PRV.002.020

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TMSIS Dataguide

Medicaid.gov

Version:

PROV-ATTRIBUTES-EFF-DATE

Data Element

DE Number

PRV020

System DE Number

PRV.002.020

File Name

File Segment Number

File Segment Name

PROV-ATTRIBUTES-MAIN

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The first calendar day on which all of the other data elements in the same segment were effective.
Size	9(8)
FLF Start Position	52
FLF Stop Position	59
Segment Key Field Identifier	(a)
Coding Requirements	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Value must be before or the same as the associated Segment End Date value 3. Mandatory 4. Value of the CC component must be in [18,19,20]

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-8725	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Settlement Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the cost settlement period start date on the financial transaction.
RULE-8745	If a financial transaction is a non-void, and the payer ID is populated on Miscellaneous Payment segment from the FTX file and the payer id type is Sub-capitated network provider ID, then the payer ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the payment period start date on the financial transaction.
RULE-8744	If a financial transaction is a non-void, and the payer ID is populated on FQHC Wrap Payment segment from the FTX file and the payer id type is Sub-capitated network provider ID, then the payer ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the wrap period start date on the financial transaction.
RULE-8743	If a financial transaction is a non-void, and the payer ID is populated on Cost Settlement Payment segment from the FTX file and the payer id type is Sub-capitated network provider ID, then the payer ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the cost settlement period start date on the financial transaction.
RULE-8742	If a financial transaction is a non-void, and the payer ID is populated on State Directed Payment Separate Payment Term segment from the FTX file and the payer id type is Sub-capitated network provider ID, then the payer ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the payment period start date on the financial transaction.
RULE-8741	If a financial transaction is a non-void, and the payer ID is populated on Value Based Payment segment from the FTX file and the payer id type is Sub-capitated network provider ID, then the payer ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the performance period start date on the financial transaction.
RULE-8737	If a financial transaction is a non-void, and the payer ID is populated on Individual Capitation Payment segment from the FTX file and the payer id type is Sub-capitated network provider ID, then the payer ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the capitation period start date on the financial transaction.
RULE-8727	If a financial transaction is a non-void, and the PAYEE ID is populated on Miscellaneous Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the payment period start date on the financial transaction.
RULE-8726	If a financial transaction is a non-void, and the PAYEE ID is populated on FQHC Wrap Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the wrap period start date on the financial transaction.
RULE-2790	If a segment is a provider attributes main segment from a PRV file, then the provider attributes effective date value reported must be a valid date of the form CCYYMMDD.
RULE-8724	If a financial transaction is a non-void, and the PAYEE ID is populated on State Directed Payment Separate Payment Term segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the payment period start date on the financial transaction.
RULE-8723	If a financial transaction is a non-void, and the PAYEE ID is populated on Value Based Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the performance period start date on the financial transaction.
RULE-8722	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Sharing Offset segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the coverage period start date on the financial transaction.
RULE-8721	If a financial transaction is a non-void, and the PAYEE ID is populated on Group Insurance Premium Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the premium period start date on the financial transaction.
RULE-8720	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Health Insurance Premium Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the premium period start date on the financial transaction.
RULE-8719	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Capitation Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the capitation period start date on the financial transaction.
RULE-2792	If provider attributes effective date and provider attributes end date are populated on a provider attributes main segment from a PRV file, then the provider attributes effective date value reported must be before or equal to the provider attributes end date value reported.

Measure ID	Measure Name
MIS-11-004-4	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: PROV-ATTRIBUTES-EFF-DATE (PRV00002)
PRV-5-001-1	Ratio of errors for overlapping segment eff/end dates [RULE-2793] to all active PROV-ATTRIBUTES-MAIN (PRV00002) segments across all reporting and coverage periods
RULE-2793	Ratio of errors for overlapping segment eff/end dates [RULE-2793] to all active PROV-ATTRIBUTES-MAIN (PRV00002) segments

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	PRV.002.020	UPDATE	File segment	None	88
09/16/2024	4.0.0	PRV.002.020	ADD	N/A		Created