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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-1001

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 ELG00011
Data Element Name STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and STATE-PLAN-OPTION-PARTICIPATION has a valid, non-null value for STATE-PLAN-OPTION-TYPE and CLAIM-HEADER-RECORD-LT.PROGRAM-TYPE equals '13', then STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE equals '02''
Rule Definition If the program type is HCBS State Plan Option 1915(i) on a non-denied claim from an LT file, then the waiver type value reported must be '2'.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY is not equal 'F2' and with STATE-PLAN-OPTION-PARTICIPATION.STATE-PLAN-OPTION-TYPE is equal to a valid, non-null value and with CLAIM-HEADER-RECORD-LT.PROGRAM-TYPE equals '13'