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Provider Affiliation

PV056, Massachusetts

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


Name:Provider Affiliation
Data Element ID:PV056
Description:Provider Affiliation Code
State:Massachusetts
Data Type:Text
Data Type Description:ID Link to PV002
Format:varchar[30]
Length:30
Column:56
Threshold:1
File:PV
Element Submission Guideline:Report the Provider ID for any affiliation the provider has with another entity or parent company. If the provider is associated only with self, record the same value here as PV002.
Condition:All
Cat:B
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File Specification for Multiple versionsProvider File Submission - October 1, 2014 - v4.0

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsPV001 Submitter CHIA defined and maintained unique identifier Integer varchar[6] 6
Multiple versionsPV002 Plan Provider ID Carrier Unique Provider Code Text varchar[30] 30
Multiple versionsPV003 Tax Id Federal Tax ID of non-individual Provider Numeric char[9] 9
Multiple versionsPV004 UPIN Id Unique Physician ID Text char[6] 6
Multiple versionsPV005 DEA ID Provider DEA Text char[9] 9
Multiple versionsPV006 License Id State practice license ID Text varchar[25] 25
Multiple versionsPV007 Medicaid Id MassHealth-assigned Provider ID Text varchar[25] 25
Multiple versionsPV008 Last Name Last name of the Provider in PV002 Text varchar[50] 50
Multiple versionsPV009 First Name First name of the Provider in PV002 Text varchar[50] 50
Multiple versionsPV010 Middle Initial Middle initial of the Provider in PV002 Text char[1] 1
Multiple versionsPV011 Suffix Suffix of the Provider in PV002 Lookup Table - Integer int[1] 1
Multiple versionsPV012 Entity Name Group / Facility name Text varchar[100] 100
Multiple versionsPV013 Entity Code Provider entity code Lookup Table - Text char[2] 2
Multiple versionsPV014 Gender Code Gender of Provider identified in PV002 Lookup Table - Text char[1] 1
Multiple versionsPV015 DOB Date Provider's date of birth Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPV016 Provider Street Address 1 Street address of the Provider Text varchar[50] 50
Multiple versionsPV017 Provider Street Address 2 Street Address 2 of the Provider Text varchar[50] 50
Multiple versionsPV018 City Name City of the Provider Text varchar[35] 35
Multiple versionsPV019 State Code State of the Provider External Code Source 2 - Text char[2] 2
Multiple versionsPV020 Country Code Country Code of the Provider External Code Source 1 - Text char[3] 3
Multiple versionsPV021 Zip Code Zip code of the Provider External Code Source 2 - Text varchar[9] 9
Multiple versionsPV022 Taxonomy Taxonomy Code External Code Source 5 - Text char[10] 10
Multiple versionsPV023 Mailing Street Address1 Name Street address of the Provider / Entity Text varchar[50] 50
Multiple versionsPV024 Mailing Street Address2 Name Secondary Street address of the Provider / Entity Text varchar[50] 50
Multiple versionsPV025 Mailing City Name City name of the Provider / Entity Text varchar[35] 35
Multiple versionsPV026 Mailing State Code State name of the Provider / Entity External Code Source 2 - Text char[2] 2
Multiple versionsPV027 Mailing Country Code Country name of the Provider / Entity External Code Source 1 - Text char[3] 3
Multiple versionsPV028 Mailing Zip Code Zip code of the Provider External Code Source 2 - Text varchar[9] 9
Multiple versionsPV029 Provider Type Code Provider Type Code Carrier Defined Table - Text varchar[10] 10
Multiple versionsPV030 Primary Specialty Code Specialty Code External Code Source 4 - Integer varchar [3] 3
Multiple versionsPV031 Provider Organization ID CHIA defined and maintained Org ID for Providers Integer varchar[6] 6
Multiple versionsPV032 Registered Provider Organization ID (RPO) Registered Provider Organization ID Text Char[30] 30
