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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1577

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 COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.COPAY-WAIVED-IND
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the COPAY-WAIVED-IND field is populated, the value must be contained in the set of valid values with id: 'COPAY-WAIVED-IND' and (if CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the copay waiver indicator is populated on a non-denied claim from an OT file, then the copay waiver indicator reported must be found in the list of valid values.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-OT.COPAY-WAIVED-IND equal to a valid, non-null value