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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

REFERRING-PROV-NUM

Data Element

DE Number

CLT264

System DE Number

CLT.003.264

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 A unique identification number assigned to a provider which identifies the physician or other provider who referred the patient. For physicians, this must be the individual's ID number, not a group identification number. If the referring provider number is not available, but the physician's Drug Enforcement Agency (DEA) ID is on the State file, then the State should use the DEA ID for this data element.
Size X(30)
FLF Start Position 553
FLF Stop Position 582
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 30 characters or less
2. Conditional
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
CIP189 CIP.002.189 REFERRING-PROV-NUM CIP00002 CLAIM-HEADER-RECORD-IP
CIP318 CIP.003.318 REFERRING-PROV-NUM CIP00003 CLAIM-LINE-RECORD-IP
CLT135 CLT.002.135 REFERRING-PROV-NUM CLT00002 CLAIM-HEADER-RECORD-LT
COT117 COT.002.117 REFERRING-PROV-NUM COT00002 CLAIM-HEADER-RECORD-OT
COT266 COT.003.266 REFERRING-PROV-NUM COT00003 CLAIM-LINE-RECORD-OT