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TMSIS Dataguide Medicaid.gov
Version 3.27.0

BILLING-PROV-NPI-NUM

Data Element

DE Number

CIP180

System DE Number

CIP.002.180

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition

The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.
Size X(10)
FLF Start Position 1002
FLF Stop Position 1011
Segment Key Field Identifier Not Applicable
Coding Requirements

1.Value must be 10 digits
2. Value must have an associated Provider Identifier Type equal to '2'
3. Value must exist in the NPPES NPI data file
4. Conditional
5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'
6. When Type of Claim is in ['1','3','A','C'], then value must be populated
7. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CLT131 CLT.002.131 BILLING-PROV-NPI-NUM CLT00002 CLAIM-HEADER-RECORD-LT
COT113 COT.002.113 BILLING-PROV-NPI-NUM COT00002 CLAIM-HEADER-RECORD-OT
CRX071 CRX.002.071 BILLING-PROV-NPI-NUM CRX00002 CLAIM-HEADER-RECORD-RX