EDI Dictionary
Schedule demo
EDI Dictionary
Transaction Sets
Segments
Elements
X12 Release 5030
X12 Release
4010
4010
4030
4050
5010
5030
5050
6020
6040
7010
7030
7050
8010
4020
4040
4060
5020
5040
6010
6030
6050
7020
7040
7060
Schedule demo
X12 Release 5030
X12 Release
4010
4010
4030
4050
5010
5030
5050
6020
6040
7010
7030
7050
8010
4020
4040
4060
5020
5040
6010
6030
6050
7020
7040
7060
Transaction Sets
Segments
Elements
EDI-Dictionary
5030
275 Patient Information
PRV-300
PRV
Provider Information
Opt
AtMax 1
To specify the identifying characteristics of a provider
Elements
Position
Element
Name
Type
Min/Max
Repeat
1
1221
Provider Code
Mandatory
ID
1/3
AtMax 1
2
128
Reference Identification Qualifier
Rel
ID
2/3
AtMax 1
3
127
Reference Identification
Rel
Alphanumeric
1/80
AtMax 1
4
156
State or Province Code
Opt
ID
2/2
AtMax 1
C035
Provider Specialty Information
Opt
AtMax 1
6
1223
Provider Organization Code
Opt
ID
3/3
AtMax 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