFF-DATE The first calendar day on which all of the other data elements in the same segment were effective. N/A
PRV099 PRV.007.099 PROV-MEDICAID-END-DATE The last calendar day on which all of the other data elements in the same segment were effective. N/A
PRV100 PRV.007.100 PROV-MEDICAID-ENROLLMENT-STATUS-CODE A code representing the provider's Medicaid and/or CHIP enrollment status for the time span specified by the Provider Medicaid Effective Date and Provider Medicaid End Date data elements. Note: The State Plan Enrollment data element identifies whether the provider is enrolled in Medicaid, CHIP, or both. PRV100 Values
PRV101 PRV.007.101 STATE-PLAN-ENROLLMENT The state plan with which a provider has an affiliation and is able to provide services to the state's fee for service enrollees. PRV101 Values
PRV102 PRV.007.102 PROV-ENROLLMENT-METHOD Process by which a provider was enrolled in Medicaid or CHIP. PRV102 Values
PRV103 PRV.007.103 APPL-DATE The date on which the provider applied for enrollment into the State's Medicaid and/or CHIP program. N/A
PRV104 PRV.007.104 STATE-NOTATION

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

 N/A
Definition
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.

File Segment Length
1100