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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-1960

Validation Rule
Last updated

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 CRX00002
Data Element Name CLAIM-LINE-RECORD-RX.OTHER-INSURANCE-AMT
Validation Logic if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', 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 RX file, then the other insurance amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.
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'