PRV-2-010-10

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

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 Type	Inferential

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

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

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

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	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	PRV-2-010-10	UPDATE	Annotation	Calculate the percent of submitting state provider IDs that are individual providers but have more than one reported NPI	N/A
11/20/2025	4.0.22	PRV-2-010-10	UPDATE	Specification	STEP 1: Provider reported on the provider attributes main segment at any timeDefine 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 missingSTEP 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 NPIOf 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 missingSTEP 4: More than one NPI per submitting state provider IDOf 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 percentageDivide 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	N/A
04/24/2025	4.0.7	PRV-2-010-10	ADD	N/A		Created

PRV-2-010-10

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements