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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-9093

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 CLT00002
Data Element Name CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-FORM-GROUP field is populated, then the value must be contained in the set of valid values with id: 'MBESCBES-FORM-GROUP' and (if CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the MBESCBES form group is populated on a non-denied claim line from a LT file, then the MBESCBES form group reported must be found in the list of valid values for 'MBESCBES-FORM-GROUP'.
Denominator Logic # of LT claim lines with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-LT.MBESCBES-FORM-GROUP equal to a valid, non-null value