CIP.002.180

BILLING-PROV-NPI-NUM

Data Element

DE Number

CIP180

System DE Number

CIP.002.180

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.
Size	X(10)
FLF Start Position	871
FLF Stop Position	880
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 10 digits 2. Value must have an associated Provider Identifier Type equal to "2" 3. Value must exist in the NPPES NPI data file 4. Conditional 5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01" 6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization)

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-6890	If a claim is a non-denied claim from an IP file, then the billing provider NPI number value reported must be compatible with specified T-MSIS picture format: X(10).
RULE-690	If the billing provider NPI number is populated on a non-denied claim from an IP file, then the billing provider NPI number value reported must be a valid NPI number.
RULE-7301
RULE-7474	If a claim is a non-denied, non-void claim from an IP file and the billing provider NPI num is populated then claim header billing provider NPI num exists in the NPPES NPI data file.
RULE-7507	If a claim is a non-denied, non-void claim from an IP file and the billing provider NPI is populated and is a valid NPI in the NPPES file, then the 'entity type code' is equal to '2' (organization) in the NPPES NPI data file.
RULE-7760	If a claim is a non-denied claim from an IP file, and is a Medicaid or Medicaid-expansion CHIP Encounter or Separate CHIP Encounter claim and is an original claim or a replacement/resubmission claim payment then the billing provider NPI number must be populated.
RULE-7818	If a claim is a non-denied claim from an IP file, and is a Medicaid or Medicaid-expansion CHIP Fee-for-service or Separate CHIP Fee-for-service claim and is an original claim or a replacement/resubmission claim payment then the billing provider NPI number must be populated.
RULE-7905	If the billing provider NPI number is populated on a non-denied claim from an IP file, and is a Medicaid or Medicaid-expansion CHIP Encounter, or separate CHIP Encounter claim then the billing provider NPI number value reported must be a valid NPI number.
RULE-7909	If the billing provider NPI number is populated on a non-denied claim from an IP file, and is a Medicaid or Medicaid-expansion CHIP FFS, or separate CHIP FFS claim then the billing provider NPI number value reported must be a valid NPI number.

Measure ID	Measure Name
MCR-26-004-2	IP - Average # of PROV-LOCATION-ID per billing NPI
RULE-7909	% of claim headers with Billing Provider NPI Number in an invalid format
RULE-7905	% of claim headers with Billing Provider NPI Number in an invalid format
RULE-7818	% missing: BILLING-PROV-NPI-NUM (CIP00002)
RULE-7760	% missing: BILLING-PROV-NPI-NUM (CIP00002)
MIS-79-008-8	% missing: BILLING-PROV-NPI-NUM (CIP00002)
MIS-21-008-8	% missing: BILLING-PROV-NPI-NUM (CIP00002)
MCR-61-005-5	% of claim headers with Billing Provider NPI Number in an invalid format
MCR-60-005-5	% of claim headers with Billing Provider NPI Number in an invalid format
FFS-51-005-5	% of claim headers with Billing Provider NPI Number in an invalid format
FFS-50-005-5	% of claim headers with Billing Provider NPI Number in an invalid format
MIS-2-008-8	% missing: BILLING-PROV-NPI-NUM (CIP00002)
MCR-26-007-3	IP - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per servicing NPI
FFS-18-004-4	IP - Average # of PROV-LOCATION-ID per beneficiary
MCR-26-001-1	IP - Average # of PROV-LOCATION-ID per beneficiary
MCR-23-008-3	IP - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per servicing NPI
MCR-23-005-2	IP - Average # of PROV-LOCATION-ID per billing NPI
MCR-23-001-1	IP - Average # of PROV-LOCATION-ID per beneficiary
FFS-20-007-8	IP - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per servicing NPI
FFS-20-004-4	IP - Average # of PROV-LOCATION-ID per billing NPI
FFS-20-001-1	IP - Average # of PROV-LOCATION-ID per beneficiary
FFS-19-008-8	IP - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per servicing NPI
FFS-19-006-6	IP - Average # of PROV-LOCATION-ID per billing NPI
FFS-19-003-3	IP - Average # of PROV-LOCATION-ID per beneficiary
FFS-18-009-9	IP - Average # of unique combinations of PROV-LOCATION-ID and billing NPI per servicing NPI
FFS-18-007-7	IP - Average # of PROV-LOCATION-ID per billing NPI

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT131	CLT.002.131	BILLING-PROV-NPI-NUM	CLT00002	CLAIM-HEADER-RECORD-LT
COT113	COT.002.113	BILLING-PROV-NPI-NUM	COT00002	CLAIM-HEADER-RECORD-OT
CRX071	CRX.002.071	BILLING-PROV-NPI-NUM	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CIP.002.180	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.180	ADD	N/A		Created