|
2
|
Provider Sub
Identifier
|
4
|
A-Numeric
|
None
|
Identification
number that uniquely identifies multiple providers using the same
TIN.
|
|
1
|
Provider Taxpayer
Number (TIN)
|
9
|
A-Numeric
|
None
|
The IRS TIN
assigned to the institution/provider supplying the care, e.g., 10130427,
ZA000025. For institutions, it must be the Employer Identification
Number (EIN). For individual providers it must be the EIN or Social
Security Number (SSN), if available. If not available, the contractor
shall report the contractor-assigned number.
|
|
3
|
Provider Taxpayer
Number Identifier
|
1
|
A-Numeric
|
A, E, S
|
Code to identify
the Provider TIN as being an EIN or SSN or contractor assigned:
A = Assigned by contractor
E = Tax Identification Number (EIN)
S = Social Security Number (SSN)
|
|
4
|
Contractor Number
|
2
|
A-Numeric
|
04, 05, 08, 10,
12, 13, 15, 71, 73, 74
|
Identification
code for the contractor. Used to identify each contractor submitting
Provider File Records. Code values are defined in the TSM, Chapter
2, Addendums A and B. |
|
5
|
Provider Contract
Affiliation Code
|
1
|
A-Numeric
|
0, 1, 2, 3,
4, 5
|
Code indicating
whether the provider is under contract with the contractor. All
codes are irrespective of any partnership agreements. For provider
records:
0 = Not Applicable
1 = Contracted
2 = Not Contracted
3 = Contracted/Not Contracted
4 = Active Duty TPR
5 = Non-Certified Providers
|
|
6
|
Institutional/
Non-Institutional Indicator
|
1
|
A-Numeric
|
I, N
|
Code used to
identify a provider as an institution or non-institution. Coded
as follows:
I = Institution
N = Non-Institution
|
|
7
|
Provider or
Hospital Name
|
40
|
A-Numeric
|
None
|
The name of
the provider or Hospital.
|
|
8
|
Provider Street
Address
|
30
|
A-Numeric
|
None
|
Street address
of the provider’s location.
|
|
9
|
Provider City
|
18
|
A-Numeric
|
None
|
The city in
which the provider of medical care is located.
|
|
10
|
Provider State
or Country Code
|
3
|
A-Numeric
|
None
|
Code assigned
to identify the state or foreign country in which the provider is
physically located. Code values are defined in the TSM, Chapter
2, Addendums A and B. |
|
11
|
Provider Zip
Code
|
5
|
A-Numeric
|
None
|
The first five
digits of the zip code or a three-character country code for provider’s
health care business location where the care was provided. The first
five digits are used along with other “key” elements to uniquely identify
multiple providers using the same Provider Taxpayer Number.
|
|
12
|
Provider ZIP
Code
|
4
|
A-Numeric
|
None
|
Digits 6 through
9 of the ZIP code of the location where the care was provided.
|
|
13
|
Provider Major
Specialty/Type of Institution (HIPAA)
|
10
|
A-Numeric
|
Codes are located
in the TSM for Institutional Codes, Chapter 2, Addendum D, Figure 2.D-1. |
For non-institutional
codes: http://www.wpc.edi.com/References/Code, describing a provider’s
major specialty, e.g., Provider Taxonomy, for non-institutional
TRICARE Encounter Data records (TEDs)/Health Care Service Records
(HCSRs) or a code describing the Type of Institution for institutional
TEDs/HCSRs.
|
|
14
|
Provider Acceptance
Date
|
8
|
Numeric
|
None
|
Date a provider
met criteria to provide services. If the provider was never qualified
to provide services zero fill. Format YYYYMMDD.
|
|
15
|
Provider Termination
Date
|
8
|
Numeric
|
None
|
Date a provider
is either suspended or terminated as a valid TRICARE provider (not
to be used as the date a change was made to the file). If the provider
was never qualified to provide services, zero filled. Format YYYYMMDD.
|
|
16
|
Provider Individual
|
10
|
A-Numeric
|
None
|
The individual
National Provider Identifier (NPI), e.g., 0123456789.
|
|
17
|
Provider Group
NPI
|
10
|
A-Numeric
|
None
|
The group national
provider Identifier, e.g., 0123456789.
|
|
18
|
Provider Network
Status Indicator
|
1
|
A-Numeric
|
1, 2
|
Code assigned
to identify whether or not the provider is a network or non-network
provider (at the date of service). Coded as follows:
1 = Network provider
2 = Non-network provider
|
|
19
|
Maternity Care
Value Indicator
|
8
|
Numeric
|
0, 1, 2
|
Code indicating
the network hospital’s assigned maternity care performance ranking
based on the number of core metrics that provider met as stated
in Section 4, paragraph 4.2. Coded as follows: 0 = Below Value Tier (The network hospital
met the target for two, one, or zero core metrics, or chose not
to participate in the Leapfrog Hospital Survey, or who are rated
“not applicable” by Leapfrog).
1 = Value Tier (The network
hospital met the target for any three of the four core metrics.)
2 = High Value Tier (The network
hospital met the target for all four core metrics.)
|
|
20
|
High-Risk
Delivery Indicator
|
8
|
Numeric
|
0, 1
|
Code indicating
the assigned High Value and Value tier
network hospitals that also met the Leapfrog target for High-Risk
Deliveries with at least 50 very-low birth weight babies
per year. Coded as follows:
0
= Not High-Risk Delivery Tier (The network hospital
with a Maternity Care Value Indicator of 1 (Value Tier)
or 2 (High Value Tier) but did not meet a minimum threshold
of very-low birth weight deliveries per year, or chose not to participate
in the Leapfrog Hospital Survey , or who are rated “not applicable”
by Leapfrog.)
1 = High-Risk
Delivery Tier (The network hospital with a Maternity Care Value Indicator
of 1 (Value Tier) or 2 (High Value Tier)
who also met the Leapfrog target for High-Risk Deliveries with
at least 50 very-low birth weight babies per year).
|