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-414

Validation Rule
Last updated

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-1
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-FLAG-1, then CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-1'
Rule Definition If the first procedure code flag is populated on a non-denied claim from an IP file, then the first procedure code must be populated.
Denominator Logic # of IP headers with CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-FLAG-1 is valid, non-null AND CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2'