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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-1947

Validation Rule
Last updated

No Updates

Tier 1.1
Tier Description Value Error
Error Category E1102
Error Category Message Value does not match specification
Rule Type Two Record Type (1 to 1)
File Segment Number CRX00002
Data Element Name CLAIM-LINE-RECORD-RX.PRESCRIPTION-NUM
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-RX has a valid, non-null value for PRESCRIPTION-NUM, then CLAIM-LINE-RECORD-RX.PRESCRIPTION-NUM does not contain any pipe (|) or asterisk (*) characters'
Rule Definition If the prescription number is populated on a non-denied RX claim line file, then the prescription number must not contain any pipe or asterisk characters.
Denominator Logic # of RX claim lines with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-RX.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-RX.PRESCRIPTION-NUM equal to a valid, non-null value