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11.5.3 PRD - provider data segment

This segment will be employed as part of a patient referral message and its related transactions. The PRD segment contains data specifically focused on a referral, and it is inter-enterprise in nature. The justification for this new segment comes from the fact that we are dealing with referrals that are external to the facilities that received them. Therefore, using a segment such as the current PV1 would be inadequate for all the return information that may be required by the receiving facility or application. In addition, the PV1 does not always provide information sufficient to enable the external facility to make a complete identification of the referring entity. The information contained in the PRD segment will include the referring provider, the referred-to provider, the referred-to location or service, and the referring provider clinic address.

Figure 11-4. PRD attributes

SEQ

LEN

DT

OPT

RP/#

TBL#

ITEM#

ELEMENT NAME

1

200

CE

R

Y

0286

01155

Role

2

106

XPN

O

Y


01156

Provider Name

3

60

XAD

O



01157

Provider Address

4

60

PL

O



01158

Provider Location

5

100

XTN

O

Y


01159

Provider Communication Information

6

200

CE

O


0185

01161

Preferred Method of Contact

7

100

CM

O

Y


01162

Provider Identifiers

8

26

TS

O



01163

Effective Start Date of Role

9

26

TS

O



01164

Effective End Date of Role

11.5.3.0 PRD field definitions

11.5.3.1 Role (CE) 01155

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the contact role that defines the relationship of the person described in this segment to the patient being referred. When a referral that is inter-enterprise in nature, there are several important relationships that must be identified. For example, the proper identification of both the referring and the referred-to provider is critical for proper processing of a referral. In addition, some enterprises may want information regarding a consulting provider or the identity of the person who actually prepared the referral. This contact role may also expand to represent affiliated persons to whom information regarding this referral must be forwarded or copied. Refer to user-defined table 0286 - Provider role for suggested values.

User-defined Table 0286 - Provider role

Value

Description

RP

Referring Provider

PP

Primary Care Provider

CP

Consulting Provider

RT

Referred to Provider

11.5.3.2 Provider name (XPN) 01156

Components: <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)> ^ <name type code (ID) >

Definition: This field contains the name of the provider identified in this segment. Generally, this field will describe a physician associated with the referral. However, it is not limited to physicians. This field may contain the name of any valid healthcare provider associated with this referral. If this Provider Name is a physician’s name, you may refer to PRD-1-provider identifiers (Section 11.5.3.7) for the physician identifier.

11.5.3.3 Provider address (XAD) 01157

Components: <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)>

Definition: This field contains the mailing address of the provider identified in this segment. One of the key components to completing the "circle of care" and provider/institution bonding is the issuance of follow-up correspondence to the referring provider.

11.5.3.4 Provider location (PL) 01158

Components: <point of care (IS)> ^ <room (IS)> ^ <bed (IS)> ^ <facility (HD)> ^ <location status (IS)> ^ <person location type (IS)> ^ <building (IS)> ^ <floor (IS)> ^ <location description (ST)>

Subcomponents of facility: <namespace ID (IS) & <universal ID (ST)> & <universal ID type (ID)>

Definition: This field contains the location of the provider as needed when a provider that may be external to a given enterprise must be referenced. For example, if this provider represented the referred-to physician, the Provider Location should identify the clinic of the physician or provider to whom this referral has been sent. The identification of the provider’s location is specified by an application and facility identifier carried in the facility field. The application ID and facility ID would be used in the same manner as their corresponding fields in the MSH segment (MSH-3-sending application, MSH-5-receiving application MSH-4-sending facility, MSH-6-receiving facility). That is, the facility field will contain an application identifier and facility identifier which describes the location of this provider. However, it should be noted that they may describe a different location because the provider location being referenced in this field may not be the location from which the message originated, which is being described by the MSH.

11.5.3.5 Provider communication information (XTN) 01159

Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^ <telecommunication use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>

Definition: This field contains information, such as the phone number or electronic mail address, used to communicate with the provider or organization.

11.5.3.6 Preferred method of contact (CE) 01161

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the preferred method to use when communicating with the provider. Refer to user-defined table 0185 - Preferred method of contact for suggested values.

11.5.3.7 Provider identifiers (CM) 01162

Components: <ID number (ST)> ^ <type of ID number (IS)> ^ <other qualifying info (ST)>

Definition: This repeating field contains the provider’s unique identifiers such as UPIN, Medicare and Medicaid numbers. Refer to PRA-6-practitioner ID numbers in Chapter 8 ( Section 8.6.3.6, "Practitioner ID numbers") for suggested values.

11.5.3.8 Effective start date of role (TS) 01163

Definition: This field contains the date that the role of the provider effectively began. For example, this date may represent the date on which a physician was assigned as a patient’s primary care provider.

11.5.3.9 Effective end date of role (TS) 01164

Definition: This field contains the date that the role of the provider effectively ended. For example, this date may represent the date that a physician was removed as a patient’s primary care provider.

Note: The "Effective Start Date of Role" and "Effective End Date of Role" should not be used as trigger events. For example, they should not be used to trigger a change in role. These two dates are for informational purposes only.

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