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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-464

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 ELG00002
Data Element Name PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH • CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and PRIMARY-DEMOGRAPHICS-ELIGIBILITY has a valid, non-null value for DATE-OF-DEATH and CLAIM-HEADER-RECORD-IP has a valid, non-null value for PROCEDURE-CODE-DATE-4, then CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4 is less than or equal to PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH'
Rule Definition If a non-denied IP claim has a value populated for procedure code date 4 and the primary demographics eligibility segment has a value populated for date of death, then the procedure code date 4 is less that or equal to the date of death.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with PRIMARY-DEMOGRAPHICS-ELIGIBILITY.DATE-OF-DEATH equal to a valid, non-null value and with CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-DATE-4 equal to a valid, non-null value