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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-7587

Validation Rule
Last updated

No Updates

Tier 2.1
Tier Description Relational error
Error Category E2101
Error Category Message Missing parent record (single file)
Rule Type Two Record Type (1 to 1)
File Segment Number PRV00002
Data Element Name PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE • PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE-PROV-ID • PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE • PROV-IDENTIFIERS.PROV-IDENTIFIER • PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE
Validation Logic if PROV-ATTRIBUTES-MAIN has a non-null value for SUBMITTING-STATE-PROV-ID and PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE is equal to one of the following: '01', '02', then for every record of type PROV-ATTRIBUTES-MAIN, there must be a valid record of type PROV-IDENTIFIERS that matches on the join keys and Entity Type Code is equal to '2' in the NPPES NPI data file, and PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2' and PROV-IDENTIFIERS.PROV-IDENTIFIER is a valid National Provider Identifier (NPI) number that exists in the NPPES NPI data file
Rule Definition If submitting state provider ID is populated on a provider attributes main segment from an PRV file, and facility group individual code is equal to '01' (facility) or '02' (group), and the provider identifier type = '2' and the submitting state provider ID is a valid NPI in the NPPES file, then the entity type code is equal to '2' (organization) in the NPPES NPI data file.
Denominator Logic # of PROV-ATTRIBUTES-MAIN segments with PROV-ATTRIBUTES-MAIN.SUBMITTING-STATE-PROV-ID equal to a non-null value and with PROV-ATTRIBUTES-MAIN.FACILITY-GROUP-INDIVIDUAL-CODE is equal to one of the following values: '01', '02'