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TMSIS Dataguide Medicaid.gov
Version 3.27.0

RULE-1248

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type Two Record Type (1 to 1)
File Segment Number CLT00002
Data Element Name CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
Rule Definition If the servicing provider NPI number is populated on a non-denied claim line from an LT file, then the servicing provider NPI number value reported must be a valid NPI number.
Denominator Logic # of LT claim lines with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-LT.SERVICING-PROV-NPI-NUM equal to a valid, non-null value