PRV.003.056

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TMSIS Dataguide

Medicaid.gov

Version:

ADDR-BORDER-STATE-IND

Data Element

DE Number

PRV056

System DE Number

PRV.003.056

File Name

File Segment Number

File Segment Name

PROV-LOCATION-AND-CONTACT-INFO

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	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.)
Size	X(1)
FLF Start Position	373
FLF Stop Position	373
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 1 character 3. Mandatory 2. Value must be in Address Border State Indicator List (VVL)

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

RULE ID	RULE Definition
RULE-2861	If the address border state indicator is populated on a provider location and contact information file, then the address border state indicator reported must be found in the list of valid values.
RULE-7041	If a segment is a provider location and contact information segment from a PRV file, then the address border state indicator value reported must be compatible with the specified T-MSIS picture format: X(1).

Measure ID	Measure Name

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.003.056	UPDATE	File segment	None	89
09/16/2024	4.0.0	PRV.003.056	ADD	N/A		Created