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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-9076

Validation Rule
Last updated

No Updates

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number CIP00002
Data Element Name CLAIM-DX-IP.ADJUSTMENT-IND
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and the ADJUSTMENT-IND field is populated, then the value must be contained in the set of valid values with id: 'ADJUSTMENT-IND' and (if CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is non-null then CLAIM-HEADER-RECORD-IP.DISCHARGE-DATE is >= Valid Values Effective-Date and <= Valid Values End-Date, else if CLAIM-HEADER-RECORD-IP.ADMISSION-DATE is non-null then CLAIM-HEADER-RECORD-IP.ADMISSION-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-IP.ADMISSION-DATE <= Valid Values End-Date)'
Rule Definition If the adjustment indicator is populated on the Claim Diagnosis IP segment from a CIP file, then the adjustment indicator reported must be found in the list of valid values for 'ADJUSTMENT-IND'.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-DX-IP.ADJUSTMENT-IND equal to a valid, non-null value