PRV Provider Information

To specify the identifying characteristics of a provider

Position: PRV-01 · Element: 1221 · Name: Provider Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 3 · Repeat: -

Code indentifying the type of provider

Position: PRV-02 · Element: 128 · Name: Reference Identification Qualifier · Type: Identifier (ID) · Requirement: Mandatory · Min: 2 · Max: 3 · Repeat: -

Code qualifying the Reference Identification

Position: PRV-03 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

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

Position: PRV-04 · Element: 156 · Name: State or Province Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Code (Standard State/Province) as defined by appropriate government agency

PRV-05 C035 Provider Specialty Information Composite (composite) Optional

Position: 01 · Element: 1222 · Name: Provider Specialty Code · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 3 · Repeat: -

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

Position: 02 · Element: 559 · Name: Agency Qualifier Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Code identifying the agency assigning the code values

C035-02 qualifies C035-01.

Position: 03 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

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.

Position: PRV-06 · Element: 1223 · Name: Provider Organization Code · Type: Identifier (ID) · Requirement: Optional · Min: 3 · Max: 3 · Repeat: -

Code identifying the organizational structure of a provider