An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-9096

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-DX-LT.DIAGNOSIS-TYPE
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and the DIAGNOSIS-TYPE field is populated, then the value must be contained in the set of valid values with id: 'DIAGNOSIS-TYPE' and (if CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-LT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the diagnosis type is populated on a non-denied claim header from a LT file, then the diagnosis id reported must be found in the list of valid values for 'DIAGNOSIS-TYPE'
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-DX-LT.DIAGNOSIS-TYPE equal to a valid, non-null value