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TMSIS Dataguide Medicaid.gov
Version 3.38.0

BILLING-PROV-NPI-NUM

Data Element

DE Number

CLT131

System DE Number

CLT.002.131

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00002

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

09/12/2024

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 805
FLF Stop Position 814
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 10 digits
2. Value must have an associated Provider Identifier Type (PRV.005.007) 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. When Type of Claim not in [3,C,W], then value must match Provider Identifier (PRV.002.081)
8. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)