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Provider File Submission

Massachusetts

Versions: December 1, 2010 - v2.1 • June 7, 2013 - v3.1• October 1, 2014 - v4.0Compare Versions


Name:Provider File Submission
State:Massachusetts
Definition:A MA APCD file containing information on all types of health care provider entities. Typically these are active, contracted providers.
VersionDecember 1, 2010 - v2.1

File Specification for Provider File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text HD 2
Multiple versionsHD002 Payer Header Submitter/Carrier ID Text 8
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Text 30
Multiple versionsHD004 Type of File Header Type of File Text PV 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer ####### 10
Multiple versionsHD008 Comments Header Carrier Comments Text Free Text Comments 80
Multiple versionsPV001 Payer Carrier Specific Submitter Code as defined by APCD. This must match the Submitter Code reported in HD002 Text 8
Multiple versionsPV002 Plan Provider ID Carrier Unique Provider Code Text 30
Multiple versionsPV003 Tax Id The Federal Tax ID associated with the provider identified in PV002. Text ######### 12
Multiple versionsPV004 UPIN Id Unique Physician Identification Number (UPIN) Text 10
Multiple versionsPV005 DEA ID Primary DEA number for the provider identified in PV002. Text 10
Multiple versionsPV006 License Id State practice license for the Provider in PV002 Text 25
Multiple versionsPV007 Medicaid Id Medicaid assigned number for the Provider in PV002 Text 25
Multiple versionsPV008 Last Name Last name of the Provider in PV002 Text Free Text Name 50
Multiple versionsPV009 First Name First name of the Provider in PV002 Text Free Text Name 50
Multiple versionsPV010 Middle Initial Middle initial of the Provider in PV002 Text Free Text Name 1
Multiple versionsPV011 Suffix Suffix of the Provider in PV002 Text 2
Multiple versionsPV012 Entity Name Group / Facility name Text Free Text Name 100
Multiple versionsPV013 Entity Code Provider facility code Text tlkpEntityCode 10
Multiple versionsPV014 Gender Code Gender of Provider Text tlkpGender 1
Multiple versionsPV015 DOB Date Provider's date of birth Date CCYYMMDD 8
Multiple versionsPV016 Street Address1 Name Street address of the Provider Text Free Text Address 50
Multiple versionsPV017 Street Address2 Name Secondary Street Address of the Provider Text Free Text Address 50
Multiple versionsPV018 City Name City of the Provider Text Free Text Address 35
Multiple versionsPV019 State Code State of the Provider Text External Code Source 2 2
Multiple versionsPV020 Country Code Country Code of the Provider Text External Code Source 1 3
Multiple versionsPV021 Zip Code Zip code of the Provider Text External Code Source 3 10
Multiple versionsPV022 Taxonomy Primary Taxonomy Code of the Provider Text External Code Source 13 10
Multiple versionsPV023 Mailing Street Address1 Name Street address of the Provider / Entity Text Free Text Address 50
Multiple versionsPV024 Mailing Street Address2 Name Secondary Street address of the Provider / Entity Text Free Text Address 50
Multiple versionsPV025 Mailing City Name City name of the Provider / Entity Text Free Text Address 35
Multiple versionsPV026 Mailing State Code State name of the Provider / Entity Text External Code Source 2 2
Multiple versionsPV027 Mailing Country Code Country name of the Provider / Entity Text External Code Source 1 3
Multiple versionsPV028 Mailing Zip Code Zip code of the Provider Text External Code Source 3 10
Multiple versionsPV029 Provider Type Code Provider Type Code Text Carrier Defined Reference Table 10
Multiple versionsPV030 Primary Specialty Code Specialty Code Text External Code Source 13 - AND/OR - Carrier Defined Reference Table 10
Multiple versionsPV031 Filler The APCD will reserve this field for possible future use. Please fill with null values in the format described. Filler Filler 1
Multiple versionsPV032 Filler The APCD will reserve this field for possible future use. Please fill with null values in the format described. Filler Filler 20
Multiple versionsPV033 Filler The APCD will reserve this field for possible future use. Please fill with null values in the format described. Filler Filler 30
Multiple versionsPV034 ProviderIDCode Provider Identification Code Text tlkpEntityQualifierCode 5
Multiple versionsPV035 SSN Id Provider's Social Security Number Text ######### 9
Multiple versionsPV036 Medicare Id Provider's Medicare Number Text 30
Multiple versionsPV037 Begin Date Provider Start Date Date CCYYMMDD 8
Multiple versionsPV038 End Date Provider End Date Date CCYYMMDD 8
Multiple versionsPV039 National Provider ID National Provider Identification (NPI) of the National Provider Text External Code Source 4 25
Multiple versionsPV040 National Provider2 ID National Provider Identification (NPI) of the Provider Text External Code Source 4 25
Multiple versionsPV041 GIC Provider Link ID GIC Provider Link ID for GIC Carriers only Text GIC ID 25
Multiple versionsPV042 Secondary Specialty2 Code Specialty Code Text External Code Source 13 - AND/OR - Carrier Defined Reference Table 10
Multiple versionsPV043 Secondary Specialty3 Code Specialty Code Text External Code Source 13 - AND/OR - Carrier Defined Reference Table 10
Multiple versionsPV044 Secondary Specialty4 Code Specialty Code Text External Code Source 13 - AND/OR - Carrier Defined Reference Table 10
Multiple versionsPV045 P4PFlag Pay-for-Performance (P4P) indicator Text tlkpFlagIndicators 1
Multiple versionsPV046 NonClaimsFlag Nonclaims Financial Transaction Indicator Text tlkpFlagIndicators 1
Multiple versionsPV047 Uses Electronic Medical Records Provider Uses EMR indicator Text tlkpFlagIndicators 1
Multiple versionsPV048 EMR Vendor Electronic Medical Record Vendor name Text Free Text Name 40
Multiple versionsPV049 Accepting New Patients Indicates if provider or provider group is accepting new patients as it applies to this carrier's products/plans. Text tlkpFlagIndicators 1
Multiple versionsPV050 Offers e-Visits Indicates if the provider uses eVisit tools (web based software) for well visits Text tlkpFlagIndicators 1
Multiple versionsPV051 Filler The APCD will reserve this field for possible future use. Please fill with null values. Filler Filler 20
Multiple versionsPV052 Has multiple offices Indicates if the provider has multiple office locations where it sees patients Text tlkpFlagIndicators 1
Multiple versionsPV053 Filler Indicates if the provider has multiple office locations where it sees patients Text Filler 1
Multiple versionsPV054 Medical/Healthcare Home ID Medical Home Identification Number Text 15
Multiple versionsPV055 PCP Flag Indicates if the provider is a PCP. For Facilities or entities where this is not applicable value of N (No) is allowed. Text tlkpFlagIndicators 1
Multiple versionsPV056 Provider Affiliation Provider Affiliation Code Text 30
Multiple versionsPV057 Provider Telephone Telephone number associated with the provider identified in PV002 Text ########## 10
Multiple versionsPV058 Delegated Provider Record Flag Provider Record Source Indicator Text tlkpFlagIndicators 1
Multiple versionsPV059 Filler The APCD will reserve this field for possible future use. Please fill with null values in the format described. Filler Filler 2
Multiple versionsPV060 Office Type Office Type Code Text tlkpOfficeType 1
Multiple versionsPV061 Prescribing Provider Prescribing privilege indicator Text tlkpFlagIndicators 1
Multiple versionsPV062 Provider Affiliation Start Date Provider Start Date Date CCYYMMDD 8
Multiple versionsPV063 Provider Affiliation End Date Provider End Date Date CCYYMMDD 8
Multiple versionsPV064 PPO Indicator Indicates if the provider is a contracted provider Text tlkpFlagIndicators 1
Multiple versionsPV899 Record Type File Type Identifier Text PV 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text TR 2
Multiple versionsTR002 Payer Carrier Specific Submitter Code as defined by APCD. This must match the Submitter Code reported in HD002 Text 8
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Text 30
Multiple versionsTR004 Type of File This is an indicator that defines the type of file and the data contained within the file. This must match the File Type reported in HD004. Text PV 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Date CCYYMMDD 8

