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Provider File Submission

Virginia



Name:Provider File Submission
State:Virginia
Definition:Not Provided
VersionAugust 2013 - v1.2

File Specification for Provider File Submission

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not Provided char 2
HD002 Payer Code NAIC code (example: 12345); leave blank if not applicable varchar 8
HD003 Payer Name Not Provided varchar 75
HD004 Beginning Month Example: 200801 Date CCYYMM 6
HD005 Ending Month Example: 200812 Date CCYYMM 6
HD006 Record count Total number of records submitted in the medical eligibility file, excluding header and trailer records int 10
MP001 Provider ID Unique identified for the provider as assigned by the reporting entity varchar 30
MP002 Provider Tax ID Tax ID of the provider. Do not code punctuation. varchar 10
MP003 Provider Entity Not Provided char 1
MP004 Provider First Name Individual first name. Set to null if provider is a facility or organization. varchar 25
MP005 Provider Middle Name or Initial Not Provided varchar 25
MP006 Provider Last Name or Organization Name Full name of provider organization or last name of individual provider varchar 60
MP007 Provider Suffix Example: Jr;null if provider is an organization. Do not use credentials such as MD or PhD varchar 10
MP008 Provider Specialty Report the HIPAA-compliant health care provider taxonomy code. Code set is freely available at the National Uniform Claims Committee's web site http://www.nucc.org/ varchar 50
MP009 Provider Office Street Address Physical address - address where provider delivers health care services varchar 50
MP010 Provider Office City Physical address - address where provider delivers health care services varchar 30
MP011 Provider Office State Physical address - address where provider delivers health care services. Use postal service standard 2 letter abbreviations. char 2
MP012 Provider Office Zip Physical address - address where provider delivers health care services. Minimum 5 digit code. varchar 11
MP013 Provider DEA Number Not Provided varchar 12
MP014 Provider NPI Not Provided varchar 20
MP015 Provider State License Number Prefix with two-character state of licensure with no punctuation. Example COLL12345 varchar 15
MP899 Record Type Not Provided char 2
TR001 Record Type Not Provided char 2
TR002 Payer Code NAIC code (example: 12345); leave blank if not applicable varchar 8
TR003 Payer Name Not Provided varchar 75
TR004 Beginning Month Example: 200801 Date CCYYMM 6
TR005 Ending Month Example: 200812 Date CCYYMM 6
TR006 Extraction Date Not Provided Date CCYYMMDD 8

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Data Element ID Data Element Code Value
HD001 Record Type MP
MP003 Provider Entity F Facility
G Group Practice
I IPA
P Practitioner
MP899 Record Type MP
TR001 Record Type MP
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