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TMSIS Dataguide Medicaid.gov
Version 3.28.0

RULE-1126

Data Quality Measure
Last updated

Key Information

Measure Name % of claim headers with a Billing Provider Number that is not found on the provider file during the dates of service
File Type Multiple Files
Measure ID RULE-1126
Measure Type Claims percentage
Content area ALL MULTI PRO

Validation

Validation Type Inferential

Measure Priority

Measure Priority Medium
Focus Area N/A
Category Provider information

Claim Information

Claim Type Medicaid,FFS or Medicaid,Cap or Medicaid,Enc or Medicaid,Serv or Medicaid,Supp or CHIP,FFS or CHIP,Cap or CHIP,Enc or CHIP,Serv or CHIP,Supp
Adjustment Type All Adjustment Types
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.02
TA Minimun 0
TA Maximum 0.02
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element BILLING-PROV-NUM • SUBMITTING-STATE-PROV-ID • PROV-IDENTIFIER • BEGINNING-DATE-OF-SERVICE • ENDING-DATE-OF-SERVICE
DD Data Element Number CLT130 • PRV019 • PRV081 • CLT048 • CLT049

Annotation N/A
Specification RULE-1126