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TMSIS Dataguide Medicaid.gov
Version 3.38.0

RULE-1823

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 CRX00002
Data Element Name CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND
Validation Logic 'if CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY does not equal 'F2', then If the PAYMENT-LEVEL-IND field is populated, the value must be contained in the set of valid values with id: 'PAYMENT-LEVEL-IND' and (if CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE is non-null then CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE >= Valid Values Effective-Date and CLAIM-HEADER-RECORD-RX.PRESCRIPTION-FILL-DATE <= Valid Values End-Date)'
Rule Definition If the payment level indicator is populated on a non-denied claim from an RX file, then the payment level indicator reported must be found in the list of valid values.
Denominator Logic # of RX claim headers with CLAIM-HEADER-RECORD-RX.CLAIM-STATUS-CATEGORY not equal to 'F2' and with CLAIM-HEADER-RECORD-RX.PAYMENT-LEVEL-IND equal to a valid, non-null value