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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1914

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 CRX00002
Data Element Name CLAIM-LINE-RECORD-RX.LINE-NUM-ADJ
Validation Logic 'if CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-IND equals '0' and CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then CLAIM-LINE-RECORD-RX has a null or invalid value for LINE-NUM-ADJ'
Rule Definition If the line adjustment indicator is for an original claim on a non-denied claim from an RX file, then the adjustment line number must not be populated.
Denominator Logic # of RX claim lines with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS not in '26', '87', '542', '585', '654' AND with CLAIM-LINE-RECORD-RX.LINE-ADJUSTMENT-INT equals '0'