PRV.005.080

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TMSIS Dataguide

Medicaid.gov

Version:

PROV-IDENTIFIER-END-DATE

Data Element

DE Number

PRV080

System DE Number

PRV.005.080

File Name

File Segment Number

File Segment Name

PROV-IDENTIFIERS

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The last calendar day on which all of the other data elements in the same segment were effective.
Size	9(8)
FLF Start Position	84
FLF Stop Position	91
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Value must be greater than or equal to associated Segment Effective Date value 3. Mandatory 4. Value of the CC component must be in [18,19,20,99]

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

RULE ID	RULE Definition
RULE-2212	If the health home spa name is populated on a health home SPA providers ELG file segment and the health home SPA providers health home spa provider end date is greater than the states tmsis cutover date then the effective and end dates on the health home SPA providers segment must fall with the effective and end dates of one or more continuous provider identifiers segments.
RULE-2258	If the lock-in provider number is populated on a lock-in information ELG file segment and the lock-in information lockin end date is greater than the states tmsis cutover date then the effective and end dates on the lock-in information segment must fall with the effective and end dates of one or more continuous provider identifiers segments.
RULE-2357	If the LTSS provider number is populated on a LTSS participation ELG file segment and the LTSS participation LTSS eligibility end date is greater than the states tmsis cutover date then the effective and end dates on the LTSS participation segment must fall with the effective and end dates of one or more continuous provider identifiers segments.
RULE-2910	If provider identifier effective date and provider identifier end date are populated on a provider identifiers segment from a PRV file, then the provider identifier effective date value reported must be before or equal to the provider identifier end date value reported.
RULE-2913	If a segment is a provider identifiers segment from a PRV file, then the provider identifier end date value reported must be a valid date of the form CCYYMMDD.
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-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-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-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-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-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-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-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-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.

Measure ID	Measure Name
MIS-11-033-33	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: PROV-IDENTIFIER-END-DATE (PRV00005)
PRV-5-004-4	Ratio of errors for overlapping segment eff/end dates [RULE-2911] to all active PROV-IDENTIFIERS (PRV00005) segments across all reporting and coverage periods
RULE-2911	Ratio of errors for overlapping segment eff/end dates [RULE-2911] to all active PROV-IDENTIFIERS (PRV00005) 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
03/14/2025	4.0.4	PRV.005.080	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]
12/19/2024	4.0.1	PRV.005.080	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99]	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99]
09/16/2024	4.0.0	PRV.005.080	UPDATE	File segment	None	91
09/16/2024	4.0.0	PRV.005.080	ADD	N/A		Created