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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-9179

Validation Rule
Last updated

No Updates

Tier 1.1
Tier Description Missing Value Error
Error Category E1105
Error Category Message Data Element Value is Missing
Rule Type One Record Type (Single Record)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.PROVIDER-CLAIM-FORM-CODE
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654', then CLAIM-HEADER-RECORD-LT has a non-null value for PROVIDER-CLAIM-FORM-CODE'
Rule Definition if the CLAIM-HEADER-RECORD-LT segment is populated from a CLT file, then the PROVIDER-CLAIM-FORM-CODE must be populated for non-denied claims.
Denominator Logic # of LT CLAIM-HEADER-RECORD-LT segments with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and with CLAIM-HEADER-RECORD-LT.CLAIM-DENIED-INDICATOR does not equal '0' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM does not equal 'Z' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654'