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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1815

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 ELG00011
Data Element Name STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.PROGRAM-TYPE equals '13', then STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE equals '02''
Rule Definition If a non-denied RX claim has a program type of (13) HCBS State Plan Option 1915(i), then the state plan option participation ELG file must have a state plan option type equal to '02'.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.PROGRAM-TYPE equal to '13'