Multiple versionsPV033 Filler Filler Filler char[0] 0
Multiple versionsPV034 Provider ID Code Provider Identification Code Lookup Table - Integer int[1] 1
Multiple versionsPV035 SSN Id Provider's Social Security Number Numeric char[9] 9
Multiple versionsPV036 Medicare ID Provider's Medicare Number, other than UPIN Text varchar[30] 30
Multiple versionsPV037 Begin Date Provider Start Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPV038 End Date Provider End Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPV039 National Provider ID National Provider Identification (NPI) of the Provider External Code Source 3 - Integer int[10] 10
Multiple versionsPV040 National Provider ID 2 National Provider Identification (NPI) of the Provider External Code Source 3 - Integer int[10] 10
Multiple versionsPV041 GIC Provider Link ID GIC Provider Link ID for GIC Carriers only Text varchar[25] 25
Multiple versionsPV042 Proprietary Specialty Code Specialty Code Carrier Defined Table - Text varchar[10] 10
Multiple versionsPV043 Other Specialty Code 2 Specialty Code Carrier Defined Table - OR - External Code Source 4 - Integer - OR - Carrier Defined Table varchar[10] 10
Multiple versionsPV044 Other Specialty Code 3 Specialty Code Carrier Defined Table - OR - External Code Source 4 - Integer - OR - Carrier Defined Table varchar[10] 10
Multiple versionsPV045 Pay for Performance Flag Indicator - Provider Contract Payment Lookup Table - Integer int[1] 1
Multiple versionsPV046 NonClaims Flag Indicator - Provider Contract Payment Lookup Table - Integer int[1] 1
Multiple versionsPV047 Filler Filler filler Char[1] 1
Multiple versionsPV048 Filler Filler Filler Char[40] 40
Multiple versionsPV049 Accepting New Patients Indicator - New Patients Accepted Lookup Table - Integer int[1] 1
Multiple versionsPV050 Filler Indicator - eVisit Option Filler char[1] 1
Multiple versionsPV051 Filler Filler Filler char[0] 0
Multiple versionsPV052 Has multiple offices Indicator - Multiple Office Provider Lookup Table - Integer int[1] 1
Multiple versionsPV053 Filler Filler Text char[0] 0
Multiple versionsPV054 Medical / Healthcare Home ID Medical Home Identification Number Text varchar[15] 15
Multiple versionsPV055 PCP Flag Indicator - Provider is a PCP Lookup Table - Integer int[1] 1
Multiple versionsPV056 Provider Affiliation Provider Affiliation Code Text varchar[30] 30
Multiple versionsPV057 Provider Telephone Telephone number associated with the provider identified in PV002 Numeric varchar[10] 10
Multiple versionsPV058 Delegated Provider Record Flag Indicator - Delegated Record Lookup Table - Integer int[1] 1
Multiple versionsPV059 Filler Filler Filler char[0] 0
Multiple versionsPV060 Office Type Office Type Code Lookup Table - Integer int[1] 1
Multiple versionsPV061 Prescribing Provider Indicator - Prescribing Authority Lookup Table - Integer int[1] 1
Multiple versionsPV062 Provider Affiliation Start Date Provider Start Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPV063 Provider Affiliation End Date Provider End Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPV064 PPO Indicator Indicator - Provider PPO Contract Lookup Table - Integer int[1] 1
Multiple versionsPV065 Disbursement Code MassHealth Disbursement Method Code Lookup Table - Integer int[1] 1
Multiple versionsPV066 Filler Filler Filler char[0] 0
Multiple versionsPV067 Filler Filler Filler char[0] 0
Multiple versionsPV068 Filler Filler Filler char[0] 0
Multiple versionsPV069 Filler Filler Filler char[0] 0
Multiple versionsPV070 Filler Filler Filler char[0] 0
Multiple versionsPV899 Record Type File Type Identifier Text char[2] 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsTR004 Type of File Validates the file type defined in HD004. Text char[2] 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Full Date - Integer int[8] CCYYMMDD 8

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