CLT.002.136

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

REFERRING-PROV-NPI-NUM

Data Element

DE Number

CLT136

System DE Number

CLT.002.136

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-LT

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	861
FLF Stop Position	870
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-1134	If the referring provider NPI number is populated on a non-denied claim from an LT file, then the referring provider NPI number reported must be found in the list of valid values.
RULE-1135	If a claim is a non-denied claim from an LT file, then the referring provider NPI number value reported must be compatible with specified T-MSIS picture format: X(10).
RULE-7485	If a claim is a non-denied, non-void claim from an LT 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-4-034_1-48	% missing: REFERRING-PROV-NPI-NUM (CLT00002)
MIS-23-037-37	% missing: REFERRING-PROV-NPI-NUM (CLT00002)
MIS-81-037-37	% missing: REFERRING-PROV-NPI-NUM (CLT00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP190	CIP.002.190	REFERRING-PROV-NPI-NUM	CIP00002	CLAIM-HEADER-RECORD-IP
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	CLT.002.136	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	CLT.002.136	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.\|