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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1560

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 COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.PLACE-OF-SERVICE
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE is equal to one of the following: '119', '120', '121', '122', then CLAIM-HEADER-RECORD-OT has a null or invalid value for PLACE-OF-SERVICE'
Rule Definition If the type of service is for a a HMO, HIO, PACE, PCCM, or PHP capitation payment or for a premium payment on a non-denied claim line from an OT file, then the place of service value must not be populated.
Denominator Logic # of OT claims with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-OT.TYPE-OF-SERVICE in '119','120', '121', '122'