| 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. |
| Version | December 1, 2010 - v2.1 |
| Data Element ID | Data Element | Description | Type | Format | Length |
|---|---|---|---|---|---|
 HD001 |
Record Type | Header Record Identifier | Text | HD | 2 |
| HD002 |
Payer | Header Submitter/Carrier ID | Text | 8 | |
| HD003 |
National Plan ID | Header CMS National Plan Identification Number (PlanID) | Text | 30 | |
| HD004 |
Type of File | Header Type of File | Text | PV | 2 |
| HD005 |
Period Beginning Date | Header Period Start Date | Date Period | CCYYMM | 6 |
| HD006 |
Period Ending Date | Header Period Ending Date | Date Period | CCYYMM | 6 |
| HD007 |
Record Count | Header Record Count | Integer | ####### | 10 |
| HD008 |
Comments | Header Carrier Comments | Text | Free Text Comments | 80 |
| PV001 |
Payer | Carrier Specific Submitter Code as defined by APCD. This must match the Submitter Code reported in HD002 | Text | 8 | |
| PV002 |
Plan Provider ID | Carrier Unique Provider Code | Text | 30 | |
| PV003 |
Tax Id | The Federal Tax ID associated with the provider identified in PV002. | Text | ######### | 12 |
| PV004 |
UPIN Id | Unique Physician Identification Number (UPIN) | Text | 10 | |
| PV005 |
DEA ID | Primary DEA number for the provider identified in PV002. | Text | 10 | |
| PV006 |
License Id | State practice license for the Provider in PV002 | Text | 25 | |
| PV007 |
Medicaid Id | Medicaid assigned number for the Provider in PV002 | Text | 25 | |
| PV008 |
Last Name | Last name of the Provider in PV002 | Text | Free Text Name | 50 |
| PV009 |
First Name | First name of the Provider in PV002 | Text | Free Text Name | 50 |
| PV010 |
Middle Initial | Middle initial of the Provider in PV002 | Text | Free Text Name | 1 |
| PV011 |
Suffix | Suffix of the Provider in PV002 | Text | 2 | |
| PV012 |
Entity Name | Group / Facility name | Text | Free Text Name | 100 |
| PV013 |
Entity Code | Provider facility code | Text | tlkpEntityCode | 10 |
| PV014 |
Gender Code | Gender of Provider | Text | tlkpGender | 1 |
| PV015 |
DOB Date | Provider's date of birth | Date | CCYYMMDD | 8 |
| PV016 |
Street Address1 Name | Street address of the Provider | Text | Free Text Address | 50 |
| PV017 |
Street Address2 Name | Secondary Street Address of the Provider | Text | Free Text Address | 50 |
| PV018 |
City Name | City of the Provider | Text | Free Text Address | 35 |
| PV019 |
State Code | State of the Provider | Text | External Code Source 2 | 2 |
| PV020 |
Country Code | Country Code of the Provider | Text | External Code Source 1 | 3 |
| PV021 |
Zip Code | Zip code of the Provider | Text | External Code Source 3 | 10 |
| PV022 |
Taxonomy | Primary Taxonomy Code of the Provider | Text | External Code Source 13 | 10 |
| PV023 |
Mailing Street Address1 Name | Street address of the Provider / Entity | Text | Free Text Address | 50 |
| PV024 |
Mailing Street Address2 Name | Secondary Street address of the Provider / Entity | Text | Free Text Address | 50 |
| PV025 |
Mailing City Name | City name of the Provider / Entity | Text | Free Text Address | 35 |
| PV026 |
Mailing State Code | State name of the Provider / Entity | Text | External Code Source 2 | 2 |
| PV027 |
Mailing Country Code | Country name of the Provider / Entity | Text | External Code Source 1 | 3 |
| PV028 |
Mailing Zip Code | Zip code of the Provider | Text | External Code Source 3 | 10 |
| PV029 |
Provider Type Code | Provider Type Code | Text | Carrier Defined Reference Table | 10 |
| PV030 |
Primary Specialty Code | Specialty Code | Text | External Code Source 13 - AND/OR - Carrier Defined Reference Table | 10 |
| PV031 |
Filler | The APCD will reserve this field for possible future use. Please fill with null values in the format described. | Filler | Filler | 1 |
| PV032 |
Filler | The APCD will reserve this field for possible future use. Please fill with null values in the format described. | Filler | Filler | 20 |
| PV033 |
Filler | The APCD will reserve this field for possible future use. Please fill with null values in the format described. | Filler | Filler | 30 |
