PRV-2-002-2

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TMSIS Dataguide

Medicaid.gov

Version:

PRV-2-002-2

Data Quality Measure

Last updated

Key Information

Measure Name	% of Submitting State Provider IDs with PROV-IDENTIFIER-TYPE = 2 (NPI)
File Type	PRV
Measure ID	PRV-2-002-2
Measure Type	Non-Claims Percentage
Content area	PRO

Validation

Validation Type	Longitudinal

Measure Priority

Measure Priority	Medium
Focus Area	N/A
Category	Provider identifiers

Claim Information

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Thresholds

Minimum	0.01
Maximum	0.999
TA Minimun	0.01
TA Maximum	0.999
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	SUBMITTING-STATE-PROV-ID • PROV-IDENTIFIER-TYPE
DD Data Element Number	PRV075 • PRV077

Annotation

Calculate the percent of submitting state provider IDs that have an NPI

Specification

STEP 1: Provider enrolled on the last day of DQ report month

Define the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:

1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month

2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing

3. SUBMITTING-STATE-PROV-ID is not missing

STEP 2: Provider identifier is active on the last day of DQ report month

Of the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:

1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month

2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missing

OR

1b. PROV-IDENTIFIER-EFF-DATE is missing

2b. PROV-IDENTIFIER-END-DATE is missing

STEP 3: Provider classification type is "NPI"

Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria:

1. PROV-IDENTIFIER-TYPE = 2

STEP 4: Calculate percent that have NPI

Divide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count from STEP 2

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/15/2023	3.16.0	PRV-2-002-2	UPDATE	Specification	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Calculate percent that that have NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count from STEP 2	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Calculate percent that have NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count from STEP 2
04/21/2023	3.6.0	PRV-2-002-2	UPDATE	Annotation	N/A	Calculate the percent of submitting state provider IDs that have an NPI
04/21/2023	3.6.0	PRV-2-002-2	UPDATE	Specification	N/A	STEP 1: Provider enrolled on the last day of DQ report monthDefine the provider population from segment PROV-MEDICAID-ENROLLMENT-PRV00007 by keeping active records that satisfy the following criteria:1. PROV-MEDICAID-EFF-DATE <= last day of the reporting month2. PROV-MEDICAID-END-DATE >= last day of the reporting month OR missing3. SUBMITTING-STATE-PROV-ID is not missing STEP 2: Provider identifier is active on the last day of DQ report monthOf the providers that meet the criteria from STEP 1, further refine the population using segment PROV-IDENTIFIER-PRV00005 by keeping records that satisfy the following criteria:1a. PROV-IDENTIFIER-EFF-DATE <= last day of the reporting month2a. PROV-IDENTIFIER-END-DATE >= last day of the reporting month OR missingOR1b. PROV-IDENTIFIER-EFF-DATE is missing2b. PROV-IDENTIFIER-END-DATE is missingSTEP 3: Provider classification type is "NPI"Of the providers that meet the criteria from STEP 2, keep records that satisfy the following criteria: 1. PROV-IDENTIFIER-TYPE = 2STEP 4: Calculate percent that that have NPIDivide the count of unique SUBMITTING-STATE-PROV-IDs from STEP 3 by the count from STEP 2