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Provider File Submission

Rhode Island

Versions: February 2014 - v1.1• June 2014 - v1.3Compare Versions


At A Glance

Name:Provider File Submission
State:Rhode Island
Definition:Not provided
VersionJune 2014 - v1.3

File Specification for Provider File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type This field must be coded HD to indicate the start of the header record. Text 2
Multiple versionsHD002 Submitter Code This field must contain the submitter code assigned to you by Onpoint Health Data. Text 8
Multiple versionsHD003 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
Multiple versionsHD004 Type of File This field must be coded PV to indicate submission of provider data. Text 2
Multiple versionsHD005 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
Multiple versionsHD006 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
Multiple versionsHD007 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
Multiple versionsHD008 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
Multiple versionsPV001 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
Multiple versionsPV002 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
Multiple versionsPV003 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
Multiple versionsPV004 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
Multiple versionsPV005 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
Multiple versionsPV006 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
Multiple versionsPV007 Provider NPI Use this field to report the National Provider Identifier (NPI) for the provider. Text 10
Multiple versionsPV008 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
Multiple versionsPV010 Provider DEA Number Use this field to report the individual provider's Drug Enforcement Agency (DEA) number. Text 10
Multiple versionsPV011 Provider License ID Use this field to report the provider's state license number. Text 20
Multiple versionsPV013 Provider Taxonomy Code - 1 Use this field to report the taxonomy code for the provider. Text 10
Multiple versionsPV014 Provider Taxonomy Code - 2 Use this field to report an additional taxonomy code for the provider. Text 10
Multiple versionsPV015 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
Multiple versionsPV016 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
Multiple versionsPV017 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
Multiple versionsPV018 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
Multiple versionsPV019 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
Multiple versionsPV020 Entity Code Use this field to report the value that defines the entity provider type. Text 2
Multiple versionsPV021 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
Multiple versionsPV022 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
Multiple versionsPV023 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
Multiple versionsPV024 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
Multiple versionsPV025 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
Multiple versionsPV026 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
Multiple versionsPV027 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
Multiple versionsPV028 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
Multiple versionsPV029 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
Multiple versionsPV030 Placeholder N/A N/A N/A
Multiple versionsPV031 Placeholder N/A N/A N/A
Multiple versionsPV032 Placeholder N/A N/A N/A
Multiple versionsPV033 Placeholder N/A N/A N/A
Multiple versionsPV034 Placeholder N/A N/A N/A
Multiple versionsPV899 Record Type Use this field to report the constant value of "PV" to denote a provider file record. Text 2
Multiple versionsTR001 Record Type This field must be coded TR to indicate the start of the trailer record. Text 2
Multiple versionsTR002 Submitter Code This field must contain the submitter code assigned to you by Onpoint Health Data. Text 8
Multiple versionsTR003 Placeholder This field must be coded as null; it is reserved for trailer consistency across all clients using Onpoint CDM. Text 30
Multiple versionsTR004 Type of File This field must be coded PV to indicate submission of provider data. Text 2
Multiple versionsTR005 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
Multiple versionsTR006 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
Multiple versionsTR007 Date Processed Use this field to report the date on which the file was created in CCYYMMDD format. Date CCYYMMDD 8

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Codes and Values

Data Element ID Data Element Code Value
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
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