PRV.009.120

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TMSIS Dataguide

Medicaid.gov

Version:

AFFILIATED-PROGRAM-ID

Data Element

DE Number

PRV120

System DE Number

PRV.009.120

File Name

File Segment Number

File Segment Name

PROV-AFFILIATED-PROGRAMS

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A data element to identify the Medicaid/CHIP programs, waivers and demonstrations in which the provider participates.
Size	X(50)
FLF Start Position	53
FLF Stop Position	102
Segment Key Field Identifier	4
Coding Requirements	1. Value must be 50 characters or less 2. Value must not contain a pipe or asterisk symbols 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-2990	If the affiliated program type is equal to '2' (health plan (state assigned health plan ID)) on a provider affiliated programs PRV file segment and the provider affiliated programs prov affiliated program end date is greater than the states tmsis cutover date then the effective and end dates on the provider affiliated programs segment must fall with the effective and end dates of one or more continuous mangaged care main segments.
RULE-2991	If a provider affiliated programs segment affiliated program type is populated, then the affiliated program ID must be populated.
RULE-2992	If the affiliated program id is populated on the provider affiliated programs file, then the affiliated program id reported must not contain any pipe or asterisk characters.
RULE-6541	If a segment is a provider affiliated programs segment from a PRV file, then the affliated program identification value reported must be compatible with the specified T-MSIS picture format: X(50).
RULE-7174	If the provider affiliated programs segment has an affiliated program type of health home entity and the affiliated program ID is populated, then there must be a record of type provider attributes main that matches on the join keys.

Measure ID	Measure Name
MIS-11-051-51	% distinct SUBMITTING-STATE-PROV-IDs with only missing values in any active segment: AFFILIATED-PROGRAM-ID (PRV00009)
EL-13-001-1	% of MC enrollments with a plan ID that does not link to a health plan affiliated with any provider in the provider file

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.009.120	UPDATE	File segment	None	95
09/16/2024	4.0.0	PRV.009.120	ADD	N/A		Created