Downloads
 
Download as an MS Excel™ spreadsheet.
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Data Element ID Data Element Code Value
HD001 Record Type HD
HD004 Type of File PV
PV013 Entity Code 01 Academic Institution
02 Adult Foster Care
03 Ambulance Services
04 Hospital Based Clinic
05 Stand-Alone, Walk-In/Urgent Care Clinic
06 Other Clinic
07 Community Health Center - General
08 Community Health Center - Urgent Care
09 Government Agency
10 Health Care Corporation
11 Home Health Agency
12 Acute Hospital
13 Chronic Hospital
14 Rehabilitation Hospital
15 Psychiatric Hospital
16 DPH Hospital
17 State Hospital
18 Veterans Hospital
19 DMH Hospital
20 Sub-Acute Hospital
21 Licensed Hospital Satellite Emergency Facility
22 Hospital Emergency Center
23 Nursing Home
24 Freestanding Ambulatory Surgery Center
25 Hospital Licensed Ambulatory Surgery Center
26 Non-Health Corporations
27 School Based Health Center
28 Rest Home
29 Licensed Hospital Satellite Facility
30 Hospital Licensed Health Center
31 Other
PV014 Gender Code F Female
M Male
O Other
U Unknown
PV034 ProviderIDCode 0 Other; any type of entity not otherwise defined that performs health care services.
1 Person; physician, clinician, orthodontist, and any individual that is licensed/certified to perform health care services.
2 Facility; hospital, health center, long term care, rehabilitation and any building that is licensed to transact health care services.
3 Professional Group; collection of licensed/certified health care professionals that are practicing health care services under the same entity name and Federal Tax Identification Number.
4 Retail Site; brick-and-mortar licensed/certified place of transaction that is not solely a health care entity, i.e., pharmacies, independent laboratories, vision services.
5 E-Site; internet-based order/logistic system of health care services, typically in the form of durable medical equipment, pharmacy or vision services. Address assigned should be the address of the company delivering services or order fulfillment.
6 Financial Parent; financial governing body that does not perform health care services itself but directs and finances health care service entities, usually through a Board of Directors.
7 Transportation; any form of transport that conveys a patient to/from a healthcare provider
PV045 P4PFlag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV046 NonClaimsFlag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV047 Uses Electronic Medical Records 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV049 Accepting New Patients 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV050 Offers e-Visits 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV052 Has multiple offices 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV055 PCP Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV058 Delegated Provider Record Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV060 Office Type 0 Other
1 Facility
2 Doctors office
3 Clinic
4 Walk in Clinic
5 Laboratory
PV061 Prescribing Provider 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV064 PPO Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV899 Record Type PV
TR001 Record Type TR
TR004 Type of File PV
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