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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1274

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number CLT00002
Data Element Name CLAIM-LINE-RECORD-LT.SELF-DIRECTION-TYPE
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the SELF-DIRECTION-TYPE field is populated, the value must be contained in the set of valid values with id: 'SELF-DIRECTION-TYPE' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the self direction type is populated on a non-denied LT claim line file, then the value reported must be in the list of valid values for self direction type.
Denominator Logic # of LT claim lines with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-LT.SELF-DIRECTION-TYPE equal to a valid, non-null value