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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1356

Validation Rule
Last updated

No Updates

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.ADJUDICATION-DATE • CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is not equal to one of the following: '2', 'B', 'V' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for ADJUDICATION-DATE and CLAIM-HEADER-RECORD-OT has a valid, non-null value for BEGINNING-DATE-OF-SERVICE, then CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE is less than or equal to CLAIM-HEADER-RECORD-OT.ADJUDICATION-DATE'
Rule Definition If adjudication date and beginning date of service are populated on a non-denied claim from an OT file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment, then the beginning date of service value reported must be before or equal to the adjudication date value reported.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM not in: '2', 'B', 'V' AND with CLAIM-HEADER-RECORD-OT.ADJUDICATION-DATE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-OT.BEGINNING-DATE-OF-SERVICE equal to a valid, non-null value