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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-817

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 CIP00002
Data Element Name CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for OPERATING-PROV-NPI-NUM, then CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
Rule Definition If the operating provider NPI number is populated on a non-denied IP claim line, then the operating provider NPI number reported must be found in the list of valid values.
Denominator Logic # of IP claim lines with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-IP.OPERATING-PROV-NPI-NUM has a valid, non-null value