PRV-2-009-9

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

PRV-2-009-9

Data Quality Measure

Last updated

Key Information

Measure Name	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 2 (NPI) that don't have any PROV-CLASSIFICATION-TYPE = 1 (taxonomy)
File Type	PRV
Measure ID	PRV-2-009-9
Measure Type	Non-Claims Percentage
Content area	PRO

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Provider characteristics

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

Minimum	0
Maximum	0.05
TA Minimun	0
TA Maximum	0.05
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	SUBMITTING-STATE-PROV-ID • PROV-IDENTIFIER-TYPE • PROV-CLASSIFICATION-TYPE
DD Data Element Number	PRV075 • PRV077 • PRV088

Annotation

Calculate the percent of submitting state provider IDs that have an NPI, but not a taxonomy code

Specification

STEP 1: Provider enrolled on the last day of DQ report month

Define the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:

1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month

2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing

3. SUBMITTING-STATE-PROV-ID is not missing

STEP 2: Provider identifier is active on the last day of DQ report month

Of the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:

1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month

2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missing

OR

1b. PROV-IDENTIFIER-EFF-DATE is missing

2b. PROV-IDENTIFIER-END-DATE is missing

STEP 3: Provider classification type is "NPI"

Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria:

1. PROV-IDENTIFIER-TYPE = 2

STEP 4: Provider taxonomy is active on the last day of DQ report month

Of the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:

1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month

2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missing

OR

1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing

2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missing

STEP 5: Provider classification is taxonomy

Of the providers that meet the criteria from STEP 4, keep records that satisfy the following criteria:

1. PROV-CLASSIFICATION-TYPE is = 1

STEP 6: Calculate percent that have a taxonomy

Divide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 by the count from STEP 3

STEP 7: Calculate percent that do not have any taxonomy codes

Subtract the percent from STEP 6 from 1

Published Date	Data Guide Version	DQM	Action	Field	Before	After
04/21/2023	3.6.0	PRV-2-009-9	UPDATE	Annotation	Calculate the percent of submitting-state-provider-IDs that have an NPI, but not a taxonomy code	Calculate the percent of submitting state provider IDs that have an NPI, but not a taxonomy code
04/21/2023	3.6.0	PRV-2-009-9	UPDATE	Specification	STEP 1: Provider enrolled on the last of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider classification is taxonomyOf the providers that meet the criteria from STEP 4, keep records that satisfy the following criteria: 1. PROV-CLASSIFICATION-TYPE is = 1STEP 6: Calculate percent that have a taxonomyDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 by the count from STEP 3STEP 7: Calculate percent that do not have any taxonomy codesSubtract the percent from STEP 6 from 1	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Provider taxonomy is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 3, further refine the population using segment PROVIDER-TAXONOMY-CLASSIFICATION-PRV00006 by keeping records that satisfy the following criteria:1a. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE <= last day of the reporting month2a. PROV-TAXONOMY-CLASSIFICATION-END-DATE >= last day of the reporting month OR missingOR1b. PROV-TAXONOMY-CLASSIFICATION-EFF-DATE is missing2b. PROV-TAXONOMY-CLASSIFICATION-END-DATE is missingSTEP 5: Provider classification is taxonomyOf the providers that meet the criteria from STEP 4, keep records that satisfy the following criteria: 1. PROV-CLASSIFICATION-TYPE is = 1STEP 6: Calculate percent that have a taxonomyDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 5 by the count from STEP 3STEP 7: Calculate percent that do not have any taxonomy codesSubtract the percent from STEP 6 from 1