| PV034 |
ProviderIDCode | Provider Identification Code | Text | tlkpEntityQualifierCode | 5 |
| PV035 |
SSN Id | Provider's Social Security Number | Text | ######### | 9 |
| PV036 |
Medicare Id | Provider's Medicare Number | Text | 30 | |
| PV037 |
Begin Date | Provider Start Date | Date | CCYYMMDD | 8 |
| PV038 |
End Date | Provider End Date | Date | CCYYMMDD | 8 |
| PV039 |
National Provider ID | National Provider Identification (NPI) of the National Provider | Text | External Code Source 4 | 25 |
| PV040 |
National Provider2 ID | National Provider Identification (NPI) of the Provider | Text | External Code Source 4 | 25 |
| PV041 |
GIC Provider Link ID | GIC Provider Link ID for GIC Carriers only | Text | GIC ID | 25 |
| PV042 |
Secondary Specialty2 Code | Specialty Code | Text | External Code Source 13 - AND/OR - Carrier Defined Reference Table | 10 |
| PV043 |
Secondary Specialty3 Code | Specialty Code | Text | External Code Source 13 - AND/OR - Carrier Defined Reference Table | 10 |
| PV044 |
Secondary Specialty4 Code | Specialty Code | Text | External Code Source 13 - AND/OR - Carrier Defined Reference Table | 10 |
| PV045 |
P4PFlag | Pay-for-Performance (P4P) indicator | Text | tlkpFlagIndicators | 1 |
| PV046 |
NonClaimsFlag | Nonclaims Financial Transaction Indicator | Text | tlkpFlagIndicators | 1 |
| PV047 |
Uses Electronic Medical Records | Provider Uses EMR indicator | Text | tlkpFlagIndicators | 1 |
| PV048 |
EMR Vendor | Electronic Medical Record Vendor name | Text | Free Text Name | 40 |
| PV049 |
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 |
| PV050 |
Offers e-Visits | Indicates if the provider uses eVisit tools (web based software) for well visits | Text | tlkpFlagIndicators | 1 |
| PV051 |
Filler | The APCD will reserve this field for possible future use. Please fill with null values. | Filler | Filler | 20 |
| PV052 |
Has multiple offices | Indicates if the provider has multiple office locations where it sees patients | Text | tlkpFlagIndicators | 1 |
| PV053 |
Filler | Indicates if the provider has multiple office locations where it sees patients | Text | Filler | 1 |
| PV054 |
Medical/Healthcare Home ID | Medical Home Identification Number | Text | 15 | |
| PV055 |
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 |
| PV056 |
Provider Affiliation | Provider Affiliation Code | Text | 30 | |
| PV057 |
Provider Telephone | Telephone number associated with the provider identified in PV002 | Text | ########## | 10 |
| PV058 |
Delegated Provider Record Flag | Provider Record Source Indicator | Text | tlkpFlagIndicators | 1 |
| PV059 |
Filler | The APCD will reserve this field for possible future use. Please fill with null values in the format described. | Filler | Filler | 2 |
| PV060 |
Office Type | Office Type Code | Text | tlkpOfficeType | 1 |
| PV061 |
Prescribing Provider | Prescribing privilege indicator | Text | tlkpFlagIndicators | 1 |
| PV062 |
Provider Affiliation Start Date | Provider Start Date | Date | CCYYMMDD | 8 |
| PV063 |
Provider Affiliation End Date | Provider End Date | Date | CCYYMMDD | 8 |
| PV064 |
PPO Indicator | Indicates if the provider is a contracted provider | Text | tlkpFlagIndicators | 1 |
| PV899 |
Record Type | File Type Identifier | Text | PV | 2 |
| TR001 |
Record Type | Trailer Record Identifier | Text | TR | 2 |
| TR002 |
Payer | Carrier Specific Submitter Code as defined by APCD. This must match the Submitter Code reported in HD002 | Text | 8 | |
| TR003 |
National Plan ID | CMS National Plan Identification Number (PlanID) | Text | 30 | |
| TR004 |
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 |
| TR005 |
Period Beginning Date | Trailer Period Start Date | Date Period | CCYYMM | 6 |
| TR006 |
Period Ending Date | Trailer Period Ending Date | Date Period | CCYYMM | 6 |
| TR007 |
Date Processed | Trailer Processed Date | Date | CCYYMMDD | 8 |
| 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 |
Agency for Healthcare Research and Quality • 5600 Fishers Lane, Rockville, MD 20857 • Telephone: (301) 427-1364
