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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1761

Validation Rule
Last updated

No Updates

Tier 3.0
Tier Description Relational error
Error Category E3002
Error Category Message Values inconsistently specified (multiple record types, multi file)
Rule Type Two Record Type (1 to 1)
File Segment Number ELG00018
Data Element Name CLAIM-HEADER-RECORD-RX.1115A-DEMONSTRATION-IND
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and (1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '0' or 1115A-DEMONSTRATION-INFORMATION has a null or invalid value for 1115A-DEMONSTRATION-IND), then CLAIM-HEADER-RECORD-RX.1115A-DEMONSTRATION-IND equals '0' or CLAIM-HEADER-RECORD-RX has a null or invalid value for 1115A-DEMONSTRATION-IND'
Rule Definition If the 1115A demonstration information segment indicates an individual does not participate in an 1115A demonstration, then the non-denied RX claim must not have a value populated for the 1115A demonstration indicator.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals to '0' or with 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equal to a null or invalid value