Provider File Data Elements

The Extract Identifier code for this file is PRV.

 

Refer to Appendix B, “Provider Data-Map Process,” for details on how Provider records are added or updated in the Healthx database.

 

Field #

Field Name

Req.

Len

Type

Notes

1

VersionNumber

K

10

AN

Spec Version Number:  3.04

2

RecordType

K

1

AN

Type of record being sent

P = Practitioner

All others = Facility

3

OrgProviderID

K

100

AN

This is a value that uniquely identifies the provider and is used in the HealthPlan Provider Portal to tie all provider data together. It can be an NPI, UPIN, or any other value that uniquely identifies the provider for your organization.

4

ProviderTIN

R

12

AN

Tax ID Number

5

ProviderTaxSuffix

R

10

AN

Tax ID Suffix

6

FullName

R

100

AN

Practitioner Full Name                                      Only used for Practitioner records

7

LastName

R

30

AN

Practitioner Last Name                                       Only used for Practitioner records

8

FirstName

R

30

AN

Practitioner First Name                                       Only used for Practitioner records

9

MiddleInitial

O

1

AN

Practitioner Middle Initial                                    Only used for Practitioner records

10

Gender

R

1

AN

Practitioner Gender                                            Only used for Practitioner records

11

PracticeName

O

100

AN

Practitioner Primary Practice Name                     Only used for Practitioner records

12

FacilityName

R

100

AN

Facility Name                                                     Only used for Facility records

13

Address1

R

100

AN

Facility Address 1                                               Only used for Facility records

14

Address2

O

100

AN

Facility Address 2                                               Only used for Facility records

15

City

R

50

AN

Facility City                                                        Only used for Facility records

16

State

R

2

AN

Facility State                                                    Only used for Facility records

17

Zip

R

10

AN

Facility Zip                                                         Only used for Facility records

18

Phone1

O

50

AN

Facility Phone Number plus Description               Only used for Facility records

19

Phone2

O

50

AN

Facility Phone Number2  plus Description            Only used for Facility records

20

Phone3

O

50

AN

Facility  Phone Number3  plus Description           Only used for Facility records

Field #

Field Name

Req.

Len

Type

Notes

21

NPIN

O

10

AN

National Provider ID

22

UPIN

O

6

AN

Universal Provider ID Number

23

DEANumber

O

15

AN

Practitioner DEA Number                                  Only used for Practitioner records

24

StateLicenseNumber

O

15

AN

State License Number

25

Email

O

80

AN

Email Address

26

IntSystemID

O

64

AN

Claim System Internal ID

27

ExtProviderID

O

64

AN

Claim System External ID

28

PanelStatus

O

1

AN

Y = Accepting

N = No new patients                                          Only used for Practitioner records

29

EffDate

O

8

DT

Effective Date

30

TermDate

O

8

DT

Termination Date

31

ProviderStatus

O

2

AN

Status – In-Network, Out-of-Network, etc.

32

PCPFlag

O

1

AN

Is the  Practitioner a PCP – Y/N                          Only used for Practitioner records

33

PCPCode

O

25

AN

Practitioner PCP Code                                         Only used for Practitioner records

34

PCPCodeDesc

O

255

AN

Practitioner PCP Description                                Only used for Practitioner records

35

FacilityHours

O

1000

AN

Text Description of Office Hours                         Only used for Facility records

36

FacilityAccred

O

1

AN

Facility Certification specific to JCAHO only, yes/no                                                            Only used for Facility records

37

UserDefinedText1

O

255

AN

User Defined Text Field 1

38

UserDefinedText2

O

255

AN

User Defined Text Field 2

39

UserDefinedText3

O

255

AN

User Defined Text Field 3

40

UserDefinedDate1

O

8

DT

User Defined Date Field 1

41

UserDefinedDate2

O

8

DT

User Defined Date Field 2

42

UserDefinedDate3

O

8

DT

User Defined Date Field 3

43

UserDefinedNumeric1

O

12

DE

User Defined Numeric Field 1

44

UserDefinedNumeric2

O

12

DE

User Defined Numeric Field 2

45

UserDefinedNumeric3

O

12

DE

User Defined Numeric Field 3



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