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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-493

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 CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.ADMISSION-DATE • CLAIM-HEADER-RECORD-IP.ADJUDICATION-DATE
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM is not equal to one of the following: '2', '4', '5', 'B', 'D', 'E', 'V', 'X', 'Y', 'Z' and CLAIM-HEADER-RECORD-IP has a valid, non-null value for ADMISSION-DATE and CLAIM-HEADER-RECORD-IP has a valid, non-null value for ADJUDICATION-DATE, then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is less than or equal to CLAIM-HEADER-RECORD-IP.ADJUDICATION-DATE'
Rule Definition If the admission date and adjudication date are populated on a non-denied, beneficiary-specific Medicaid or S-CHIP claim from an IP file, then the admission date value reported must be before the adjudication date value reported.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not in: '2', '4', '5', 'B', 'D', 'E', 'V', 'X', 'Y', 'Z' AND with CLAIM-HEADER-RECORD-IP.ADMISSION-DATE equal to a valid, non-null value AND with CLAIM-HEADER-RECORD-IP.ADJUDICATION-DATE equal to a valid, non-null value