Military Health System

OR PROVIDER TERMINATION DATE = ZEROES

THEN PROVIDER TERMINATION DATE MUST = ZEROES

THEN IDME RATIO EFFECTIVE DATE MUST = ZEROES

THEN DRG EXEMPT/NON-EXEMPT INDICATOR MUST BE BLANK.

THEN DRG EXEMPT/NON-EXEMPT INDICATOR MUST NOT = BLANK.

AND PROVIDER STATE/COUNTRY CODE ≠

AND INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =

THEN DRG INDICATOR MUST =

AND PROVIDER STATE/COUNTRY CODE =

THEN DRG EXEMPT/NON-EXEMPT INDICATOR MUST =

AND INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =

THEN PROVIDER MAJOR SPECIALTY/TYPE OF INSTITUTION MUST = DRG NON-EXEMPT TYPE OF INSTITUTION (REFER TO Addendum D).

AND INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =

THEN PROVIDER TAXPAYER NUMBER

AND PROVIDER SUB-IDENTIFIER

AND ZIP CODE (FIRST FIVE DIGITS)

AND PROVIDER MAJOR SPECIALTY/TYPE OF INSTITUTION MUST NOT ALREADY EXIST ON THE PROVIDER FILE.

AND IF INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =

THEN PROVIDER TAXPAYER NUMBER

AND PROVIDER SUB-IDENTIFIER

AND ZIP CODE (FIRST FIVE DIGITS)

MUST NOT ALREADY EXIST ON THE PROVIDER FILE.

AND INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =

AND THE PROVIDER TAXPAYER NUMBER

AND ZIP CODE (FIRST FIVE DIGITS) ARE THE SAME AS AN EXISTING RECORD ON THE PROVIDER FILE,

AND THE FIRST CHARACTER OF THE PROVIDER SUB-IDENTIFIER IS ALPHABETIC, FOLLOWED BY A NUMBER OTHER THAN 001

THEN THE FIRST CHARACTER OF THE PROVIDER SUB-IDENTIFIER MUST MATCH AN EXISTING SUB-IDENTIFIER (WHICH ENDS IN 001) FOR THIS TAXPAYER NUMBER AND ZIP CODE (FIRST FIVE DIGITS) ON THE PROVIDER FILE. THIS LEADING ALPHA PREFIX MUST BE FOLLOWED BY THREE UNIQUE NUMERIC DIGITS

OR THE FIRST TWO CHARACTERS OF THE PROVIDER SUB-IDENTIFIER ARE ALPHABETIC, FOLLOWED BY A NUMBER OTHER THAN 01.

THEN THE FIRST TWO CHARACTERS OF THE PROVIDER SUB-IDENTIFIER MUST MATCH AN EXISTING SUB-IDENTIFIER (WHICH ENDS IN ‘01’) FOR THIS TAXPAYER NUMBER AND ZIP CODE ON THE PROVIDER FILE. THE ALPHA PREFIX MUST BE FOLLOWED BY TWO UNIQUE NUMERIC DIGITS.

AND INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =

THEN AN ACTIVE PROVIDER RECORD MUST EXIST ON THE PROVIDER FILE FOR THE SAME PROVIDER TAXPAYER NUMBER, PROVIDER SUB-IDENTIFIER, PROVIDER ZIP CODE, AND PROVIDER MAJOR SPECIALTY/TYPE OF INSTITUTION. (IN THE CASE OF FOREIGN COUNTRY, ZIP WILL BE BLANK; ANY DUPLICATES ADDED WILL HAVE TO BE ASSIGNED ANOTHER PROVIDER TAXPAYER NUMBER.)

AND INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =

THEN AN ACTIVE PROVIDER RECORD MUST EXIST ON THE PROVIDER FILE FOR THE SAME PROVIDER TAXPAYER NUMBER, PROVIDER SUB-IDENTIFIER, AND PROVIDER ZIP CODE (FIRST FIVE DIGITS).

AND INSTITUTIONAL/NON-INSTITUTIONAL INDICATOR =

AND THE FIRST CHARACTER OF THE PROVIDER SUB-IDENTIFIER IS ALPHABETIC FOLLOWED BY 001 OR THE FIRST TWO CHARACTERS OF THE PROVIDER SUB-IDENTIFIER IS ALPHABETIC FOLLOWED BY 01.

THEN ALL ASSOCIATED RECORDS USING THE SAME PROVIDER TAXPAYER NUMBER AND PROVIDER ZIP CODE (FIRST FIVE DIGITS) AND THE SAME ONE OR TWO CHARACTER ALPHA PREFIX OF THE SUB-IDENTIFIER AND DIFFERENT NUMERIC SUFFIX OF THE SUB-IDENTIFIER MUST ALSO BE INACTIVATED.