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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-735

Validation Rule
Last updated

No Updates

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.CLAIM-DENIED-INDICATOR
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equals 'Z', then CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR equals '0''
Rule Definition If the claim status category or the type of claim is for denied claims on a claim from an IP file, the claim denied indicator value reported must also indicate the claim is denied.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY equal to 'F2' OR with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM equal to 'Z'