United States Health Information Knowledgebase

 

Medical Provider File Submission

Colorado

Versions: August 2011 - v3• March 2013 - v5• March 2014 - v6Compare Versions


Name:Medical Provider File Submission
State:Colorado
Definition:Not Provided
VersionMarch 2014 - v6

File Specification for Medical Provider File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Not Provided char 2
Multiple versionsHD002 Payer Code Distributed by CIVHC varchar 8
Multiple versionsHD003 Payer Name Distributed by CIVHC varchar 75
Multiple versionsHD004 Beginning Month Example: 200801 Date CCYYMM 6
Multiple versionsHD005 Ending Month Example: 200812 Date CCYYMM 6
Multiple versionsHD006 Record count Total number of records submitted in the medical eligibility file, excluding header and trailer records int 10
Multiple versionsMP001 Provider ID Unique identified for the provider as assigned by the reporting entity varchar 30
Multiple versionsMP002 Provider Tax ID Tax ID of the provider. Do not code punctuation. varchar 10
Multiple versionsMP003 Provider Entity Not Provided char 1
Multiple versionsMP004 Provider First Name Individual first name. Set to null if provider is a facility or organization. varchar 25
Multiple versionsMP005 Provider Middle Name or Initial Not Provided varchar 25
MP006 Provider Last Name or Organization Name Full name of provider organization or last name of individual provider varchar 60
Multiple versionsMP007 Provider Suffix Example: Jr; null if provider is an organization. Do not use credentials such as MD or PhD varchar 10
Multiple versionsMP008 Provider Specialty Report the HIPAA-compliant health care provider taxonomy code. Code set is freely available at the National Uniform Claims Committee's web site at http://www.nucc.org/ varchar 50
Multiple versionsMP009 Provider Office Street Address Physical address - address where provider delivers health care services varchar 50
Multiple versionsMP010 Provider Office City Physical address - address where provider delivers health care services varchar 30
Multiple versionsMP011 Provider Office State Physical address - address where provider delivers health care services. Use postal service standard 2 letter abbreviations. char 2
Multiple versionsMP012 Provider Office Zip Physical address - address where provider delivers health care services. Minimum 5 digit code. varchar 11
Multiple versionsMP013 Provider DEA Number Not Provided varchar 12
Multiple versionsMP014 Provider NPI Not Provided varchar 20
Multiple versionsMP015 Provider State License Number Prefix with two-character state of licensure with no punctuation. Example COLL12345 varchar 20
MP016 Provider office Address Physical address - address where provider delivers health care services: Suite number, floor number, Unit number, etc. Varchar 10
MP017 Provider Office number Provider Office number: Telephone number where provider delivers health care services. varchar 10
Multiple versionsMP899 Record Type Not Provided char 2
Multiple versionsTR001 Record Type Not Provided char 2
Multiple versionsTR002 Payer Code Distributed by CIVHC varchar 8
Multiple versionsTR003 Payer Name Distributed by CIVHC varchar 75
Multiple versionsTR004 Beginning Month Example: 200801 Date CCYYMM 6
Multiple versionsTR005 Ending Month Example: 200812 Date CCYYMM 6
Multiple versionsTR006 Extraction Date Not Provided Date YYYYMMDD 8

Downloads
 
Download as an MS Excel™ spreadsheet.
[Download Excel Reader Exit Disclaimer]
 
Data Element ID Data Element Code Value
HD001 Record Type MP
MP003 Provider Entity F Facility
G Provider
I IPA
P Practitioner
MP899 Record Type MP
TR001 Record Type MP
Scroll To Top