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TMSIS Dataguide Medicaid.gov
Version 3.27.0

BILLING-PROV-NPI-NUM

Data Element

DE Number

CRX071

System DE Number

CRX.002.071

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00002

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition

The National Provider ID (NPI) of the billing provider responsible for billing for the service on the claim. The billing provider can also be servicing, referring, or prescribing provider; can be admitting provider except for Long Term Care.
Size X(10)
FLF Start Position 507
FLF Stop Position 516
Segment Key Field Identifier Not Applicable
Coding Requirements

1. Value must be 10 digits
2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'
3. Value must exist in the NPPES NPI data file
4. Conditional
5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal '01'
6. When Type of Claim is in ['1','3','A','C'], then value must be populated
7. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.002.081)
8. NPPES Entity Type Code associated with this NPI must equal ‘2’ (Organization)
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
COT113 COT.002.113 BILLING-PROV-NPI-NUM COT00002 CLAIM-HEADER-RECORD-OT