PRV.005.077

PROV-IDENTIFIER-TYPE

Data Element

DE Number

PRV077

System DE Number

PRV.005.077

File Name

PRV - PROVIDER

File Segment Number

PRV00005

File Segment Name

PROV-IDENTIFIERS

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to identify the kind of provider identifier that is captured in the Provider Identifier data element. The state should submit updates to T-MSIS whenever an identifier is retired or issued. see Provider Identifier Type List (VVL.146)
Size	X(1)
FLF Start Position	57
FLF Stop Position	57
Segment Key Field Identifier	4
Coding Requirements	1. Value must be 1 character 2. Value must be in Provider Identifier Type List (VVL) 3. Mandatory 4. When value equals "2", the associated Provider Identifier (PRV.005.081) must be a valid NPI

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

RULE ID	RULE Definition
RULE-7569	If submitting state provider is populated on a provider attributes main segment from a PRV file, and facility group individual code is equal to '03' (individual), then there is no more than one distinct provider identifier in provider identifiers segment where provider identifier type is equal to 2.
RULE-8736	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the payment period start date on the financial transaction.
RULE-8735	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the wrap period start date on the financial transaction.
RULE-8734	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the cost settlement period start date on the financial transaction.
RULE-8733	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the payment period start date on the financial transaction.
RULE-8732	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the performance period start date on the financial transaction.
RULE-8731	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the coverage period start date on the financial transaction.
RULE-8730	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the premium period start date on the financial transaction.
RULE-8729	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the premium period start date on the financial transaction.
RULE-8728	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 State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the capitation period start date on the financial transaction.
RULE-819	If a claim is a non-denied claim from an IP file that is not an encounter claim and the operating provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value 'NPI'.
RULE-7589	If submitting state provider ID is populated on a provider attributes main segment from an PRV file, and facility group individual code is equal to '03' (individual), and the provider identifier type = '2' and the submitting state provider ID is a valid NPI in the NPPES file, then the entity type code is equal to '1' (individual) in the NPPES NPI data file.
RULE-7587	If submitting state provider ID is populated on a provider attributes main segment from an PRV file, and facility group individual code is equal to '01' (facility) or '02' (group), and the provider identifier type = '2' and the submitting state provider ID is a valid NPI in the NPPES file, then the entity type code is equal to '2' (organization) in the NPPES NPI data file.
RULE-1129	If a claim is a non-denied claim from an LT file that is not an encounter claim and the billing provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.
RULE-747	If a claim is a non-denied claim from an IP file that is not an encounter claim and the home health provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.
RULE-7362	If SUBMITTING-STATE-PROV-ID is populated on a PROV-IDENTIFIERS segment from an PRV file, then PROV-IDENTIFIER-TYPE must be populated.
RULE-6499	If a segment is a provider identifiers segment from a PRV file, the provider identifier type value reported must be compatible with the specified T-MSIS picture format: X(1).
RULE-2901	If the provider identifier is populated on a provider identifiers segment from a PRV file, then provider identifier type must also be populated.
RULE-2900	If provider identifier type is populated on a provider identifiers segment from a PRV file, then the provider identifier type value reported must be in the list of valid values for provider identifier type.
RULE-1893	If a claim is a non-denied claim from an RX file that is not an encounter claim and the dispensing prescription provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.
RULE-1848	If a claim is a non-denied claim from an RX file that is not an encounter claim and the billing provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.
RULE-1668	If a claim is a non-denied, non-void claim from an OT file, and the claim line servicing provider NPI number is populated, then for matching records in provider identifiers, the provider identifier type is equal to 2 (NPI).
RULE-1591	If a claim is a non-denied claim from an OT file that is not an encounter claim and the home health provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.
RULE-1544	If a claim is a non-denied, non-void claim from an OT file, and the billing provider NPI number is populated, then for matching records in provider identifiers, the provider identifier type is equal to 2 (NPI).
RULE-1249	If a claim is a non-denied claim from an LT file that is not an encounter claim and the servicing provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value 'NPI'.
RULE-1179	If a claim is a non-denied claim from an LT file that is not an encounter claim and the home health provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.

Measure ID	Measure Name
PRV-2-001-1	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 1 (state-specific Medicaid provider ID)
PRV-2-002-2	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 2 (NPI)
PRV-2-003-3	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 3 (Medicare ID)
PRV-2-004-4	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 4 (NCPDP ID)
PRV-2-005-5	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 5 (federal tax ID)
PRV-2-006-6	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 6 (state tax ID)
PRV-2-007-7	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 7 (SSN)
PRV-2-008-8	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 8 (other)
MIS-11-035-35	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: PROV-IDENTIFIER-TYPE (PRV00005)
PRV-2-009-9	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 2 (NPI) that don't have any PROV-CLASSIFICATION-TYPE = 1 (taxonomy)
PRV-2-010-10	% of Submitting State Provider IDs (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with more than one NPI (PROV-IDENTIFIER-TYPE = 2) (across all time)
PRV-2-011-11	% of providers that require NPI (non-atypical) that are missing NPI (PROV-IDENTIFIER-TYPE=2)
RULE-7569	% of Provider Attributes Main segments for individual providers (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with more than one NPI (PROV-IDENTIFIER-TYPE = 2) (across all time)
RULE-7362	% of segments missing PROV-IDENTIFIER-TYPE (PRV00005)

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.005.077	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.077	ADD	N/A		Created