PRV Provider Information

To specify the identifying characteristics of a provider

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Position

Element

Name

Type

Requirement

Min

Max

Repeat

PRV01

1221

Provider Code

Identifier (ID)

Mandatory

Code identifying the type of provider

PRV02

128

Reference Identification Qualifier

Identifier (ID)

Conditional

Code identifying the Reference Identification

P0203: If either PRV-02 or PRV-03 is present, then the other is required

PRV03

127

Reference Identification

String (AN)

Conditional

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

PRV04

156

State or Province Code

Identifier (ID)

Optional

Code specifying the Standard State/Province as defined by appropriate government agency

PRV05

C035

Provider Specialty Information

Composite (composite)

Optional

1222

Provider Specialty Code

String (AN)

Mandatory

Code indicating the primary specialty of the provider, as defined by the receiver

559

Agency Qualifier Code

Identifier (ID)

Optional

Code identifying the agency assigning the code values

C035-02 qualifies C035-01.

1073

Yes/No Condition or Response Code

Identifier (ID)

Optional

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

1223

Provider Organization Code

Identifier (ID)

Optional

Code identifying the organizational structure of a provider