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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-9112

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 COT00002
Data Element Name CLAIM-LINE-RECORD-OT.MBESCBES-CATEGORY-OF-SERVICE
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and the MBESCBES-CATEGORY-OF-SERVICE field is populated and CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP equals '2' and CLAIM-LINE-RECORD-OT.MBESCBES-FORM equals '64.21U', then the value must be contained in the set of valid values with id: '64.21U-FORM' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the MBESCBES category of service is populated and MBESCBES form is '64.21U' on a non-denied claim line from a OT file, then the MBESCBES category of service reported must be found in the list of valid values for '64.21U-FORM'.
Denominator Logic # of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-OT.MBESCBES-CATEGORY-OF-SERVICE equal to a valid, non-null value and with CLAIM-LINE-RECORD-OT.MBESCBES-FORM-GROUP is equal to '2' and with CLAIM-LINE-RECORD-OT.MBESCBES-FORM is equal to '64.21U'