| Name: | Provider File Submission |
|---|---|
| State: | Tennessee |
| Definition: | Not Provided |
| Version | January 31, 2014 - v1.0 |
| Data Element ID | Data Element | Description | Type | Format | Length |
|---|---|---|---|---|---|
| CITY_PROVIDER | Provider Location City | This field contains the name of the city in which the provider is located as reported by the payer in the medical claims field. | Text | 30 | |
| CITY_PHARMACY | Pharmacy City | This field contains the name of the city in which the pharmacy is located as reported by the payer in the pharmacy claims field. | Char | 30 | |
| COUNTRY | Provider Location Location Country | This field contains the country name of the provider's practice location. Its source is the Service Provider Country element reported by the payer in the medical claims data. | Char | 30 | |
| ENTITY_TYPE | Service Provider Entity Type Qualifier | This field is used to distinguish an individual practitioner from a business entity. Its source is the Service Provider Entity Type Qualifier element reported by the payer in the medical claims data. | Char | 1 | |
| IDN | Provider ID Number | This field is the primary identification number for each Provider record. | Numeric | 20 | |
| NPI | NPI | This field contains the National Provider ID. | Text | 10 | |
| NPI_RX | National Pharmacy ID Number | This field contains the National Pharmacy ID Number. Its source is the National Pharmacy ID Number element reported by the payer in the pharmacy claims data. | Char | 10 | |
| PAYERCODE | Payer Code | This field contains the data reporter code for the payer or data reporter submitting payments. The first two characters indicate the data collection state and the third character indicates the type of data reporter. A single payer may have multiple data reporter codes because the payer is submitting from more than one system or from more than one location. All data reporter codes associated with a single payer will have the same first seven characters. A suffix in the eighth position may be used to distinguish the location and/or system variations. | Text | 8 | |
| PAYER | PAYER | This field contains the Payer ID Number. This code is used to identify the data reporter. Its source is the Payer element reported by the payer in the pharmacy claims data and Payer element reported by the payer in the medical claims data. | Text | 8 | |
| PHARMACY_NAME | Pharmacy Name | This field contains the name of the pharmacy. Its source is the Pharmacy Name element reported by the payer in the pharmacy claims data. | Char | 100 | |
| PID | Pharmacy Number | This field contains the payer-assigned pharmacy number. Its source is the Pharmacy Number element reported by the payer in the pharmacy claims data. | Char | 40 | |
| PRESCRIBING_PHYSICIAN_NUMBER | Prescribing Physician Number | This field contains either the NPI number, DEA number or the State License ID for the prescribing physician. Based on NCPDP 466-EZ values, we would expect one of the following values. Use the designated prefix followed by a dash preceding the number. | Text | 14 | |
| PROVIDER_ADDRESS_1 | Provider Address Line 1 | Not Available | Text | 30 | |
| PROVIDER_ADDRESS_2 | Provider Address Line 2 | Not Available | Text | 30 | |
| PROVIDER_COUNTY | Provider County | Not Available | Text | 30 | |
| PROVIDER_ID | Provider ID | Not Available | Numeric | 20 | |
| PRV_FNAME | ProviderFirstName | This field contains the first name of the individual provider or prescribing physician. Its source is the payer-supplied Service Provider First Name element in the medical claims data or the Prescribing Physician First Name element in the pharmacy claims data. If the provider is a facility, this field will be blank. | Text | 25 | |
| PRV_LNAME | Provider Last Name | Organization Name or Provider Last Name. | Text | 100 | |
| PRV_MNAME | Provider Middle Name | This field contains the middle name or initial of the individual provider or prescribing physician. Its source is the payer-supplied Service Provider Middle Name element in the medical claims data or the Prescribing Physician Middle Name element in the pharmacy claims data. | Text | 25 | |
| PRV_SUFFIX | Provider Suffix | This field contains the generational suffix of the individual provider. Its source is the Service Provider Suffix element reported by the payer in the medical claims data. | Text | 10 | |
| PRV_TAXID | Provider Tax ID | This field contains the provider's federal tax ID number. Its source is the Service Provider Tax ID Number element reported by the payer in the medical claims data. For an individual, this code is often the Social Security number. | Text | 25 | |
| PRV_ZIPCODE | Provider Zip code | This field contains the ZIP code of the provider's practice location. Its source is the Service Provider ZIP Code element reported by the payer in the medical claims data. | Text | 9 | |
| SPECIALTY | Payer Supplier Provider Specialty | This field identifies the service provider's specialty as reported by the payer. Its source is the Service Provider Specialty element in the medical claims data. | Char | 50 | |
| PRV_STATE | Provider Location State | This field identifies the state of the provider's practice location using the two-character abbreviation defined by the U.S. Postal Service. Its source is the Service Provider State or Province element reported by the payer in the medical claims data. | Text | 2 | |
| RX_STATE | Pharmacy State | This field contains the pharmacy location's two-character state abbreviation as defined by the U.S. Postal Service and as reported by the payer in the pharmacy claims field. | Char | 2 | |
| SVC_PHARMIDN | Servicing Pharmacy ID Number | This field contains the servicing pharmacy ID number. This field cannot be used to aggregate all claims associated with a pharmacy. | Numeric | 20 | |
| TAXID | Pharmacy Tax ID Number | This field contains the pharmacy's federal tax ID number. Its source is the Pharmacy Tax ID Number element reported by the payer in the pharmacy claims data. If the individual retail pharmacy tax ID number is not available, this field contains the pharmacy chain's tax ID number. | Char | 100 | |
| TAXONOMY | Taxonomy Code | This field contains the CMS-defined code for the provider's specialty/taxonomy. The American Medical Association (AMA) holds the copyright for the Health Care Provider Taxonomy code set on behalf of the National Uniform Claim Committee, which maintains the coding system. | Char | 30 | |
| ZIPCODE | Pharmacy ZIP Code | This field contains the ZIP code of the pharmacy location. Its source is the Pharmacy ZIP Code element reported by the payer in the pharmacy claims data. | Numeric | 9 | |
| FILLER | FILLER | This field is reserved for additional fields that may be added in the future. | Char | 500 |
| Data Element ID | Data Element | Code | Value |
|---|---|---|---|
| ENTITY_TYPE | Service Provider Entity Type Qualifier | 1 | Person |
| 2 | Non-person entity | ||
| PAYERCODE | Payer Code | TNC | Commercial data reporter |
| TNG | Governmental payer | ||
| TNT | Third-party administrator | ||
| PRESCRIBING_PHYSICIAN_NUMBER | Prescribing Physician Number | 01 | National Provider Identifier (NPI) |
| 12 | Drug Enforcement Administration (DEA) | ||
| 13 | State Issued License Provider ID |
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