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TMSIS Dataguide Medicaid.gov

Version:

4.0.20

RULE-887

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 ELG00018
Data Element Name CLAIM-HEADER-RECORD-LT.1115A-DEMONSTRATION-IND
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and (1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equals '0' or 1115A-DEMONSTRATION-INFORMATION has a null or invalid value for 1115A-DEMONSTRATION-IND), then CLAIM-HEADER-RECORD-LT has a null or invalid value for 1115A-DEMONSTRATION-IND or CLAIM-HEADER-RECORD-LT.1115A-DEMONSTRATION-IND equals '0''
Rule Definition If a non-denied claim on a LT file has a 1115A demonstration indicator value equal to 'no' then the 1115A demonstration information segment also has a 1115A demonstration indicator value equal to 'no'.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equal to '0' or with 1115A-DEMONSTRATION-INFORMATION.1115A-DEMONSTRATION-IND equal to a null or invalid value