|
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).
|