COT.002.146

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

HEALTH-HOME-PROVIDER-NPI

Data Element

DE Number

COT146

System DE Number

COT.002.146

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 National Provider ID (NPI) of the health home provider.
Size	X(10)
FLF Start Position	1002
FLF Stop Position	1011
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 Service (COT.003.186) equals '121', value must not be populated 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-1588	If the health home provider NPI is populated on a non-denied claim from an OT file, then the health home provider NPI reported must be found in the list of valid values.
RULE-1589	If a claim is a non-denied claim from an OT file, then the health home provider NPI value reported must be compatible with specified T-MSIS picture format: X(10).
RULE-1590	If the type of service is for a premium payment on a non-denied claim line from an OT file, then the health home provider NPI value must not be populated.
RULE-1591	If a claim is a non-denied claim from an OT file that is not an encounter claim and the home health provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.
RULE-7492	If a claim is a non-denied, non-void claim from an OT file and the health home provider NPI is populated then claim header health home provider NPI exists in the NPPES NPI data file.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP221	CIP.002.221	HEALTH-HOME-PROVIDER-NPI	CIP00002	CLAIM-HEADER-RECORD-IP
CLT167	CLT.002.167	HEALTH-HOME-PROVIDER-NPI	CLT00002	CLAIM-HEADER-RECORD-LT
CRX104	CRX.002.104	HEALTH-HOME-PROVIDER-NPI	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	COT.002.146	UPDATE	Coding requirement	Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Service (COT.003.186) equals '121', value must not be populated5. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Service (COT.003.186) equals '121', value must not be populated5. Value must exist in the NPPES NPI data file
08/28/2023	3.12.0	COT.002.146	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 Service (COT.003.186) equals '121', value must not be populated	Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Conditional4. When Type of Service (COT.003.186) equals '121', value must not be populated5. Value must exist in the NPPES NPI data file
06/24/2022	3.0.0	HEALTH-HOME-PROVIDER-NPI	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP221\|HEALTH-HOME-PROVIDER-NPI\|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).\| \|CLT167\|HEALTH-HOME-PROVIDER-NPI\|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).\| \|COT146\|HEALTH-HOME-PROVIDER-NPI\|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).\| \|CRX104\|HEALTH-HOME-PROVIDER-NPI\|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\| \|CIP221\|HEALTH-HOME-PROVIDER-NPI\|The National Provider ID (NPI) of the health home provider.\| \|CLT167\|HEALTH-HOME-PROVIDER-NPI\|The National Provider ID (NPI) of the health home provider.\| \|COT146\|HEALTH-HOME-PROVIDER-NPI\|The National Provider ID (NPI) of the health home provider.\| \|CRX104\|HEALTH-HOME-PROVIDER-NPI\|The National Provider ID (NPI) of the health home provider.\|