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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-1336

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 COT00002
Data Element Name CLAIM-HEADER-RECORD-OT.MSIS-IDENTIFICATION-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X' and CLAIM-HEADER-RECORD-OT has a valid, non-null value for MSIS-IDENTIFICATION-NUM, then CLAIM-HEADER-RECORD-OT.MSIS-IDENTIFICATION-NUM starts with the '&' symbol'
Rule Definition If the MSIS ID is populated on a non-denied service tracking claim from an OT file, then the MSIS ID must begin with an '&' symbol.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-OT.TYPE-OF-CLAIM is in '4', 'D', 'X' AND with CLAIM-HEADER-RECORD-OT.MSIS-IDENTIFICATION-NUM equal to a valid, non-null value