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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-7339

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.ADJUSTMENT-IND
Validation Logic 'if CLAIM-HEADER-RECORD-OT has a null value for ICN-ADJ, then CLAIM-HEADER-RECORD-OT.ADJUSTMENT-IND is equal to one of the following: '0', '5', '6''
Rule Definition If a segment is an OT claim header and icn adj is not populated, then the adjustment indicator is an original claim/encounter payment, credit gross adjustment or a debit gross adjustment payment.
Denominator Logic # of OT claim headers with CLAIM-HEADER-RECORD-OT.ICN-ADj having a null value