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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1579

Validation Rule
Last updated

No Updates

Tier 1.0
Tier Description Formatting Error
Error Category E1001
Error Category Message Value illegal for specified data type
Rule Type Parse Rule
File Segment Number COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.THIRD-PARTY-COINSURANCE-AMOUNT-PAID
Validation Logic if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2', then Value must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99
Rule Definition If a claim is a non-denied claim from an OT file, then the third party coinsurance amount value reported must be compatible with specified T-MSIS picture format: S9(11)V99.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2'