Report the identifier of the medical home the provider Require Medical / Medical Home is linked-to here. The value in this when PV 54 Healthcare 6/24/10 Text ID Link to PV002 Identification 0% B element must have a corresponding PV034 = Home ID Number Provider ID (PV002) in this or a 1, 2, or 3 previously submitted provider file. Lookup Report the that defines the Required Indicator - Provider PV 55 PCP Flag 11/8/12 Table - int[1] element. EXAMPLE: 1 = Yes, when 100% A0 is a PCP Integer provider is a PCP. PV034 = 1 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the Provider ID for any affiliation the provider has with Provider Provider Affiliation another entity or parent company. If PV 56 2/2016 Text ID Link to PV002 All 90% A2 Affiliation Code the provider is associated only with self, record the same value here as PV002. Report the telephone number of the Telephone number provider associated with the Provider associated with the PV 57 6/24/10 Numeric Telephone identification in PV002. Do not All 10% C Telephone provider identified in separate components with hyphens, PV002 spaces or other special characters. Delegated Report the value that defines the Lookup Provider Indicator - Delegated element. EXAMPLE: 1 = Yes, PV 58 11/8/12 Table - int[1] All 100% A2 Record Record provider record was sourced from Integer Flag the delegated provider’s system. Value Description 1 Yes 2 No 3 Unknown
PV 54 Medical / Healthcare Home ID 6/24/10 Text ID Link to PV002 Medical Home Identification Number Report the identifier of the medical home the provider is linked-to here. The value in this element must have a corresponding Provider ID (PV002) in this or a previously submitted provider file. Require when PV034 = 1, 2, or 3 0% B PV 55 PCP Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Provider is a PCP Report the that defines the element. EXAMPLE: 1 = Yes, provider is a PCP. Required when PV034 = 1 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PV 56 Provider Affiliation 2/2016 Text ID Link to PV002 Provider Affiliation Code Report the Provider ID for any affiliation the provider has with another entity or parent company. If the provider is associated only with self, record the same value here as PV002. All 90% A2 PV 57 Provider Telephone 6/24/10 Numeric Telephone Telephone number associated with the provider identified in PV002 Report the telephone number of the provider associated with the identification in PV002. Do not separate components with hyphens, spaces or other special characters. All 10% C PV 58 Delegated Provider Record Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Delegated Record Report the value that defines the element. EXAMPLE: 1 = Yes, provider record was sourced from the delegated provider’s system. All 100% A2 Value Description 1 Yes 2 No 3 Unknown
v6-apcd-provider-file-submission-guide-FINAL.docx