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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-9230

Validation Rule
Last updated

Tier 2.1
Tier Description Relational error
Error Category E2102
Error Category Message Values inconsistently specified (multi record, single file)
Rule Type Two Record Type (1 to 1)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM
Validation Logic 'if FILE-HEADER-RECORD-LT.DATA-DICTIONARY-VERSION equals 'V4.0.0' and 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 the TYPE-OF-CLAIM field is populated, then CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to one of the following: '1', 'A', 'X', '3', 'C', 'W''
Rule Definition If the type of claim is populated on a non-denied claim from an LT file in T-MSIS File Layout V4.0.0, then the type of claim value reported must be Fee-For-Service or Encounter.
Denominator Logic # of LT claim headers with FILE-HEADER-RECORD-LT.DATA-DICTIONARY-VERSION = 'V4.0.0' and with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and 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-HEADER-RECORD-LT.TYPE-OF-CLAIM is equal to a non-null value