CRX.002.075

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

PRESCRIBING-PROV-NPI-NUM

Data Element

DE Number

CRX075

System DE Number

CRX.002.075

File Name

CRX - CLAIM PHARMACY

File Segment Number

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 provider who prescribed a medication to a patient.
Size	X(10)
FLF Start Position	561
FLF Stop Position	570
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. Mandatory 4. Value must exist in the NPPES NPI data file 5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)

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

RULE ID	RULE Definition
RULE-1852	If the prescribing provider NPI number is populated on a non-denied claim from an RX file, then the prescribing provider NPI number reported must be found in the list of valid values.
RULE-7081	If a claim line is a non-denied claim line from an RX file, then the prescribing provider NPI number value reported must be compatible with specified T-MSIS picture format: X(10).
RULE-7496	If a claim is a non-denied, non-void claim from an RX file and the prescribing provider NPI num is populated then claim header prescribing provider NPI num exists in the NPPES NPI data file.
RULE-7511	If a claim is a non-denied, non-void claim from an RX file and the prescribing provider NPI is populated and is a valid NPI in the NPPES file, then the 'entity type code' is equal to '1' (individual) in the NPPES NPI data file.

Measure ID	Measure Name
MIS-8-021-21	% missing: PRESCRIBING-PROV-NPI-NUM (CRX00002)
MIS-27-021-21	% missing: PRESCRIBING-PROV-NPI-NUM (CRX00002)
MIS-85-021-21	% missing: PRESCRIBING-PROV-NPI-NUM (CRX00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
11/02/2023	3.16.0	CRX.002.075	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. Mandatory	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to '2'3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)
06/24/2022	3.0.0	PRESCRIBING-PROV-NPI-NUM	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CRX075\|PRESCRIBING-PROV-NPI-NUM\|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\| \|CRX075\|PRESCRIBING-PROV-NPI-NUM\|The National Provider ID (NPI) of the provider who prescribed a medication to a patient.\|