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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-1672

Validation Rule
Last updated

Tier 1.1
Tier Description Value Error
Error Category E1103
Error Category Message Value not in specified valid value set
Rule Type Valid Value
File Segment Number COT00002
Data Element Name CLAIM-LINE-RECORD-OT.SERVICING-PROV-SPECIALTY
Validation Logic 'if CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS is not equal to one of the following: '26', '87', '542', '585', '654', then If the SERVICING-PROV-SPECIALTY field is populated, the value must be contained in the set of valid values with id: 'PROV-SPECIALTY' and (if CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE is non-null then CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE >= Valid Values Effective-Date and CLAIM-LINE-RECORD-OT.ENDING-DATE-OF-SERVICE <= Valid Values End-Date)'
Rule Definition If the servicing provider specialty is populated on a non-denied claim line from an OT file, then the servicing provider specialty value reported must be in the list of valid values for 'provider specialty'.
Denominator Logic # of OT claim lines with CLAIM-HEADER-RECORD-OT.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-LINE-RECORD-OT.CLAIM-LINE-STATUS not in: '26', '87', '542', '585', '654' and with CLAIM-LINE-RECORD-OT.PROV-SPECIALTY equal to a valid, non-null value