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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-696

Validation Rule
Last updated

No Updates

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type One Record Type (Single Record)
File Segment Number CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.ADMITTING-PROV-NPI-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for ADMITTING-PROV-NPI-NUM, then CLAIM-HEADER-RECORD-IP.ADMITTING-PROV-NPI-NUM is a valid National Provider Identifier (NPI) number'
Rule Definition If the admitting provider NPI number is populated on a non-denied claim from an IP file, then the admitting provider NPI number value reported must be in the list of valid values.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-IP.ADMITTING-PROV-NPI-NUM equal to a valid, non-null value