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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-7292

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.PROCEDURE-CODE-FLAG-6
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-IP.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-6, then CLAIM-HEADER-RECORD-IP has a non-null value for PROCEDURE-CODE-FLAG-6'
Rule Definition #N/A
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-IP.CLAIM-DENIED-INDICATOR not equal to '0' AND with CLAIM-HEADER-RECORD-IP.TYPE-OF-CLAIM not equal to 'Z' AND with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS not in ('26','026','87','087','542','585','654') AND with CLAIM-HEADER-RECORD-IP.PROCEDURE-CODE-6 equal to a non-null value