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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

PRV-2-010-10

Data Quality Measure
Last updated

Key Information

Measure Name % of Submitting State Provider IDs (FACILITY-GROUP-INDIVIDUAL-CODE = 03) with more than one NPI (PROV-IDENTIFIER-TYPE = 2) (across all time)
File Type PRV
Measure ID PRV-2-010-10
Measure Type Non-claims percentage
Content area PRO

Validation

Validation Type Inferential

Measure Priority

Measure Priority N/A
Focus Area N/A
Category N/A

Claim Information

Claim Type N/A
Adjustment Type N/A
Crossover Type N/A

Thresholds

Minimum 0
Maximum 0.01
TA Minimun
TA Maximum
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		No
For TA
(Longitudinal) 		No

Data Elements

DD Data Element FACILITY-GROUP-INDIVIDUAL-CODE • PROV-IDENTIFIER-TYPE • PROV-IDENTIFIER • SUBMITTING-STATE-PROV-ID
DD Data Element Number PRV026 • PRV077 • PRV081 • PRV019

Annotation Calculate the percent of submitting state provider IDs that are individual providers but have more than one reported NPI
Specification STEP 1: Provider reported on the provider attributes main segment at any time

Define the provider population from segment PROV-ATTRIBUTES-MAIN-PRV00002 by keeping active records that satisfy the following criteria:

1. SUBMITTING-STATE-PROV-ID is not missing



STEP 2: Provider is an individual

Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 1, further refine the population by keeping records that satisfy the following criteria:

1. FACILITY-GROUP-INDIVIDUAL=CODE = "03"



STEP 3: Provider identifier type is NPI

Of the SUBMITTING-STATE-PROV-IDs that meet the criteria from STEP 2, further refine the population using segment PROV-IDENTIFIERS-PRV00005 by keeping records that meet the following criteria:

1. PROV-IDENTIFIER-TYPE = "2"

2. PROV-IDENTIFIER is not missing



STEP 4: More than one NPI per submitting state provider ID

Of the SUBMITTING-STATE-PROV-IDs identified in STEP 3, limit to unique SUBMITTING-STATE-PROV-IDs that meet the following criteria:

1. Two or more unique PROV-IDENTIFIER values kept in STEP 3 for the SUBMITTING-STATE-PROV-ID



STEP 5: Calculate percentage

Divide the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 4 by the count of unique SUBMITTING-STATE-PROVIDER-IDENTIFIER values from STEP 2