An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-7923

Data Quality Measure
Last updated

Key Information

Measure Name % of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Beginning Date of Service
File Type COT
Measure ID RULE-7923
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 0.05
TA Minimun 0
TA Maximum 0.05
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element BILLING-PROV-NUM • PROV-IDENTIFIER • SUBMITTING-STATE-PROV-ID • PRESCRIPTION-FILL-DATE
DD Data Element Number CRX070 • PRV081 • PRV019 • CRX085

Annotation N/A
Specification RULE-7923