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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-1249

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 Three Record Type Rule
File Segment Number CLT00002
Data Element Name PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE
Validation Logic 'if CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-CLAIM and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W' and CLAIM-LINE-RECORD-LT has a valid, non-null value for SERVICING-PROV-NPI-NUM and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then there are greater than 0 PROV-IDENTIFIERS records with matching join keys, where PROV-IDENTIFIERS.PROV-IDENTIFIER-TYPE equals '2''
Rule Definition If a claim is a non-denied claim from an LT file that is not an encounter claim and the servicing provider NPI is populated, then the prov identifier type on the provider identifiers segment must be populated with the value 'NPI'.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT has a valid, non-null value for TYPE-OF-CLAIM and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in: '3', 'C', 'W' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-LT. SERVICING-PROV-NPI-NUM equal to a valid, non-null value