PRV

Information Receiver Provider Information

Pos: 090

Max: 1

Detail - Optional

Loop: 2100B

Elements: 3

User Option (Usage): Situational

To specify the identifying characteristics of a provider

Element Summary:

	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	PRV01	1221	Provider Code Description: Code identifying the type of provider	M	ID	1/3	Required

	Code	Name
	H	Hospital
	R	Rural Health Clinic
	AD	Admitting
	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
	SB	Submitting
	SK	Skilled Nursing Facility
	SU	Supervising

PRV02

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification
If the National Provider ID is mandated for use, code value “HPI” must be used, otherwise one of the other code values may be used.

2/3

Required

Code

Name

Mutually Defined

ZZ is used to indicate the “Health Care Provider Taxonomy” code list (provider specialty code) which is available on the Washington Publishing Company web site: http://www.wpc-edi.com. This taxonomy is maintained by the Blue Cross Blue Shield Association and ASC X12N TG2 WG15.

PRV03

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Receiver Provider Specialty Code
Use this number for the reference number as qualified by the preceding data element (PRV02).

1/30

Required

	ExternalCodeList
	Name: HCPT
	Description: Health Care Provider Taxonomy

Notes:

1. This segment is used to convey additional information about a provider’s role in the eligibility/benefit being inquired about and who is also the Information Receiver. For example, if the Information Receiver is also the Referring Provider, this PRV segment would be used to identify the provider’s role.
2. PRV02 qualifies PRV03.

Example:

PRV*PE*ZZ*203BA0504N~

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