Report the end date of provider's relationship with parent entity / group in PV056 (Provider Affiliation) in Provider Century Year CCYYMMDD Format. Do not report Full Date PV 63 Affiliation 11/8/12 Month Day - int[8] Provider End Date any value here if the affiliation is still All 98% B - Integer End Date CCYYMMDD active, or if there is no known affiliation in PV056. Self-affiliations should report the same value here as in PV038. Required Report the value that defines the Lookup when PPO Indicator - Provider element. EXAMPLE: 1 = Yes, PV 64 11/8/12 Table - int[1] PV034 = 0, 100% A0 Indicator PPO Contract provider is a contracted network Integer 1, 2, 3, 4, provider. or 5 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable The APCD reserves this field for PV 65 Filler 4/5/13 Filler Filler char[0] Filler future use. Do not populate with any All 0% Z data. The APCD reserves this for PV 66 Filler 4/5/13 Filler Filler char[0] Filler future use. Do not populate with any All 0% Z data. The APCD reserves this field for PV 67 Filler 4/5/13 Filler Filler char[0] Filler future use. Do not populate with any All 0% Z data. The APCD reserves this field for PV 68 Filler 4/5/13 Filler Filler char[0] Filler future use. Do not populate with any All 0% Z data. The APCD reserves this for PV 69 Filler 4/5/13 Filler Filler char[0] Filler future use. Do not populate with any All 0% Z data.
PV 63 Provider Affiliation End Date 11/8/12 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Provider End Date Report the end date of provider's relationship with parent entity / group in PV056 (Provider Affiliation) in CCYYMMDD Format. Do not report any value here if the affiliation is still active, or if there is no known affiliation in PV056. Self-affiliations should report the same value here as in PV038. All 98% B PV 64 PPO Indicator 11/8/12 Lookup Table - Integer int[1] Indicator - Provider PPO Contract Report the value that defines the element. EXAMPLE: 1 = Yes, provider is a contracted network provider. Required when PV034 = 0, 1, 2, 3, 4, or 5 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PV 65 Filler 4/5/13 Filler Filler char[0] Filler The APCD reserves this field for future use. Do not populate with any data. All 0% Z PV 66 Filler 4/5/13 Filler Filler char[0] Filler The APCD reserves this for future use. Do not populate with any data. All 0% Z PV 67 Filler 4/5/13 Filler Filler char[0] Filler The APCD reserves this field for future use. Do not populate with any data. All 0% Z PV 68 Filler 4/5/13 Filler Filler char[0] Filler The APCD reserves this field for future use. Do not populate with any data. All 0% Z PV 69 Filler 4/5/13 Filler Filler char[0] Filler The APCD reserves this for future use. Do not populate with any data. All 0% Z
v3-1-apcd-provider-file-submission-guide-2013-06.docx