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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1541

Validation Rule
Last updated

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 COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BILLING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', '3', 'C', then CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
Rule Definition If the billing provider NPI number is populated on a non-denied claim from an OT file, then the billing provider NPI number value reported must be a valid NPI number.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-OT.BILLING-PROV-NPI-NUM equal to a valid, non-null value