PRV Provider Information

To specify the identifying characteristics of a provider

Position
Element
Name
Type
Requirement
Min
Max
Repeat
PRV01
Provider Code
Identifier (ID)
Mandatory
1
3
1
Code identifying the type of provider
PRV02
Reference Identification Qualifier
Identifier (ID)
Conditional
2
3
1
Code qualifying the Reference Identification
P0203: If either PRV-02 or PRV-03 is present, then the other is required
PRV03
Reference Identification
String (AN)
Conditional
1
50
1
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
PRV04
State or Province Code
Identifier (ID)
Optional
2
2
1
Code (Standard State/Province) as defined by appropriate government agency
PRV05
Provider Specialty Information
Composite (composite)
Optional
1
01
Provider Specialty Code
String (AN)
Mandatory
1
3
-
Code indicating the primary specialty of the provider, as defined by the receiver
02
Agency Qualifier Code
Identifier (ID)
Optional
2
2
-
Code identifying the agency assigning the code values
C035-02 qualifies C035-01.
03
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response
C035-03 is the provider specialty certification indicator. A "Y" value indicates the provider is certified in the specialty indicated. An "N" value indicates the provider is not certified in the specialty indicated. A "U" value indicates that it is unknown whether the provider is certified in the specialty indicated.
PRV06
Provider Organization Code
Identifier (ID)
Optional
3
3
1
Code identifying the organizational structure of a provider

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