PRV-4-001-1

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Measure Name	# of providers by Provider Classification Type
File Type	PRV
Measure ID	PRV-4-001-1
Measure Type	Frequency
Content area	PRO

Validation Type	Frequency

Measure Priority	N/A
Focus Area	N/A
Category	N/A

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Minimum	N/A
Maximum	N/A
TA Minimun
TA Maximum
Longitudinal Threshold	N/A
For TA (for including in compliance training)	No
For TA (Longitudinal)	No

DD Data Element	PROV-CLASSIFICATION-TYPE
DD Data Element Number	PRV088

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	PRV-4-001-1	UPDATE	Annotation	For the data element, provider classification type code, run the frequency of unique state submitting provider IDs for each valid value, any valid value, and any invalid value, including missing	N/A
11/20/2025	4.0.22	PRV-4-001-1	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missingSTEP 2: Provider taxonomy on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 3: FrequencyCount the number of unique SUBMITTING-STATE-PROV-IDs from STEP 2 for:1. (1,2,3,4) Each valid value: PROV-CLASSIFICATION-TYPE = ("1", "2", "3", "4", respectively)2. (A) Any valid value: PROV-CLASSIFICATION-TYPE = ("1" or "2" or "3" or "4")3. (N) No valid value: PROV-CLASSIFICATION-TYPE (NOT ("1" or "2" or "3" or "4") or missing4. (T) total: PROV-CLASSIFICATION-TYPE = (any missing or non-missing value)	N/A
04/24/2025	4.0.7	PRV-4-001-1	ADD	N/A		Created

PRV-4-001-1

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements