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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-7935

Data Quality Measure
Last updated

Key Information

Measure Name % of claim lines with a Servicing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Ending Date of Service
File Type Multiple Files
Measure ID RULE-7935
Measure Type Claims Percentage
Content area ALL MULTI PRO

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area N/A
Category Provider enrollment

Claim Information

Claim Type Medicaid,FFS or CHIP,FFS
Adjustment Type Original and Replacement
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.05
TA Minimun 0
TA Maximum 0.05
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element SUBMITTING-STATE-PROV-ID • PROV-MEDICAID-ENROLLMENT-STATUS-CODE • SERVICING-PROV-NUM • ENDING-DATE-OF-SERVICE
DD Data Element Number PRV097 • PRV100 • COT189 • COT167

Annotation N/A
Specification RULE-7935