PRV Provider Information

To specify the identifying characteristics of a provider

Sequence

Element

Name

Type

Requirement

Min

Max

Repeat

01

1221

Provider Code

Identifier (ID)

Mandatory

1

3

1

Code identifying the type of provider

Codes (26)

02

128

Reference Identification Qualifier

Identifier (ID)

Conditional

2

3

1

Code identifying the Reference Identification

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

Codes (1904)

03

127

Reference Identification

String (AN)

Conditional

1

80

1

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

04

156

State or Province Code

Identifier (ID)

Optional

2

2

1

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

05

C035

Provider Specialty Information

Composite (composite)

Optional

1

01

1222

Provider Specialty Code

String (AN)

Mandatory

1

3

-

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

Codes (11)

02

559

Agency Qualifier Code

Identifier (ID)

Optional

2

2

-

Code identifying the agency assigning the code values

C035-02 qualifies C035-01.

Codes (206)

03

1073

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.

Codes (9)

06

1223

Provider Organization Code

Identifier (ID)

Optional

3

3

1

Code identifying the organizational structure of a provider

Codes (8)