COT.002.114

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

BILLING-PROV-TAXONOMY

Data Element

DE Number

COT114

System DE Number

COT.002.114

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The taxonomy code for the provider billing for the service.
Size	X(12)
FLF Start Position	737
FLF Stop Position	748
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 4. If Type of Service (COT.003.186) is in [119,120,121,122], then value should not be populated

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

RULE ID	RULE Definition
RULE-1545	If the billing provider taxonomy is populated on a non-denied claim from an OT file, then the billing provider taxonomy value reported must be in the list of valid values for provider taxonomy.
RULE-1546	If the type of service is for a capitation payment to a HMO, HIO, PACE, PCCM, or PHP plan or for a premium payment on a non-denied claim line from an OT file, then the BILLING-PROV-TAXONOMY value must not be populated.
RULE-7080	If a claim is a non-denied claim from an OT file, then the billing provider taxonomy value reported must be compatible with specified T-MSIS picture format: X(12).
RULE-7914	If the billing provider taxonomy is populated on a non-denied claim from an OT 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-7919	If the type of claim is a fee for service and billing provider taxonomy is populated on a claim header from an OT 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-50-003-3	% of claim headers that have an invalid Billing Provider Taxonomy
FFS-51-003-3	% of claim headers that have an invalid Billing Provider Taxonomy
MCR-60-003-3	% of claim headers that have an invalid Billing Provider Taxonomy
MCR-61-003-3	% of claim headers that have an invalid Billing Provider Taxonomy
MIS-6-008_1-38	% missing: BILLING-PROV-TAXONOMY (COT00002)
MIS-25-006-6	% missing: BILLING-PROV-TAXONOMY (COT00002)
MIS-83-006-6	% missing: BILLING-PROV-TAXONOMY (COT00002)
RULE-7914	% of claim headers that have an invalid Billing Provider Taxonomy
RULE-7919	% 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
CLT132	CLT.002.132	BILLING-PROV-TAXONOMY	CLT00002	CLAIM-HEADER-RECORD-LT
CRX072	CRX.002.072	BILLING-PROV-TAXONOMY	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	COT.002.114	UPDATE	Coding requirement	1. Value must be in Provider Taxonomy List (VVL)2. Value must be 12 characters or less3. Conditional4. Value is in [119, 120, 121, 122 ], then value should not be populated	1. Value must be in Provider Taxonomy List (VVL)2. Value must be 12 characters or less3. Conditional4. If Type of Service (COT.003.186) is in [119,120,121,122], then value should not be populated