COT.003.189

SERVICING-PROV-NUM

Data Element

DE Number

COT189

System DE Number

COT.003.189

File Name

COT - CLAIM OTHER

File Segment Number

COT00003

File Segment Name

CLAIM-LINE-RECORD-OT

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	331
FLF Stop Position	360
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 5. 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)

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

RULE ID	RULE Definition
RULE-1662	If the type of service is for a HMO, HIO, PACE, PCCM, or PHP capitation payment or a premium payment on a non-denied claim line from an OT file, then the servicing provider number value must not be populated.
RULE-1663	If the servicing provider number is populated on a non-denied, non-capitated claim from the OT 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-7123	If a claim line is a non-denied claim line from an OT file, then the servicing provider number value reported must be compatible with specified T-MSIS picture format: X(30).
RULE-7311	If a claim is a non-denied claim from an OT file, and is a Medicaid or Medicaid-expansion FFS, Medicaid or Medicaid-expansion CHIP Encounter, Separate CHIP FFS or Separate CHIP Encounter claim and is an original claim or a replacement/resubmission claim payment then either the claim line servicing provider NPI number or the servicing provider number must be populated.
RULE-7767	If a claim is a non-denied claim from an OT 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 either the claim line servicing provider NPI number or the servicing provider number must be populated.
RULE-7825	If a claim is a non-denied claim from an OT 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 either the claim line servicing provider NPI number or the servicing provider number must be populated.

Measure ID	Measure Name
MCR-21-003-2	% of claim lines with TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 where Servicing Provider Number = Billing Provider Number
RULE-7445	% of claim lines that have a SERVICING-PROV-NUM that 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
MIS-84-026-26	% missing: SERVICING-PROV-NUM (COT00003)
MIS-26-027-27	% missing: SERVICING-PROV-NUM (COT00003)
RULE-1663	% of claim headers with a Servicing Provider Number that is not found on the provider file during the dates of service
MIS-7-027-27	% missing: SERVICING-PROV-NUM (COT00003)
MCR-25-002-1	% of claim lines with TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 where Servicing Provider Number = Billing Provider Number
MCR-25-001-2	% of claim lines with Servicing Provider Num
MCR-24-003-2	% of claim lines with TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 where Servicing Provider Number = Billing Provider Number
MCR-24-002-4	% of claim lines with Servicing Provider Num
MCR-22-002-1	% of claim lines with TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 where Servicing Provider Number = Billing Provider Number
MCR-22-001-2	% of claim lines with Servicing Provider Num
ALL-21-007-7	% 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
MCR-21-002-4	% of claim lines with Servicing Provider Num
FFS-23-002-1	% of claim lines with TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 where Servicing Provider Number = Billing Provider Number
FFS-23-001-2	% of claim lines with Servicing Provider Num
FFS-22-002-2	% of claim lines with TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 where Servicing Provider Number = Billing Provider Number
FFS-22-001-3	% of claim lines with Servicing Provider Num
FFS-19-002-1	% of claim lines with TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 where Servicing Provider Number = Billing Provider Number
FFS-19-001-2	% of claim lines with Servicing Provider Num
FFS-18-002-2	% of claim lines with TYPE-OF-SERVICE = 12, 29, 15, 2, 61, 28, 41 where Servicing Provider Number = Billing Provider Number
FFS-18-001-3	% of claim lines with Servicing Provider Num
ALL-4-003-3	% of billing and servicing provider numbers on claims that are not found in the provider file

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
CLT212	CLT.003.212	SERVICING-PROV-NUM	CLT00003	CLAIM-LINE-RECORD-LT