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TMSIS Dataguide Medicaid.gov
Version 3.27.0

PRV-2-011-11

Data Quality Measure
Last updated

Key Information

Measure Name % of providers that require NPI (non-atypical) that are missing NPI (PROV-IDENTIFIER-TYPE=2)
File Type PRV
Measure ID PRV-2-011-11
Measure Type Non-Claims Percentage
Content area PRO

Validation

Validation Type Inferential

Measure Priority

Measure Priority Medium
Focus Area N/A
Category Provider classification

Claim Information

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

Thresholds

Minimum 0
Maximum 0.1
TA Minimun 0
TA Maximum 0.1
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element PROV-CLASSIFICATION-TYPE • PROV-CLASSIFICATION-CODE • PROV-IDENTIFIER-TYPE • PROV-IDENTIFIER
DD Data Element Number PRV088 • PRV089 • PRV077 • PRV081

Annotation Calculate the percent of providers that require NPI (are not atypical) and are missing NPI
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 taxonomy 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 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 3: Provider Classification Lookup Designation indicates NPI is required (non-atypical providers)

Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population by keeping records that meet the following criteria:

1. PROV-CLASSIFICATION-TYPE and PROVIDER-CLASSIFICATION-CODE match values in Atypical Provider Lookup table

2. 'NPI Required' is "YES"



STEP 4: Provider identifier 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 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 5: NPI is present

Of the records that meet the criteria from STEP 4, restrict to segments that meet the following criteria:

1. PROV-IDENTIFIER-TYPE = 2

2. SUBMITTING-STATE-PROV-ID is not NULL



STEP 6: NPI is not present

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



STEP 7: Calculate percent that do not have an NPI

Divide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 6 by the count from STEP 3