STANDARD DATA DICTIONARY #355.97 -- IB PROVIDER ID # TYPE FILE 3/24/25 PAGE 1
STORED IN ^IBE(355.97, (26 ENTRIES) SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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There can be many different kinds of provider id numbers that may need to be reported when billing for hospital and professional
services. This file contains entries that will be used to classify or identify the valid kinds of provider ids that the V.A. will
use. This is needed specifically for the transmission of bills so the proper interpretation of the ID's can be made
electronically.
DD ACCESS: @
RD ACCESS:
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS:
IDENTIFIED BY: SOURCE LEVEL MINIMUM (#.02)[R], X12 CODE (#.03)
POINTED TO BY: PERF PROV SECOND ID TYPE 1500 field (#4.01) of the INSURANCE COMPANY File (#36)
PERF PROV SECOND ID TYPE UB field (#4.02) of the INSURANCE COMPANY File (#36)
REF PROV SEC ID DEF CMS-1500 field (#4.04) of the INSURANCE COMPANY File (#36)
DELETE 2006 4.1 field (#4.1) of the INSURANCE COMPANY File (#36)
PROVIDER ID TYPE field (#.06) of the IB BILLING PRACTITIONER ID File (#355.9)
PROVIDER ID TYPE field (#.06) of the IB INSURANCE CO LEVEL BILLING PROV ID File (#355.91)
PROVIDER ID TYPE field (#.06) of the FACILITY BILLING ID File (#355.92)
PRIMARY ID QUALIFIER field (#.13) of the IB NON/OTHER VA BILLING PROVIDER File (#355.93)
ID TYPE field (#.06) of the IB INS CO PROVIDER ID CARE UNIT File (#355.96)
PRIMARY ID QUALIFIER field (#128) of the BILL/CLAIMS File (#399)
SECONDARY ID QUALIFIER field (#129) of the BILL/CLAIMS File (#399)
TERTIARY ID QUALIFIER field (#130) of the BILL/CLAIMS File (#399)
PRIM INS PROVIDER ID TYPE field (#.12) of the PROVIDER sub-field (#399.0222) of the BILL/CLAIMS File (#399)
SEC INS PROVIDER ID TYPE field (#.13) of the PROVIDER sub-field (#399.0222) of the BILL/CLAIMS File (#399)
TERT INS PROVIDER ID TYPE field (#.14) of the PROVIDER sub-field (#399.0222) of the BILL/CLAIMS File (#399)
PRIM INS PROVIDER ID TYPE field (#.12) of the LINE PROVIDER sub-field (#399.0404) of the PROCEDURES sub-field
(#399.0304) of the BILL/CLAIMS File (#399)
SEC INS PROVIDER ID TYPE field (#.13) of the LINE PROVIDER sub-field (#399.0404) of the PROCEDURES sub-field
(#399.0304) of the BILL/CLAIMS File (#399)
TERT INS PROVIDER ID TYPE field (#.14) of the LINE PROVIDER sub-field (#399.0404) of the PROCEDURES sub-field
(#399.0304) of the BILL/CLAIMS File (#399)
CROSS
REFERENCED BY: NAME(B), X12 CODE(C)
355.97,.01 NAME 0;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'(X'?1P.E) X
LAST EDITED: JUL 24, 2001
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This is the name used to describe the provider id type.
CROSS-REFERENCE: 355.97^B
1)= S ^IBE(355.97,"B",$E(X,1,30),DA)=""
2)= K ^IBE(355.97,"B",$E(X,1,30),DA)
355.97,.02 SOURCE LEVEL MINIMUM 0;2 SET (Required)
'0' FOR NONE;
'1' FOR LICENSING/GOVT AGENCY - EACH PROV;
'2' FOR FACILITY - ALL PROV;
'3' FOR INSURANCE CO - ALL PROV;
'4' FOR INSURANCE CO - EACH PROV;
'5' FOR INSURANCE CO - ALL PROV BY CARE UNIT;
LAST EDITED: DEC 17, 2003
HELP-PROMPT: Enter the code that describes how this id type MUST be assigned or 0 for NO minimum requirements
DESCRIPTION: This is the minimum level or criteria of data that MUST be used to search for this type of ID
number for a provider. If this field is zero or blank, there are no minimum data requirements to
search for an ID for this id type.
355.97,.03 X12 CODE 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: DEC 08, 2005
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION: This is the X12 code that determines the qualifier to be output in the X12 data stream when
reporting this type of provider ID number.
