CLT.002.167

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TMSIS Dataguide

Medicaid.gov

Version:

HEALTH-HOME-PROVIDER-NPI

Data Element

DE Number

CLT167

System DE Number

CLT.002.167

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The National Provider ID (NPI) of the health home provider.
Size	X(12)
FLF Start Position	1034
FLF Stop Position	1045
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 10 digits 2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2" 3. Value must exist in the NPPES NPI data file 4. Conditional

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

RULE ID	RULE Definition
RULE-1177	If the health home provider NPI is populated on a non-denied claim from an LT file, then the health home provider NPI reported must be found in the list of valid values.
RULE-1178	If a claim is a non-denied claim from an LT file, then the health home provider NPI value reported must be compatible with specified T-MSIS picture format: X(12).
RULE-1179	If a claim is a non-denied claim from an LT file that is not an encounter claim and the home health provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value '2'.
RULE-7486	If a claim is a non-denied, non-void claim from an LT file and the health home provider NPI is populated then claim header health home provider NPI exists in the NPPES NPI data file.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP221	CIP.002.221	HEALTH-HOME-PROVIDER-NPI	CIP00002	CLAIM-HEADER-RECORD-IP
COT146	COT.002.146	HEALTH-HOME-PROVIDER-NPI	COT00002	CLAIM-HEADER-RECORD-OT
CRX104	CRX.002.104	HEALTH-HOME-PROVIDER-NPI	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
04/24/2025	4.0.7	CLT.002.167	UPDATE	Coding requirement	1. Value must be 12 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional	1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional
09/16/2024	4.0.0	CLT.002.167	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.167	ADD	N/A		Created