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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-1233

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 Many)
File Segment Number CLT00002
Data Element Name CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equals '2' and CLAIM-HEADER-RECORD-LT has a valid, non-null value for TOT-BILLED-AMT, then CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT is greater than or equal to the sum of all CLAIM-LINE-RECORD-LT.REVENUE-CHARGE values'
Rule Definition If the payment level indicator is for a claim detail level payment and the total billed amount is populated on a non-denied claim from an LT file, then the total billed amount value reported must be greater than or equal to the sum of all the revenue charge values reported on the associated claim lines.
Denominator Logic # of LT claim headers with CLAIM-HEADER-RECORD-LT.CLAIM-STATUS-CATEGORY not equal to F2 AND with CLAIM-HEADER-RECORD-LT.PAYMENT-LEVEL-IND equal to '2' AND with CLAIM-HEADER-RECORD-LT.TOT-BILLED-AMT equal to a valid, non-null value