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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

SERVICING-PROV-NPI-NUM

Data Element

DE Number

CLT213

System DE Number

CLT.003.213

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00003

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition The NPI of the health care professional who delivers or completes a particular medical service or non-surgical procedure. The Servicing Provider NPI Number is required when rendering provider is different than the attending provider and state or federal regulatory requirements call for a "combined claim" (i.e., a claim that includes both facility and professional components). Examples are Medicaid clinic bills or critical access hospital claims.
Size X(10)
FLF Start Position 318
FLF Stop Position 327
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. Conditional
4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)
5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)
6. Value must exist in the NPPES NPI data file
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP261 CIP.003.261 SERVICING-PROV-NPI-NUM CIP00003 CLAIM-LINE-RECORD-IP
COT190 COT.003.190 SERVICING-PROV-NPI-NUM COT00003 CLAIM-LINE-RECORD-OT