An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1598

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.UNDER-SUPERVISION-OF-PROV-NPI
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 equals '121', then CLAIM-HEADER-RECORD-OT has a null or invalid value for UNDER-SUPERVISION-OF-PROV-NPI'
Rule Definition If the type of service is for a premium payment on a non-denied claim line from an OT file, then the under-supervision-of NPI value must not be populated.
Denominator Logic # of OT claim lines 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 is '121'