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*********************** Updated:05/16/2008 Copyright © 1996-2008 Management Systems Consulting, Inc. | | | PRV | ![]() | | Dependent Benefit Related Provider Information | . | | Pos: 390 | Max: 1 | | Detail - Optional | | Loop: 2120D | Elements: 3 | |
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To specify the identifying characteristics of a provider Element Summary: | | | | | | | | | | | | | | _Ref_ | Id | _________Element Name__________ | Req | Type | Min/Max | | | | | PRV01 | 1221 | Provider Code | M | ID | 1/3 | | | | | | | Description: Code identifying the type of provider | | | | | | Code | Name_______________________________ | | | | | | H | Hospital | | | | | | R | Rural Health Clinic | | | | | | AT | Attending | | | | | | BI | Billing | | | | | | CO | Consulting | | | | | | CV | Covering | | | | | | HH | Home Health Care | | | | | | LA | Laboratory | | | | | | OT | Other Physician | | | | | | P1 | Pharmacist | | | | | | P2 | Pharmacy | | | | | | PC | Primary Care Physician | | | | | | PE | Performing | | | | | | RF | Referring | | | | | | SK | Skilled Nursing Facility | | | PRV02 | 128 | Reference Identification Qualifier | M | ID | 2/3 | | | | | | | Description: Code qualifying the Reference Identification | | | | | | Code | Name_______________________________ | | | | | | 9K | Servicer | | | | | | D3 | National Association of Boards of Pharmacy Number | | | | | | EI | Employer's Identification Number | | | | | | SY | Social Security Number | | | | | | TJ | Federal Taxpayer's Identification Number | | | | | | ZZ | Mutually Defined | | | | | | HPI | Health Care Financing Administration National Provider Identifier | | | PRV03 | 127 | Reference Identification | M | AN | 1/30 | | | | | | | Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier |
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