CIP.002.181

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

BILLING-PROV-TAXONOMY

Data Element

DE Number

CIP181

System DE Number

CIP.002.181

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The taxonomy code for the institution billing for the beneficiary.
Size	X(12)
FLF Start Position	1012
FLF Stop Position	1023
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Provider Taxonomy List (VVL) 2. Value must be 12 characters or less 3. Conditional

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-6341	If a claim is a non-denied claim from an IP file, then the billing provider taxonomy value reported must be compatible with specified T-MSIS picture format: X(12).
RULE-693	If the billing provider taxonomy is populated on a non-denied encounter or FFS claim from an IP file, then the billing provider taxonomy value reported must be in the list of valid values for provider taxonomy.
RULE-7916	If the billing provider taxonomy is populated on a non-denied claim from an IP file, and is a Medicaid-expansion CHIP Encounter or separate CHIP Encounter claim then the billing provider taxonomy value reported must be in the list of valid values for provider taxonomy.
RULE-7917	If the type of claim is a fee for service and billing provider taxonomy is populated on a claim header from an IP file, then the billing provider taxonomy value reported must be in the list of valid values for provider taxonomy.

Measure ID	Measure Name
ALL-33-001-1	Billing Provider Taxonomy values
FFS-50-001-1	% of claim headers that have an invalid Billing Provider Taxonomy
FFS-51-001-1	% of claim headers that have an invalid Billing Provider Taxonomy
FFS-52-001-1	% of claim headers where BILLING-PROV-TAXONOMY does not begin with 27 or 28
MCR-60-001-1	% of claim headers that have an invalid Billing Provider Taxonomy
MCR-61-001-1	% of claim headers that have an invalid Billing Provider Taxonomy
MCR-62-001-1	% of claim headers where BILLING-PROV-TAXONOMY does not begin with 27 or 28
MIS-2-009_1-59	% missing: BILLING-PROV-TAXONOMY (CIP00002)
MIS-21-009-9	% missing: BILLING-PROV-TAXONOMY (CIP00002)
MIS-79-009-9	% missing: BILLING-PROV-TAXONOMY (CIP00002)
RULE-7916	% of claim headers that have an invalid Billing Provider Taxonomy
RULE-7917	% of claim headers that have an invalid Billing Provider Taxonomy

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT132	CLT.002.132	BILLING-PROV-TAXONOMY	CLT00002	CLAIM-HEADER-RECORD-LT
COT114	COT.002.114	BILLING-PROV-TAXONOMY	COT00002	CLAIM-HEADER-RECORD-OT
CRX072	CRX.002.072	BILLING-PROV-TAXONOMY	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After