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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1273

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to 1)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.ADMISSION-DATE • CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE is not equal to one of the following: '119', '120', '121', '122' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for ADMISSION-DATE and CLAIM-LINE-RECORD-LT has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-HEADER-RECORD-LT.ADMISSION-DATE is less than or equal to CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE'
Rule Definition If admission date is populated on a non-denied claim from an LT file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment or premium payment and adjudication date is populated on a non-denied claim line that is not a capitated payment or premium payment, then the admission date value reported must be before or equal to the adjudication date value reported.
Denominator Logic # of LT claim lines with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in: '2', 'B', 'V' AND with CLAIM-LINE-RECORD-LT.TYPE-OF-SERVICE not in: '119', '120', '121', '122' AND with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' AND with CLAIM-HEADER-RECORD-LT.ADMISSION-DATE equal to a valid, non-null value AND with CLAIM-LINE-RECORD-LT.ADJUDICATION-DATE equal to a valid, non-null value