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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1895

Validation Rule
Last updated

No Updates

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 CRX00002
Data Element Name CLAIM-HEADER-RECORD-RX.HEALTH-HOME-PROVIDER-NPI
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX has a valid, non-null value for HEALTH-HOME-PROVIDER-NPI, then CLAIM-HEADER-RECORD-RX.HEALTH-HOME-PROVIDER-NPI is a valid National Provider Identifier (NPI) number'
Rule Definition If the health home provider NPI is populated on a non-denied claim from an RX file, then the health home provider NPI reported must be found in the list of valid values.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.HEALTH-HOME-PROVIDER-NPI equal to a valid, non-null value