United States Health Information Knowledgebase

 

Provider File Submission

Tennessee



Name:Provider File Submission
State:Tennessee
Definition:Not Provided
VersionJanuary 31, 2014 - v1.0

File Specification for Provider File Submission

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

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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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