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TMSIS Dataguide Medicaid.gov
Version 3.28.0

BILLING-PROV-NPI-NUM

Data Element

DE Number

COT113

System DE Number

COT.002.113

File Name

COT - CLAIM OTHER

File Segment Number

COT00002

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

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.

For sub-capitation payments, report the national provider identifier (NPI) for the sub-capitated entity if the provider has one.
Size X(10)
FLF Start Position 727
FLF Stop Position 736
Segment Key Field Identifier Not Applicable
Coding Requirements

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
4. When Type of Claim (COT.002.037) not in ('3','C','W') then value must match Provider Identifier (PRV.002.081)
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP180 CIP.002.180 BILLING-PROV-NPI-NUM CIP00002 CLAIM-HEADER-RECORD-IP
CLT131 CLT.002.131 BILLING-PROV-NPI-NUM CLT00002 CLAIM-HEADER-RECORD-LT
CRX071 CRX.002.071 BILLING-PROV-NPI-NUM CRX00002 CLAIM-HEADER-RECORD-RX