CLT.003.213

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TMSIS Dataguide

Medicaid.gov

Version:

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

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

RULE ID	RULE Definition
RULE-1247	If a claim line is a non-denied claim line from an LT file, then the servicing provider NPI number value reported must be compatible with specified T-MSIS picture format: X(10).
RULE-1248	If the servicing provider NPI number is populated on a non-denied claim line from an LT file, then the servicing provider NPI number value reported must be a valid NPI number.
RULE-7310
RULE-7483	If a claim is a non-denied, non-void claim from an LT file and the servicing provider NPI num is populated then claim line servicing provider NPI num exists in the NPPES NPI data file.

Measure ID	Measure Name
MIS-5-015-15	% missing: SERVICING-PROV-NPI-NUM (CLT00003)
MIS-24-014-14	% missing: SERVICING-PROV-NPI-NUM (CLT00003)
MIS-82-013-13	% missing: SERVICING-PROV-NPI-NUM (CLT00003)

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
06/19/2025	4.0.11	CLT.003.213	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. 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	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. 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
05/29/2025	4.0.9	CLT.003.213	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. 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	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. 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
05/07/2025	4.0.8	CLT.003.213	UPDATE	Coding requirement	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file	1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. 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
09/16/2024	4.0.0	CLT.003.213	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.213	ADD	N/A		Created