3 Clinic 4 Walk in Clinic 5 Laboratory 0 Other Report the that defines the Lookup Prescribing Indicator - element. EXAMPLE: 1 = Yes, PV 61 11/8/12 Table - int[1] All 100% A2 Provider Prescribing Authority provider has prescribing privileges Integer for pharmaceuticals or DME. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the start date of provider's relationship with parent entity / group Provider Century Year in PV056 (Provider Affiliation) in Full Date PV 62 Affiliation 11/8/12 Day - int[8] Provider Date CCYYMMDD Format. Providers that All 98% A0 - Integer Start Date CCYYMMDD are self-affiliated (or no affiliation) should have the same value reported here as in PV037. 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. Report the that defines the Required Lookup PPO Indicator - Provider element. EXAMPLE: 1 = Yes, when PV 64 11/8/12 Table - int[1] 100% A0 Indicator PPO Contract provider is a contracted network = 0, 1, 2, 3, Integer provider. 4, or 5
3 Clinic 4 Walk in Clinic 5 Laboratory 0 Other PV 61 Prescribing Provider 11/8/12 Lookup Table - Integer int[1] Indicator - Prescribing Authority Report the that defines the element. EXAMPLE: 1 = Yes, provider has prescribing privileges for pharmaceuticals or DME. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PV 62 Provider Affiliation Start Date 11/8/12 Full Date - Integer Century Year Day - CCYYMMDD int[8] Provider Date Report the start date of provider's relationship with parent entity / group in PV056 (Provider Affiliation) in CCYYMMDD Format. Providers that are self-affiliated (or no affiliation) should have the same value reported here as in PV037. All 98% A0 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 that defines the element. EXAMPLE: 1 = Yes, provider is a contracted network provider. Required when = 0, 1, 2, 3, 4, or 5 100% A0
apcd-provider-file-submission-guide.docx