PRV.004.069

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TMSIS Dataguide

Medicaid.gov

Version:

LICENSE-OR-ACCREDITATION-NUMBER

Data Element

DE Number

PRV069

System DE Number

PRV.004.069

File Name

File Segment Number

File Segment Name

PROV-LICENSING-INFO

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A data element to capture the license or accreditation number issued to the provider by the licensing entity or accreditation body identified in the License Issuing Entity ID data element.
Size	X(20)
FLF Start Position	134
FLF Stop Position	153
Segment Key Field Identifier	6
Coding Requirements	1. Value must be 20 characters or less 2. Value must not contain a pipe and asterisk symbol 3. Mandatory

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

RULE ID	RULE Definition
RULE-2888	If the provider licensing information segment has a value populated for license type, then the segment must have a value populated for license or accreditation number.
RULE-2889	If the license or accreditation number is populated on the provider licensing information file, then the license or accreditation number reported must not contain any pipe or asterisk characters.
RULE-6307	If a segment is a provider licensing information segment from a PRV file, then the licensing or accreditation number value reported must be compatible with the specified T-MSIS picture format: X(20).

Measure ID	Measure Name
MIS-11-025-25	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: LICENSE-OR-ACCREDITATION-NUMBER (PRV00004)

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.004.069	UPDATE	File segment	None	90
09/16/2024	4.0.0	PRV.004.069	ADD	N/A		Created