CLT.003.212

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

SERVICING-PROV-NUM

Data Element

DE Number

CLT212

System DE Number

CLT.003.212

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-LT

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	290
FLF Stop Position	319
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

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

RULE ID	RULE Definition
RULE-1246	If the servicing provider number is populated on a non-denied claim from the LT 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.
RULE-6204	If a claim line is a non-denied claim line from an LT file, then the servicing provider number value reported must be compatible with specified T-MSIS picture format: X(30).

Measure ID	Measure Name
ALL-21-006-6	% 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-4-002-2	% of billing and servicing provider numbers on claims that are not found in the provider file
MIS-5-016-16	% missing: SERVICING-PROV-NUM (CLT00003)
RULE-1246	% of claim headers with a Servicing Provider Number that is not found on the provider file during the dates of service
MIS-24-015-15	% missing: SERVICING-PROV-NUM (CLT00003)
MIS-82-014-14	% missing: SERVICING-PROV-NUM (CLT00003)
RULE-7444	% of claim lines that have a SERVICING-PROV-NUM 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
RULE-7926	% of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
RULE-7934	% of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP260	CIP.003.260	SERVICING-PROV-NUM	CIP00003	CLAIM-LINE-RECORD-IP
COT189	COT.003.189	SERVICING-PROV-NUM	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CLT.003.212	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 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)	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
09/21/2023	3.13.0	CLT.003.212	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)