CIP.003.265

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

OPERATING-PROV-NPI-NUM

Data Element

DE Number

CIP265

System DE Number

CIP.003.265

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	The National Provider ID (NPI) of the provider who performed the surgical procedures on the beneficiary.
Size	X(10)
FLF Start Position	308
FLF Stop Position	317
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. Conditional 4. Value must exist in the NPPES NPI data file

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

RULE ID	RULE Definition
RULE-6112	If a claim is a non-denied claim from an IP file, then the operating provider NPI number value reported must be compatible with specified T-MSIS picture format: X(10)
RULE-7479	If a claim is a non-denied, non-void claim from an IP file and the operating provider NPI num is populated then claim line operating provider NPI num exists in the NPPES NPI data file.
RULE-817	If the operating provider NPI number is populated on a non-denied IP claim line, then the operating provider NPI number reported must be found in the list of valid values.

Measure ID	Measure Name
MIS-3-009_1-19	% missing: OPERATING-PROV-NPI-NUM (CIP00003)
MIS-22-009-9	% missing: OPERATING-PROV-NPI-NUM (CIP00003)
MIS-80-008-8	% missing: OPERATING-PROV-NPI-NUM (CIP00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
11/02/2023	3.16.0	CIP.003.265	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. Conditional4. Value must exist in the NPPES NPI data file
06/24/2022	3.0.0	OPERATING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP265\|OPERATING-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\| \|CIP265\|OPERATING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who performed the surgical procedures on the beneficiary.\|