CIP.002.190

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

REFERRING-PROV-NPI-NUM

Data Element

DE Number

CIP190

System DE Number

CIP.002.190

File Name

CIP - CLAIM INPATIENT

File Segment Number

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 provider who recommended the servicing provider to the patient.
Size	X(10)
FLF Start Position	1114
FLF Stop Position	1123
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

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

RULE ID	RULE Definition
RULE-6916	If a claim is a non-denied claim from an IP file, then the referring provider NPI number value reported must be compatible with specified T-MSIS picture format: X(10).
RULE-703	If the referring provider NPI number is populated on a non-denied claim from an IP file, then the referring provider NPI number value reported must be in the list of valid values.
RULE-7477	If a claim is a non-denied, non-void claim from an IP file and the referring provider NPI num is populated then claim header referring provider NPI num exists in the NPPES NPI data file.

Measure ID	Measure Name
MIS-2-047_1-62	% missing: REFERRING-PROV-NPI-NUM (CIP00002)
MIS-21-050-50	% missing: REFERRING-PROV-NPI-NUM (CIP00002)
MIS-79-050-50	% missing: REFERRING-PROV-NPI-NUM (CIP00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT136	CLT.002.136	REFERRING-PROV-NPI-NUM	CLT00002	CLAIM-HEADER-RECORD-LT
COT118	COT.002.118	REFERRING-PROV-NPI-NUM	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CIP.002.190	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional
08/28/2023	3.12.0	CIP.002.190	UPDATE	Coding requirement	1. Value must be 10 digits, consisting of 9 numeric digits followed by one check digit calculated using the Luhn formula (algorithm)2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Value must exist in the NPPES NPI data file4. Conditional
06/24/2022	3.0.0	REFERRING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP190\|REFERRING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\| \|CLT136\|REFERRING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\| \|COT118\|REFERRING-PROV-NPI-NUM\|A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by CMS. Healthcare providers acquire their unique 10-digit NPIs to identify themselves in a standard way throughout their industry. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number).\|	\|DE No\|Data Element Name\|Definition\| \|CIP190\|REFERRING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient.\| \|CLT136\|REFERRING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient.\| \|COT118\|REFERRING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient.\|