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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-1788

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 CRX00002
Data Element Name CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X', then CLAIM-HEADER-RECORD-RX has a null value for TOT-BILLED-AMT or CLAIM-HEADER-RECORD-RX.TOT-BILLED-AMT equals '0.00''
Rule Definition If a claim is a non-denied service tracking claim from an RX file, then the total billed amount must be 0 or null.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-RX.TYPE-OF-CLAIM is equal to one of the following: '4', 'D', 'X'