CLT.003.265

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TMSIS Dataguide

Medicaid.gov

Version:

REFERRING-PROV-NPI-NUM

Data Element

DE Number

CLT265

System DE Number

CLT.003.265

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 National Provider ID (NPI) of the provider who recommended the servicing provider to the patient.
Size	X(10)
FLF Start Position	583
FLF Stop Position	592
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 10 digits 2. Situational 3. Value must have an associated Provider Identifier Type equal to "2" 4. Value must exist in the NPPES NPI 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-8911	if a claim is a non-denied claim from a LT file, then the referring provider NPI number value reported must be compatible with the specified T-MSIS picture format: X(10).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP190	CIP.002.190	REFERRING-PROV-NPI-NUM	CIP00002	CLAIM-HEADER-RECORD-IP
CIP319	CIP.003.319	REFERRING-PROV-NPI-NUM	CIP00003	CLAIM-LINE-RECORD-IP
CLT136	CLT.002.136	REFERRING-PROV-NPI-NUM	CLT00002	CLAIM-HEADER-RECORD-LT
COT118	COT.002.118	REFERRING-PROV-NPI-NUM	COT00002	CLAIM-HEADER-RECORD-OT
COT267	COT.003.267	REFERRING-PROV-NPI-NUM	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/10/2025	4.0.13	CLT.003.265	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CLT.003.265	UPDATE	Coding requirement	1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File	1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File
09/16/2024	4.0.0	CLT.003.265	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.265	ADD	N/A		Created