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Provider File Submission

Connecticut



Name:Provider File Submission
State:Connecticut
Definition:Not provided
VersionDecember 5, 2013 - v1.2

File Specification for Provider File Submission

Data Element ID Data Element Description Type Format Length
HD001 Record Type Header Record Identifier Text char[2] 2
HD002 Submitter Header Submitter / Carrier ID defined by AHCT Integer varchar[6] 6
HD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
HD004 Type of File Defines the file type and data expected. Text char[2] 2
HD005 Period Beginning Date Header Period Start Date Full Date - Integer int[8] YYYYMMDD 8
HD006 Period Ending Date Header Period Ending Date Full Date - Integer int[8] YYYYMMDD 8
HD007 Record Count Header Record Count Integer varchar[10] 10
HD008 Comments Header Carrier Comments Text varchar[80] 80
HD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
PV001 Submitter CT APCD defined and maintained unique identifier Integer varchar[6] 6
PV002 Plan Provider ID Carrier Unique Provider Code Text varchar[30] 30
PV003 Tax ID Federal Tax ID of non- individual Provider Numeric char[9] 9
PV004 UPIN ID Unique Physician ID Text char[6] 6
PV005 DEA ID Provider DEA Text char[9] 9
PV006 License ID State practice license ID Text varchar[25] 25
PV008 Last Name Last name of the Provider in PV002 Text varchar[50] 50
PV009 First Name First name of the Provider in PV002 Text varchar[50] 50
PV010 Middle Initial Middle initial of the Provider in PV002 Text char[1] 1
PV011 Filler Filler Filler char[0] 0
PV012 Entity Name Group / Facility name Text varchar[100] 100
PV014 Gender Code Gender of Provider identified in PV002 Text char[1] 1
PV015 Provider Date of Birth Birth date of the provider Integer int[8] CCYYMMDD 8
PV016 Provider Street Address 1 Street address of the Provider Text varchar[50] 50
PV017 Provider Street Address 2 Street Address 2 of the Provider Text varchar[50] 50
PV018 City Name City of the Provider Text varchar[35] 35
PV019 State Code State of the Provider External Code Source - USPS char[2] 2
PV020 Country Code Country Code of the Provider External Code Source - USPS char[3] 3
PV021 Zip Code Zip code of the Provider External Code Source - USPS varchar[9] 9
PV022 Taxonomy Taxonomy Code External Code Source - WPC char[10] 10
PV023 Mailing Street Address1 Name Street address of the Provider / Entity Text varchar[50] 50
PV024 Mailing Street Address2 Name Secondary Street address of the Provider / Entity Text varchar[50] 50
PV025 Mailing City Name City name of the Provider / Entity Text varchar[35] 35
PV026 Mailing State Code State name of the Provider / Entity External Code Source - USPS char[2] 2
PV027 Mailing Country Code Country name of the Provider / Entity External Code Source - USPS char[3] 3
PV028 Mailing Zip Code Zip code of the Provider External Code Source - USPS varchar[9] 9
PV030 Primary Specialty Code Specialty Code External Code Source 4 - Integer char[2] 2
PV034 Provider ID Code Provider Identification Code Integer int[1] 1
PV035 SSN Id Provider's Social Security Number Numeric char[9] 9
PV036 Medicare ID Provider's Medicare Number, other than UPIN Text varchar[30] 30
PV037 Start Date Provider Start Date Integer int[8] CCYYMMDD 8
PV038 End Date Provider End Date Integer int[8] CCYYMMDD 8
PV039 National Provider ID National Provider Identification (NPI) of the Provider External Code Source - NPPES int[10] 10
PV040 National Provider ID 2 National Provider Identification (NPI) of the Provider External Code Source - NPPES int[10] 10
PV041 Filler Filler Filler char[0] 0
PV042 Secondary Specialty Code Specialty Code Carrier Defined Table - Text varchar[10] 10
PV043 Other Specialty Code 3 Specialty Code Carrier Defined Table - OR - External Code Source 4 - Integer varchar[10] 10
PV044 Other Specialty Code 4 Specialty Code Carrier Defined Table - OR - External Code Source 4 - Integer varchar[10] 10
PV045 Filler Filler Filler char[0] 0
PV046 Filler Filler Filler char[0] 0
PV047 Uses Electronic Health Records Indicator - EHR Utilization Integer int[1] 1
PV048 Filler Filler Filler char[0] 0
PV049 Filler Filler Filler char[0] 0
PV050 Filler Filler Filler char[0] 0
PV051 Filler Filler Filler char[0] 0
PV052 Has multiple offices Indicator - Multiple Office Provider Integer int[1] 1
PV053 Filler Filler Filler char[0] 0
PV054 Medical / Healthcare Home ID Medical Home Identification Number Text varchar[15] 15
PV055 PCP Flag Indicator - Provider is a PCP Integer int[1] 1
PV056 Provider Affiliation Provider Affiliation Code Text varchar[30] 30
PV057 Provider Telephone Telephone number associated with the provider identified in PV002 Numeric varchar[10] 10
PV058 Delegated Provider Record Flag Indicator - Delegated Record Integer int[1] 1
PV059 Filler Filler Filler char[0] 0
PV060 Filler Filler Filler char[0] 0
PV061 Filler Filler Filler char[0] 0
PV062 Filler Filler Filler char[0] 0
PV063 Filler Filler Filler char[0] 0
PV064 PPO Indicator Indicator - Provider PPO Contract Integer int[1] 1
PV899 Record Type File Type Identifier Text char[2] 2
TR001 Record Type Trailer Record Identifier Text char[2] 2
TR002 Submitter Trailer Submitter / Carrier ID defined by AHCT Integer varchar[6] 6
TR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
TR004 Type of File Validates the file type defined in HD004. Text char[2] 2
TR005 Period Beginning Date Trailer Period Start Date Full Date - Integer int[8] YYYYMMDD 8
TR006 Period Ending Date Trailer Period Ending Date Full Date - Integer int[8] YYYYMMDD 8
TR007 Date Processed Trailer Processed Date Full Date - Integer int[8] YYYYMMDD 8

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Data Element ID Data Element Code Value
HD001 Record Type HD Header Elements
HD004 Type of File PV PROVIDER INFORMATION
HD009 APCD Version Number 1 Current Version; required for reporting periods as of October 2013
PV014 Gender Code F Female
M Male
U Unknown
PV034 Provider ID Code 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
PV047 Uses Electronic Health Records 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
PV064 PPO Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PV899 Record Type PV
TR001 Record Type TR end of the data file
TR004 Type of File PV
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