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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-1003

Validation Rule
Last updated

No Updates

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.PLAN-ID-NUMBER
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM is not equal to one of the following: '3', 'C', 'W', then CLAIM-HEADER-RECORD-LT has a null or invalid value for PLAN-ID-NUMBER'
Rule Definition If a claim is a non-denied non-encounter claim from an LT file, then plan id must be null.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to 'F2' AND with CLAIM-HEADER-RECORD-LT.TYPE-OF-CLAIM not in '3', 'C', 'W'