Report the date the provider or facility becomes eligible / contracted Century Year to perform services for plan Full Date PV 37 Date 11/8/12 Month Day - int[8] Provider Start Date members in CCYYMMDD Format. All 98% A2 - Integer CCYYMMDD Do not report any value here for providers that do not render services. Report the Date the provider or facility is no longer eligible to perform services for plan members / insureds Required Century Year in CCYYMMDD Format. Do not when Full Date PV 38 End Date 11/8/12 Month Day - int[8] Provider End Date report any value here for providers PV034 = 0, 98% B - Integer CCYYMMDD that are still actively eligible to 1, 2, 3, 4, provide services, or Providers who or 5 do not render services (i.e., Parent Organizations). Required External External Code National Provider Report the NPI of the Provider / when National Code Source 3 - PV 39 11/8/12 int[10] Identification (NPI) Clinician / Facility / Organization PV034 = 0, 98% B Provider ID Source 3 National Provider of the Provider defined in this record. 1, 2, 3, 4, - Integer ID or 5 External External Code Required National National Provider Report the Secondary or Other NPI Code Source 3 - when PV 40 Provider ID 11/8/12 int[10] Identification (NPI) of the Provider / Clinician / Facility / 1% C Source 3 National Provider = 0, 1, 2, 3, 2 of the Provider Organization defined in this record. - Integer ID 4, or 5 Required when GIC Report the GIC Assigned Provider GIC Provider Link ID Submitter PV 41 Provider 11/8/12 Text ID GIC Link ID. If not applicable, do not 0% B for GIC Carriers only is identified Link ID report any value here. as a GIC Submitter Report the submitter's proprietary specialty code for the provider here. Required Carrier Proprietary Known additional specialty code for when Defined Carrier Defined PV 42 Specialty 11/8/12 Specialty Code a provider should be populated in PV034 = 0, 1% B Table - Table - Specialty Code elements PV043 and PV044. Value 1, 2, 3, 4, Text comes from a Carrier Defined Table or 5 only.
PV 37 Date 11/8/12 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Provider Start Date Report the date the provider or facility becomes eligible / contracted to perform services for plan members in CCYYMMDD Format. Do not report any value here for providers that do not render services. All 98% A2 PV 38 End Date 11/8/12 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Provider End Date Report the Date the provider or facility is no longer eligible to perform services for plan members / insureds in CCYYMMDD Format. Do not report any value here for providers that are still actively eligible to provide services, or Providers who do not render services (i.e., Parent Organizations). Required when PV034 = 0, 1, 2, 3, 4, or 5 98% B PV 39 National Provider ID 11/8/12 External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Provider Report the NPI of the Provider / Clinician / Facility / Organization defined in this record. Required when PV034 = 0, 1, 2, 3, 4, or 5 98% B PV 40 National Provider ID 2 11/8/12 External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Provider Report the Secondary or Other NPI of the Provider / Clinician / Facility / Organization defined in this record. Required when = 0, 1, 2, 3, 4, or 5 1% C PV 41 GIC Provider Link ID 11/8/12 Text ID GIC GIC Provider Link ID for GIC Carriers only Report the GIC Assigned Provider Link ID. If not applicable, do not report any value here. Required when Submitter is identified as a GIC Submitter 0% B PV 42 Proprietary Specialty Code 11/8/12 Carrier Defined Table - Text Carrier Defined Table - Specialty Specialty Code Report the submitter's proprietary specialty code for the provider here. Known additional specialty code for a provider should be populated in elements PV043 and PV044. Value comes from a Carrier Defined Table only. Required when PV034 = 0, 1, 2, 3, 4, or 5 1% B
v3-1-apcd-provider-file-submission-guide-2013-06.docx