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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-7925

Data Quality Measure
Last updated

Key Information

Measure Name % of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
File Type CIP
Measure ID RULE-7925
Measure Type Claims Percentage
Content area ALL MULTI PRO

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area Managed care
Category Provider enrollment

Claim Information

Claim Type Medicaid,Enc or CHIP,Enc
Adjustment Type Original and Replacement
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 PROV-MEDICAID-ENROLLMENT-STATUS-CODE • SERVICING-PROV-NUM • ENDING-DATE-OF-SERVICE • SUBMITTING-STATE-PROV-ID
DD Data Element Number PRV100 • CIP260 • CIP244 • PRV097

Annotation N/A
Specification RULE-7925