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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

RULE-9181

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 Two Record Type (1 to 1)
File Segment Number CLT00002
Data Element Name CLAIM-LINE-RECORD-LT.MBESCBES-FORM
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' and CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', 'U' and (CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for MEDICAID-PAID-AMT and CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT does not equal '0.00'), then CLAIM-LINE-RECORD-LT has a non-null value for MBESCBES-FORM'
Rule Definition If a claim is a non-denied claim from a LT file, and is a Medicaid or Medicaid-expansion CHIP FFS or Separate CHIP FFS claim and claim line medicaid paid amt is non-null and not zero, then the claim line MBESCBES form must be populated.
Denominator Logic # of LT claim lines 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' and with CLAIM-LINE-RECORD-LT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '026', '87', '087', '542', '585', '654' and with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', 'U' and with CLAIM-LINE-RECORD-LT has a non-null and not invalidly formatted value for MEDICAID-PAID-AMT and with CLAIM-LINE-RECORD-LT.MEDICAID-PAID-AMT does not equal '0.00'