CIP.003.260

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

SERVICING-PROV-NUM

Data Element

DE Number

CIP260

System DE Number

CIP.003.260

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A unique number to identify the provider who treated the recipient. The Servicing Provider Number should be for the individual doctor who rendered the service. If "Servicing" provider and the "Billing" provider such as a sole-practitioner are the same then use the same number in both fields. The value is conditional as its usage varies by state.
Size	X(30)
FLF Start Position	264
FLF Stop Position	293
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 30 characters or less 2. Conditional 3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or 4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID 5. When Type of Claim in ['1','3','A','C’] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)

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

RULE ID	RULE Definition
RULE-6364	If a claim line is a non-denied claim line from an IP file, then the servicing provider number value reported must be compatible with specified T-MSIS picture format: X(30).
RULE-810	If the servicing provider number is populated on a non-denied claim from the IP file, then either the servicing provider number value reported must be equal to a provider identifier value reported with a provider identifier type value for state-assigned Medicaid provider identifiers on a provider identifiers segment from a PRV file where the effective and end dates of the provider identifiers segment overlap with the beginning date of service and (if populated) ending date of service on the claim line OR the servicing provider number value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the beginning date of service and (if populated) ending date of service on the claim line.

Measure ID	Measure Name
ALL-21-005-5	% of SERVICING-PROV-NUM on claim lines that do not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Beginning Date of Service
ALL-4-001-1	% of billing and servicing provider numbers on claims that are not found in the provider file
MIS-3-014-14	% missing: SERVICING-PROV-NUM (CIP00003)
RULE-810	% of claim headers with a Servicing Provider Number that is not found on the provider file during the dates of service
MIS-22-015-15	% missing: SERVICING-PROV-NUM (CIP00003)
MIS-80-014-14	% missing: SERVICING-PROV-NUM (CIP00003)
RULE-7443	% of claim lines with a of SERVICING-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Beginning Date of Service

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT212	CLT.003.212	SERVICING-PROV-NUM	CLT00003	CLAIM-LINE-RECORD-LT
COT189	COT.003.189	SERVICING-PROV-NUM	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
11/02/2023	3.16.0	CIP.003.260	UPDATE	Coding requirement	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID	1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider Identifier or4. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider ID5. When Type of Claim in ['1','3','A','C’] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in ['01', '02', '03', '04', '05', '06'] (active)