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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 | CIP00002 |
Data Element Name | CLAIM-HEADER-RECORD-IP.REFERRING-PROV-NPI-NUM |
Validation Logic | 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for REFERRING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-IP.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 IP file, then the referring provider NPI number value reported must be in the list of valid values. |
Denominator Logic | # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-IP.REFERRING-PROV-NPI-NUM equal to a valid, non-null value |