Name: | Provider File Submission |
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State: | Rhode Island |
Definition: | Not provided |
Version | June 2014 - v1.3 |
Data Element ID | Data Element | Description | Type | Format | Length |
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Record Type | This field must be coded HD to indicate the start of the header record. | Text | 2 | |
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Submitter Code | This field must contain the submitter code assigned to you by Onpoint Health Data. | Text | 8 | |
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Placeholder | This field must be coded as null; it is reserved for header consistency across all clients using Onpoint Health Data's APCD services. | Text | 30 | |
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Type of File | This field must be coded PV to indicate submission of provider data. | Text | 2 | |
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Period Beginning Date | Use this field to indicate the first month of the reporting period included in the submission in CCYYMM format. | Integer | CCYYMM | 6 |
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Period Ending Date | Use this field to report the last month of the reporting period included in the submission in CCYYMM format. | Integer | CCYYMM | 6 |
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Record Count | Use this field to report the total number of records in the submission, excluding the header and trailer records. If the number of records within the submission does not equal the number reported in this field, the submission will fail. | Integer | 10 | |
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Comments | This field may be used by the submitter to document a file name, system source, or other administrative device to assist with their internal tracking of the submission. | Text | 80 | |
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Submitter Code | Use this field to report your Onpoint-assigned submitter code for the data submitter. Note that the first two characters of the submitter code are used to indicate the reporting state and the third character designates the type of submitter. For Rhode Island's APCD collection, valid prefixes include: Notes: A single data submitter may have multiple submitter codes if they are submitting from more than one system or from more than one location. All submitter codes associated with a single data submitter will have the same first six characters. A suffix will be used to distinguish the location and/or system variations. This field contains a constant value and is primarily used for tracking compliance by data submitter. | Text | 8 | |
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National Plan ID | Use this field to report the CMS National Plan ID when implemented by the U.S. Centers for Medicaid & Medicare Services (CMS). Until CMS issues a National Plan ID, report this field as null. | Text | 30 | |
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Reporting Period Start Date | Use this field to report the first date of the reporting period for this submission using an 8-digit format of CCYYMMDD (e.g., if reporting for the first quarter of 2012, this field would be coded as "20120101"). | Date | CCYYMMDD | 8 |
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Reporting Period End Date | Use this field to report the last date of the reporting period for this submission using an 8-digit format of CCYYMMDD (e.g., if reporting for the first quarter of 2012, this field would be coded as "20120331"). | Date | CCYYMMDD | 8 |
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Entity Type Qualifier | Use this field to report the value that defines type of entity associated with the Provider Plan ID reported in PV006. | Text | 1 | |
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Provider Plan ID | Use this field to report the submitter-assigned internal provider ID (e.g., Medicaid ID, Medicare ID, private carrier ID). Note: The provider data reported in the eligibility, claims, and provider files are used to create a Provider Master Index that is used to match the data across all file types. It is expected that a provider's identifiers (e.g., plan-assigned ID, NPI, etc.) will be reported consistently by a submitter across file types as this is the payer-assigned provider ID (ME051, MC024, PC048A, PV006). | Text | 50 | |
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Provider NPI | Use this field to report the National Provider Identifier (NPI) for the provider. | Text | 10 | |
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Provider Tax ID | Use this field to report the federal taxpayer identification number for the provider. Notes: If the tax ID number is an individual's Social Security number, report this field as null. | Text | 9 | |
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Provider DEA Number | Use this field to report the individual provider's Drug Enforcement Agency (DEA) number. | Text | 10 | |
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Provider License ID | Use this field to report the provider's state license number. | Text | 20 | |
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Provider Taxonomy Code - 1 | Use this field to report the taxonomy code for the provider. | Text | 10 | |
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Provider Taxonomy Code - 2 | Use this field to report an additional taxonomy code for the provider. | Text | 10 | |
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Provider Last Name or Organization Name | Use this field to report the last name of the provider if an individual or the full name if the provider is a facility or an organization. | Text | 100 | |
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Provider First Name | Use this field to report the first name of the provider if an individual. Notes: Set to null if the provider is a facility or an organization. | Text | 35 | |
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Provider Middle Initial | Use this field to report the middle initial of the provider if an individual. Notes: Set to null if the provider is a facility or an organization. | Text | 1 | |
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Provider Suffix | Use this field to report any generational identifiers associated with the provider's name (e.g., JR, SR, III). Notes: Do not code punctuation and do not code the provider's credentials (e.g., MD, LCSW) in this field. Set to null if the provider is a facility or an organization. | Text | 10 | |
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Entity Name | Use this field to report the practice or hospital with which the provider is affiliated. Note that a new record should be reported for each affiliation (i.e., if a provider is affiliated with two practices, two records should be reported). If a provider is a sole practitioner and their name is used as the practice name, the provider's name should be reported in this field. If a provider's affiliation is unknown, report with a value of "UNKNOWN". Notes: When reporting this field, omit any punctuation | Text | 100 | |
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Entity Code | Use this field to report the value that defines the entity provider type. | Text | 2 | |