CROSS-REFERENCE: 355.97^C
1)= S ^IBE(355.97,"C",$E(X,1,30),DA)=""
2)= K ^IBE(355.97,"C",$E(X,1,30),DA)
355.97,.04 FACILITY'S DEFAULT ID # 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: SEP 07, 2000
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION: This is the number that will be the default for all providers for the id type at the facility if no
number exists for the specific provider/ins. co/care unit combination.
355.97,.05 RESTRICT EDITING 0;5 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: FEB 07, 2001
HELP-PROMPT: Enter 1 (YES) to prevent users from editing this id type's id #'s at the facility level
DESCRIPTION: This field controls whether or not users may edit the id #'s for the provider type at the facility
level.
355.97,.06 VALID FOR PERFORMING PROVIDER 0;6 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: MAY 09, 2001
HELP-PROMPT: ENTER YES (1) IF THE ID TYPE IS VALID FOR PERFORMING ID
DESCRIPTION:
This field indicates whether the id type is valid for performing provider ids.
355.97,.07 ALLOWABLE FORM TYPE 0;7 SET
'I' FOR INSTITUTIONAL;
'P' FOR PROFESSIONAL;
'B' FOR BOTH INSTITUTIONAL AND PROFESSIONAL;
LAST EDITED: OCT 25, 2006
HELP-PROMPT: Enter I if this is used on UB type forms, P if used on CMS type forms, or B if used on either type.
DESCRIPTION: This is a flag used to determine what type of form this qualifier is valid for. It is used to
validate provider id file set-up.
355.97,.08 ACTIVE 0;8 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: APR 19, 2006
HELP-PROMPT: Enter YES if this entry is Active or NO if it is In-Active
DESCRIPTION: This field must be set to YES to allow this qualifier to be selected. Old entries that are no
longer allowed should be set to NO.
355.97,1.01 STATE DEA# 1;1 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 07, 2000
HELP-PROMPT: Enter a 1 (yes) if this is a state DEA # id type
DESCRIPTION: This is the flag that tells the system this id type is a state DEA # and the data is stored in the
NEW PERSON file by state.
UNEDITABLE
355.97,1.02 FEDERAL DEA# 1;2 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JAN 08, 2001
HELP-PROMPT: Enter a 1 (yes) if this is a federal DEA # id type
DESCRIPTION: This is the flag that tells the system this id type is a federal DEA # and the data is stored in
the NEW PERSON file.
UNEDITABLE
355.97,1.03 STATE LICENSE # 1;3 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 07, 2000
HELP-PROMPT: Enter a 1 (yes) if this is a state license # id type
DESCRIPTION: This is the flag that tells the system this id type is a state license # and the data is stored in
the NEW PERSON file by state.
UNEDITABLE
355.97,1.04 FEDERAL TAX # - FACILITY 1;4 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 07, 2000
HELP-PROMPT: Enter a 1 (yes) if this is a facility federal tax id # id type
DESCRIPTION: This is the flag that tells the system this id type is a facility federal tax id and the data is
stored in the IB SITE PARAMETERS file.
UNEDITABLE
355.97,1.05 EMC ID TYPE 1;5 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 13, 2000
HELP-PROMPT: Enter yes if this type is for EMC ID #
DESCRIPTION:
This is a flag to indicate if the record is for an EMC ID #
355.97,1.06 NETWORK ID TYPE 1;6 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: SEP 13, 2000
HELP-PROMPT: Enter yes if this type is for Network ID #
DESCRIPTION:
This is a flag to indicate if the record is for a network id #.
355.97,1.07 PROVIDER'S OWN ID 1;7 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: APR 27, 2001
HELP-PROMPT: ENTER YES (1) IF THE ID IS A PROVIDER'S PERSONAL #
DESCRIPTION: This is the flag that designates an id type is a personal # for the provider, not assigned by the
facility or an insurance co
355.97,1.08 STORED OUTSIDE OF BILLING 1;8 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: APR 27, 2001
HELP-PROMPT: ENTER 1 IF THIS PROVIDER ID DATA IS NOT STORED IN IB FILES
DESCRIPTION:
This is the flag that specifies the provider id data is not stored in an IB file.
355.97,1.09 BILLING PROVIDER PRIMARY ID 1;9 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUN 11, 2004
HELP-PROMPT: Enter a 1 if this is the billing provider's primary id record
DESCRIPTION: This field is a 1 (YES) if this is the provider id type that represents the billing provider's
primary id.
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):