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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-834

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 CIP00002
Data Element Name CLAIM-LINE-RECORD-IP.NATIONAL-DRUG-CODE
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP has a valid, non-null value for NATIONAL-DRUG-CODE, then CLAIM-LINE-RECORD-IP.NATIONAL-DRUG-CODE is a valid National Drug Code (NDC) value'
Rule Definition If the National drug code is populated on a non-denied IP claim line, then the National drug code reported must be found in the list of valid values.
Denominator Logic # of IP claim lines with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-IP.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and CLAIM-LINE-RECORD-IP.NATIONAL-DRUG-CODE equal to a valid, non-null value