An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1134

Validation Rule
Last updated

No Updates

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type One Record Type (Single Record)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.REFERRING-PROV-NPI-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for REFERRING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-LT.REFERRING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
Rule Definition If the referring provider NPI number is populated on a non-denied claim from an LT file, then the referring provider NPI number reported must be found in the list of valid values.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-LT.REFERRING-PROV-NPI-NUM has a valid, non-null value