CLT.002.132

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

BILLING-PROV-TAXONOMY

Data Element

DE Number

CLT132

System DE Number

CLT.002.132

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-LT

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	815
FLF Stop Position	826
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-1130	If the billing provider taxonomy field is populated on a non-denied claim from an LT file, then the billing provider taxonomy value reported must be in the list of valid values for provider taxonomy.
RULE-6464	If a claim is a non-denied claim from an LT file, then the billing provider taxonomy value reported must be compatible with specified T-MSIS picture format: X(12).
RULE-7913	If the billing provider taxonomy is populated on a non-denied claim from an LT 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-7918	If the type of claim is a fee for service and billing provider taxonomy is populated on a claim header from an LT 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-50-002-2	% of claim headers that have an invalid Billing Provider Taxonomy
FFS-51-002-2	% of claim headers that have an invalid Billing Provider Taxonomy
FFS-52-002-2	% of claim headers where BILLING-PROV-TAXONOMY does not begin with 283Q, 283X, 282E, 31, 32, 385H, or 281P
MCR-60-002-2	% of claim headers that have an invalid Billing Provider Taxonomy
MCR-61-002-2	% of claim headers that have an invalid Billing Provider Taxonomy
MCR-62-002-2	% of claim headers where BILLING-PROV-TAXONOMY does not begin with 283Q, 283X, 282E, 31, 32, 385H, or 281P
MIS-4-008_1-46	% missing: BILLING-PROV-TAXONOMY (CLT00002)
MIS-23-008-8	% missing: BILLING-PROV-TAXONOMY (CLT00002)
MIS-81-008-8	% missing: BILLING-PROV-TAXONOMY (CLT00002)
RULE-7913	% of claim headers that have an invalid Billing Provider Taxonomy
RULE-7918	% of claim headers that have an invalid Billing Provider Taxonomy

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP181	CIP.002.181	BILLING-PROV-TAXONOMY	CIP00002	CLAIM-HEADER-RECORD-IP
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