RULE-7924
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If the billing provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the prescription fill date.
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RULE-7936
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If the dispensing prescription drug provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the claim dispensing prescription drug provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the prescription fill date is within effective and end dates of the provider medicaid enrollment segment on the pharmacy claim.
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RULE-7935
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If the servicing provider number is populated on a non-denied claim from an OT file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the effective and end dates of the provider medicaid enrollment segment overlap with the beginning date of service and (if populated) ending date of service on the claim line.
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RULE-7934
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If the servicing provider number is populated on a non-denied claim from an LT file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the effective and end dates of the provider medicaid enrollment segment overlap with the beginning date of service and (if populated) ending date of service on the claim line.
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RULE-7933
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If the servicing provider number is populated on a non-denied claim from an IP file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the effective and end dates of the provider medicaid enrollment segment overlap with the beginning date of service and (if populated) ending date of service on the claim line.
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RULE-7932
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If the billing provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the prescription fill date.
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RULE-7931
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If the billing provider number is populated on a non-denied claim from an OT file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7930
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If the billing provider number is populated on a non-denied claim from an LT file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7929
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If the billing provider number is populated on a non-denied claim from an IP file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the admission date.
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RULE-7928
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If the dispensing prescription drug provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the claim dispensing prescription drug provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the prescription fill date is within effective and end dates of the provider medicaid enrollment segment on the pharmacy claim.
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RULE-7927
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If the servicing provider number is populated on a non-denied claim from an OT file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the effective and end dates of the provider medicaid enrollment segment overlap with the beginning date of service and (if populated) ending date of service on the claim line.
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RULE-7926
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If the servicing provider number is populated on a non-denied claim from an LT file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the effective and end dates of the provider medicaid enrollment segment overlap with the beginning date of service and (if populated) ending date of service on the claim line.
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RULE-7925
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If the servicing provider number is populated on a non-denied claim from an IP file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the effective and end dates of the provider medicaid enrollment segment overlap with the beginning date of service and (if populated) ending date of service on the claim line.
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RULE-2956
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If the provider medicaid enrollment status code is populated on a provider medicaid enrollment file, then the provider medicaid enrollment status code reported must be found in the list of valid values.
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RULE-7923
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If the billing provider number is populated on a non-denied claim from an OT file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7922
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If the billing provider number is populated on a non-denied claim from an LT file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7921
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If the billing provider number is populated on a non-denied claim from an IP file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the admission date.
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RULE-7446
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If the dispensing prescription drug provider number is populated on a non-denied claim from an RX file and the claim is an Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the claim dispensing prescription drug provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the prescription fill date.
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RULE-7445
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If the servicing provider number is populated on a non-denied claim from an OT file and the claim is an Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7444
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If the servicing provider number is populated on a non-denied claim from an LT file and the claim is an Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7443
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If the servicing provider number is populated on a non-denied claim from an IP file and the claim is an Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the claim line servicing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7442
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If the billing provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the prescription fill date.
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RULE-7441
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If the billing provider number is populated on a non-denied claim from an OT file and the claim is a Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7440
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If the billing provider number is populated on a non-denied claim from an LT file and the claim is a Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the beginning date of service.
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RULE-7439
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If the billing provider number is populated on a non-denied claim from an IP file and the claim is a Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the billing provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the admission date.
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RULE-6557
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If a segment is a provider medicaid enrollment segment, then the provider medicaid enrollment status code value reported must be compatible with the specified T-MSIS picture format: X(2).
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