CRX.002.102

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

DISPENSING-PRESCRIPTION-DRUG-PROV-NPI

Data Element

DE Number

CRX102

System DE Number

CRX.002.102

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 responsible for dispensing the prescription drug.
Size	X(10)
FLF Start Position	788
FLF Stop Position	797
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. When Type of Claim not in [3,C,W] then value must match Provider Identifier (PRV.005.081) 4. Mandatory 5. Value must exist in the NPPES NPI data file 6. 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-1891	If the dispensing provider NPI number is populated on a non-denied claim from an RX file, then the dispensing provider NPI number value reported must be a valid NPI number.
RULE-1893	If a claim is a non-denied claim from an RX file that is not an encounter claim and the dispensing prescription provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.
RULE-6940	If a claim is a non-denied claim from an RX file, then the dispensing prescription drug provider NPI number value reported must be compatible with specified T-MSIS picture format: X(10).
RULE-7312
RULE-7497	If a claim is a non-denied, non-void claim from an RX file and the dispensing prescription drug provider NPI is populated then claim header dispensing prescription drug provider NPI exists in the NPPES NPI data file.
RULE-7761	If a claim is a non-denied claim from an RX 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 the claim dispensing prescription drug provider NPI number must be populated.
RULE-7819	If a claim is a non-denied claim from an RX 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 the claim dispensing prescription drug provider NPI number must be populated.

Measure ID	Measure Name
MIS-8-012-12	% missing: DISPENSING-PRESCRIPTION-DRUG-PROV-NPI (CRX00002)
MIS-27-011-11	% missing: DISPENSING-PRESCRIPTION-DRUG-PROV-NPI (CRX00002)
MIS-85-011-11	% missing: DISPENSING-PRESCRIPTION-DRUG-PROV-NPI (CRX00002)
FFS-20-009-7	RX - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per dispensing NPI
FFS-21-003-3	RX - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per dispensing NPI
MCR-23-010-10	RX - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per dispensing NPI
MCR-26-009-9	RX - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per dispensing NPI

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.002.102	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. Nppes Entity Type Code associate with this NPI must equal ‘1’ (Individual)	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to "2"3. When Type of Claim not in [3,C,W] then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. Nppes Entity Type Code associate with this NPI must equal "1" (Individual)
08/28/2023	3.12.0	CRX.002.102	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. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)4. Mandatory	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. When Type of Claim not in ('3','C','W') then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. Nppes Entity Type Code associate with this NPI must equal ‘1’ (Individual)
06/24/2022	3.0.0	DISPENSING-PRESCRIPTION-DRUG-PROV-NPI	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CRX102\|DISPENSING-PRESCRIPTION-DRUG-PROV-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\| \|CRX102\|DISPENSING-PRESCRIPTION-DRUG-PROV-NPI\|The National Provider ID (NPI) of the provider responsible for dispensing the prescription drug.\|