CLT.003.213

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

SERVICING-PROV-NPI-NUM

Data Element

DE Number

CLT213

System DE Number

CLT.003.213

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	The NPI of the health care professional who delivers or completes a particular medical service or non-surgical procedure. The Servicing Provider NPI Number is required when rendering provider is different than the attending provider and state or federal regulatory requirements call for a "combined claim" (i.e., a claim that includes both facility and professional components). Examples are Medicaid clinic bills or critical access hospital claims.
Size	X(10)
FLF Start Position	320
FLF Stop Position	329
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. When Type of Claim (CLT.002.052) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081) 5. 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-1247	If a claim line is a non-denied claim line from an LT file, then the servicing provider NPI number value reported must be compatible with specified T-MSIS picture format: X(10).
RULE-1248	If the servicing provider NPI number is populated on a non-denied claim line from an LT file, then the servicing provider NPI number value reported must be a valid NPI number.
RULE-7310
RULE-7483	If a claim is a non-denied, non-void claim from an LT file and the servicing provider NPI num is populated then claim line servicing provider NPI num exists in the NPPES NPI data file.
RULE-7765	If a claim is a non-denied claim from an LT file, and is a Medicaid or Medicaid-expansion CHIP Encounter or Separate CHIP Encounter claim and is an original claim or a replacement/resubmission claim payment then the claim line servicing provider NPI number must be populated.
RULE-7829	If a claim is a non-denied claim from an LT file, and is a Medicaid or Medicaid-expansion CHIP Fee-for-service or Separate CHIP Fee-for-service claim and is an original claim or a replacement/resubmission claim payment then the claim line servicing provider NPI number must be populated.

Measure ID	Measure Name
MIS-5-015-15	% missing: SERVICING-PROV-NPI-NUM (CLT00003)
MIS-24-014-14	% missing: SERVICING-PROV-NPI-NUM (CLT00003)
MIS-82-013-13	% missing: SERVICING-PROV-NPI-NUM (CLT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP261	CIP.003.261	SERVICING-PROV-NPI-NUM	CIP00003	CLAIM-LINE-RECORD-IP
COT190	COT.003.190	SERVICING-PROV-NPI-NUM	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
11/02/2023	3.16.0	CLT.003.213	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. Conditional4. When Type of Claim (CLT.002.052) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Claim (CLT.002.052) not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file
06/24/2022	3.0.0	SERVICING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CLT213\|SERVICING-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).\| \|COT190\|SERVICING-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\| \|CLT213\|SERVICING-PROV-NPI-NUM\|The NPI of the health care professional who delivers or completes a particular medical service or non-surgical procedure. The Servicing Provider NPI Number is required when rendering provider is different than the attending provider and state or federal regulatory requirements call for a "combined claim" (i.e., a claim that includes both facility and professional components). Examples are Medicaid clinic bills or critical access hospital claims.\| \|COT190\|SERVICING-PROV-NPI-NUM\|The NPI of the health care professional who delivers or completes a particular medical service or non-surgical procedure. The Servicing Provider NPI Number is required when rendering provider is different than the attending provider and state or federal regulatory requirements call for a "combined claim" (i.e., a claim that includes both facility and professional components). Examples are Medicaid clinic bills or critical access hospital claims.\|