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Practice Affiliation Date (Start) | Use this field to report either (a) the first date of the reporting period or (b) the first date of this provider's affiliation with this practice, whichever is later. Notes: When reporting this field, code using an 8-digit format of CCYYMMDD (e.g., January 18, 1972, would be coded as "19720118"). | Date | CCYYMMDD | 8 |
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Practice Affiliation Date (End) | Use this field to report either (a) the last date of the reporting period or (b) the last date of this provider's affiliation with this practice, whichever is earlier. Notes: When reporting this field, code using an 8-digit format of CCYYMMDD (e.g., January 18, 1972, would be coded as "19720118"). | Date | CCYYMMDD | 8 |
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Provider Gender | Use this field to report the gender of the provider if an individual. Notes: Set to null if the provider is a facility or an organization. | Text | 1 | |
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Provider Date of Birth | Use this field to report the provider's date of birth (if an individual) using an 8-digit format of CCYYMMDD (e.g., January 18, 1972, would be coded as "19720118"). Notes: Set to null if the provider is a facility or an organization. | Date | CCYYMMDD | 8 |
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Provider Physical Location - Street Address 1 | Use this field to report the first line of the street address for the physical location where the provider rendered the service (medical claims) or dispensed the prescription (pharmacy claims). Notes: A new record must be reported for each physical location reported in the claims file. | Text | 55 | |
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Provider Physical Location - Street Address 2 | Use this field to report the second line of the street address for the physical location where the provider rendered the service (medical claims) or dispensed the prescription (pharmacy claims). Notes: A new record must be reported for each physical location reported in the claims file. | Text | 55 | |
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Provider Physical Location - City | Use this field to report the city for the physical location where the provider rendered the service (medical claims) or dispensed the prescription (pharmacy claims). Notes: A new record must be reported for each physical location reported in the claims file. | Text | 30 | |
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Provider Physical Location - State or Province | Use this field to report the state or province for the physical location where the provider rendered the service (medical claims) or dispensed the prescription (pharmacy claims) using the two-character abbreviation defined by the U.S. Postal Service (for U.S. states) and Canada Post (for Canadian provinces). Notes: A new record must be reported for each physical location reported in the claims file. | Text | 2 | |
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Provider Physical Location - ZIP/Postal Code | Use this field to report the ZIP/postal code for the physical location where the provider rendered the service (medical claims) or dispensed the prescription (pharmacy claims). Notes: For U.S. ZIP codes, include the ZIP+4 (also referred to as the "plus-four" or "add-on" code). Do not code dashes or spaces within ZIP/postal codes. A new record must be reported for each physical location reported in the claims file. | Text | 9 | |
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Placeholder | N/A | N/A | N/A | |
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Placeholder | N/A | N/A | N/A | |
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Placeholder | N/A | N/A | N/A | |
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Placeholder | N/A | N/A | N/A | |
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Placeholder | N/A | N/A | N/A | |
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Record Type | Use this field to report the constant value of "PV" to denote a provider file record. | Text | 2 | |
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Record Type | This field must be coded TR to indicate the start of the trailer record. | Text | 2 | |
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Submitter Code | This field must contain the submitter code assigned to you by Onpoint Health Data. | Text | 8 | |
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Placeholder | This field must be coded as null; it is reserved for trailer consistency across all clients using Onpoint CDM. | Text | 30 | |
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Type of File | This field must be coded PV to indicate submission of provider data. | Text | 2 | |
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Period Beginning Date | Use this field to indicate the first month of the reporting period included in the submission in CCYYMM format. | Integer | CCYYMM | 6 |
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Period Ending Date | Use this field to report the last month of the reporting period included in the submission in CCYYMM format. | Integer | CCYYMM | 6 |
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Date Processed | Use this field to report the date on which the file was created in CCYYMMDD format. | Date | CCYYMMDD | 8 |
Data Element ID | Data Element | Code | Value |
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HD001 | Record Type | HD | header record |
HD003 | Placeholder | Null | |
HD004 | Type of File | PV | provider data |
PV001 | Submitter Code | RIC | Commercial carrier |
RIG | Governmental agency | ||
RIT | Third-party administrator | ||
PV005 | Entity Type Qualifier | 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 healthcare services | ||
2 | Facility: Hospital, health center, long-term care, rehabilitation, and any building that is licensed to transact healthcare services | ||
3 | Professional Group: Collection of licensed/certified healthcare professionals that are practicing healthcare 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 healthcare entity (ie, pharmacies, independent laboratories, vision services) | ||
5 | E-Site: Internet-based order/logistic system of healthcare 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 healthcare services itself but directs and finances healthcare service entities, usually through a board of directors | ||
7 | Transportation: Any form of transport that conveys a patient to/from a healthcare provider | ||
PV020 | 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 Corporation | ||
27 | School-Based Health Center | ||
28 | Rest Home | ||
29 | Licensed Hospital Satellite Facility | ||
30 | Hospital-Licensed Health Center | ||
31 | Other Facility | ||
40 | Physician (PV005 = 1) | ||
50 | Physician Group (PV005 = 3) | ||
60 | Nurse (PV005 = 1) | ||
70 | Clinician (PV005 = 1) | ||
80 | Technician (PV005 = 1) | ||
90 | Pharmacy / Site or Mail Order (PV005 = 4 or 5) | ||
99 | Other Individual or Group (PV005 = 1 or 3) | ||
PV023 | Provider Gender | F | Female |
M | Male | ||
U | Unknown | ||
PV899 | Record Type | PV | provider file record |
TR001 | Record Type | TR | trailer record |
TR003 | Placeholder | Null | |
TR004 | Type of File | PV | provider data |