EDI Dictionary
Schedule demo
X12 Release 4010
X12 Release
4010
4020
4030
4040
4050
4060
5010
5020
5030
5040
5050
6010
6020
6030
6040
6050
7010
7020
7030
7040
7050
7060
8010
Transaction Sets
Segments
Elements
EDI-Dictionary
4010
PRV
PRV
Provider Information
Batch
To specify the identifying characteristics of a provider
Elements
Position
Element
Name
Type
Min/Max
Repeat
1
1221
Provider Code
Mandatory
ID
1/3
1
2
128
Reference Identification Qualifier
Mandatory
ID
2/3
1
3
127
Reference Identification
Mandatory
Alphanumeric
1/30
1
4
156
State or Province Code
Opt
ID
2/2
1
C035
Provider Specialty Information
Opt
1
6
1223
Provider Organization Code
Opt
ID
3/3
1
Element Details
ID
1221
Name
Provider Code
Length
Min 1 / Max 3
Position
1
Requirement
Mandatory
Codes
<>
OP
Operating
<>
AS
Assistant Surgeon
<>
CV
Covering
<>
AT
Attending
<>
AD
Admitting
<>
LA
Laboratory
<>
HH
Home Health Care
<>
SK
Skilled Nursing Facility
<>
BI
Billing
<>
SU
Supervising
<>
P1
Pharmacist
<>
BS
Billing Service
<>
PT
Pay-To
<>
RF
Referring
<>
CO
Consulting
<>
R
Rural Health Clinic
<>
P2
Pharmacy
<>
RP
Reporting Provider
<>
OR
Ordering
<>
PU
Purchasing
<>
PE
Performing
<>
H
Hospital
<>
PC
Primary Care Physician
<>
OT
Other Physician
<>
ON
On Staff
<>
SB
Submitting
