578-578 Delimiter Use the ^ character value 1 Character R 579-586 License The beginning effective date of 8 Date O effective date 4 the license 587-587 Delimiter Use the ^ character value 1 Character R 588-595 License End The last date the license was 8 Date O date 4 active. (20991231 for open and unknown) 596-596 Delimiter Use the ^ character value 1 Character R 597-597 License Type 5 1 State, county, or municipality 1 Numeric O professional or business license 2 DEA license 3 Professional society accreditation 4 CLIA accreditation 5 Other Blank (Space filled) if no additional license or accreditation 598-598 Delimiter Use the ^ character value 1 Character R 599-618 License Or A data element to capture the 20 Character O license or accreditation number 5 issued to the provider by the licensing entity or accreditation body. 619-619 Delimiter Use the ^ character value 1 Character R 620-679 License issuing A free text field to capture the 60 Character O ID 5 identity of the entity issuing the license or accreditation. 680-680 Delimiter Use the ^ character value 1 Character R 681-688 License The beginning effective date of 8 Date O effective date 5 the license 689-689 Delimiter Use the ^ character value 1 Character R 690-697 License End The last date the license was 8 Date O date 5 active. (20991231 for open and unknown) 698-698 Delimiter Use the ^ character value 1 Character R 699-706 MCO Effective beginning date of 8 Date R Enrollment services which can be paid by Begin Date 1 MCO 707-707 Delimiter Use the ^ character value 1 Character R 708-715 MCO Effective ending date of services 8 Date R Enrollment End of which can be paid by MCO Date 1 20991231 if no ending date is available. 716-716 Delimiter Use the ^ character value 1 Character R
578-578 Delimiter Use the ^ character value 1 Character R 579-586 License effective date 4 The beginning effective date of the license 8 Date O 587-587 Delimiter Use the ^ character value 1 Character R 588-595 License End date 4 The last date the license was active. (20991231 for open and unknown) 8 Date O 596-596 Delimiter Use the ^ character value 1 Character R 597-597 License Type 5 1 State, county, or municipality professional or business license 2 DEA license 3 Professional society accreditation 4 CLIA accreditation 5 Other Blank (Space filled) if no additional license or accreditation 1 Numeric O 598-598 Delimiter Use the ^ character value 1 Character R 599-618 License Or 5 A data element to capture the license or accreditation number issued to the provider by the licensing entity or accreditation body. 20 Character O 619-619 Delimiter Use the ^ character value 1 Character R 620-679 License issuing ID 5 A free text field to capture the identity of the entity issuing the license or accreditation. 60 Character O 680-680 Delimiter Use the ^ character value 1 Character R 681-688 License effective date 5 The beginning effective date of the license 8 Date O 689-689 Delimiter Use the ^ character value 1 Character R 690-697 License End date 5 The last date the license was active. (20991231 for open and unknown) 8 Date O 698-698 Delimiter Use the ^ character value 1 Character R 699-706 MCO Enrollment Begin Date 1 Effective beginning date of services which can be paid by MCO 8 Date R 707-707 Delimiter Use the ^ character value 1 Character R 708-715 MCO Enrollment End Date 1 Effective ending date of services of which can be paid by MCO 20991231 if no ending date is available. 8 Date R 716-716 Delimiter Use the ^ character value 1 Character R
PIHP_CSoC_SystemsCompanionGuide-Sept2018_V12.docx